What+is+the+role+of+radiographs+in+the+diagnosis,+prognosis+and+treatment+of+periodontal+disease

The Role of Radiographs in the Diagnosis & Prognosis of Periodontal Disease
Radiographs are helpful in process of diagnosis of periodontal disease and taken at the beginning of the preventive dental treatment. Radiographs are not substitute for clinical examination, but it is an adjunct to it. Radiographs are taken so that clinicians can see things that can not be seen clinically. This includes caries, pathology within the tooth, periapical lesions, pathology within the bone including tumors or cysts, PDL space, lamina dura, and trabecular pattern. Radiographs are also useful for recognizing restorative materials, foreign objects, and periodontal destruction.

Radiographs are interpreted by the dental professional prior to treatment and in front of the patient in order to solicit more information from the patient and gather sufficient information to create an accurate prognosis for the patient. Using consistent terminology when interpreting the radiographs is essential because it allows for consistency between peers, eliminates or lowers the probability of miscommunication, describes what is seen without making a diagnosis and is important for legal purposes.

Radiographs are not helpful if they are not projected the important anatomy of the teeth and the jawbones or if processing errors or problems occurs. Some of these errors which could lead to an incorrect prognosis include underdeveloped or overdeveloped film, chemical contamination such as developer or fixer spots, reticulation of emulsion, air bubbles, overlapping films, developer or fixer cutoff, fingerprint artifacts, static electricity, scratched film or lighting. It is imperative that preventative measures are made to reduce these problems or errors. Also, if the vertical or horizontal angulation is incorrect, this leads to an inaccurate differential diagnosis. For example, if radiographs show too much elongation of the teeth and overlap of the interproximal areas, these radiographs will not help in diagnosis of periodontal disease.

There are three main types of radiographs utilized by the dental hygienist including: bite-wing, periapical, and pano radiographs. The bite-wing projections are useful in examining interproximal caries, horizontal, vertical bone loss, and furcation. If the alveolar crests show fuzziness and not consistent throughout of the lamina dura, these can be the early signs of periodontal disease. The periapical projections helps in examining the root of the teeth and trabecular bone to see if teeth as any typical or abnormal finding. The pano radiographs help in determining if the wisdoms teeth are impacted or any other lesion of the periodontal bone. If the clinician sees any slight periodontal changes, this means the disease is greater than what actually present. Radiographs do not show every detail of the anatomy. For instance, radiographs do not show the lingula and the facial of the teeth.

Radiographic appearances can also help dentist during procedure such as root canal therapy. They also help to locate an object by Buccal Object Rule or the Right-angle Technique.

The reason why we need to take radiographs that are of good quality is so that we can see what is going on in the bone, within the tooth, and in the other areas that we can't see clinically. If the radiographs are of poor quality, we might not be able to see something that is of importance because the radiograph was lacking detail or taken at an improper angle.

At RCC, we present a radiographic interpretation of our patient's radiographs in the following order:

1. Identify missing/impacted teeth. 2. Restorations- present from the maxillary right to left and then from the mandibular left to right. state condition of the margins including open margins, overhangs and correlate these finding clinically. 3. Tooth findings- possible areas of decay and correlate clinically, radiolucency around the apices of teeth and state differential diagnosis, Intrinsic and extrinsic absorption, dilaceration of roots, root resorption including etiology and other atypical anatomy findings. 4. Periodontal interpretation- first state the quality of the radiographs, Trabecular pattern, lamina dura, alveolar crest, PDL space, interradicular radiolucencies and calculus noted. 5. General osseous findings- note any radiolucencies and radiopacities and state differential diagnosis.

When looking at radiographs, it is vital to understand what you are looking at.


 * Missing or impacted teeth:** when there is a missing tooth, depending on the location it may be the cause of many problems, Impacted teeth, may trap plaque and bacteria causing decay, missing or impacted teeth may increase mesially drift, and impacted tooth may also create periodontal pocket involvement which may be fixed through orthodontic treatment. With a missing or impacted tooth the clinician may recommend a implant, extraction, or orthodontic treatment.


 * Restorations:** restorations are another important clue as to what may be effecting periodontal status. Overhangs, accumulate plaque, open margins, allow for bacteria and microbes to enter the restoration and cause recurrent decay. Open contacts allow for food impactions, irritating tissue. All restoration defects can cause severe periodontal defects. It is vital that the clinician is able to look at a defect in the restoration and correlate the clinical findings to this defect.


 * Tooth findings:** as a hygientist we are able to look at radiographs and make a differential diagnosis if there are radiolucencies on the radiographs. A radiolucency at the contacts is usually decay, but must be diagnosed by the doctor. If the radiolucency is more apical from the contact it may be cervical burn out usually caused by the way the radiograph was taken. A radiolucency between the roots of posterior molars may be a furcation, which will effect the prognossis of the case and an indicater of bone loss from periodontal disease, or could be pathology, in which the clinician should recommend to the doctor a refferal to a oral surgan for further examination. The clinician should explain any pathology found from the radiographs and why it is important to see an oral sugren to be sure. External resorption is common among reimplanted teeth, abnormal mechanical forces, trauma, chronic imflammation, which affects the apex of the tooth. The apex will apear blunted. and shorter than normal, however the bone and lamina dura appear normal. Internal resorption appears as a round to oval radiolucency within the crown or root. This may weeken the tooth creating a cause for root canal therapy or extraction. Internal resorption is usally asymptomatic, and can be caused by pulp capping,or trauma.


 * Periodontal interpretation:** periodontal interpretation helps the hygienist or doctor determine the quality of the bone structures supporting the teeth. The hygienist or doctor can also determine if there are any defects, or horizontal and vertical bone loss.


 * Osseous findings:** looking at the radiographs helps to see if there are any radiolucencies in the bone that may be due to infections, cyst, or tumors.

It is critical that we analyze all aspects of the radiographs and present all findings to our instructors and our doctor so that we can determine the patients prognosis and provide the most comprehensive and individualized treatment for our patients.