ECPD: NSK
The role of radiographs in periodontal patient management This CPD article from Dr Adejumoke Adeyemi BDS, MSc, Ph.D, MFDS RCSEd, M Perio RCSEd, FHEA provides an update on the role of radiographs in diagnosing periodontitis and indications for further radiographic investigations in the clinical management of patients with periodontitis.
Learning aims and objectives • Educate readers on the importance of radiographs in periodontitis diagnosis and patient-centred decision making • To provide readers with an overview of radiographic techniques available • To provide readers with an overview of indications for radiographic investigations in the clinical management of patients with periodontitis. Learning Outcomes: C, D According to the World Workshop Classification 2017 system of classification of periodontal and periimplant diseases and conditions, the forms of periodontitis are: 1. Necrotising periodontal diseases: acute conditions affecting the gingivae, the periodontium or supporting periodontal tissues 2. Periodontitis as a manifestation of systemic diseases 3. Periodontitis The classification creates a staging and grading system for periodontitis that is based primarily on attachment and bone loss. This classifies the disease into four stages based on severity (Stage 1 mild; Stage II moderate; Stage III severe; Stage IV very severe) and three grades based on disease susceptibility (Grade A, B or C).i
Why radiographs are important Radiographs are a type of clinical imaging system that aids clinical assessment and discussion. They are used to explain findings and enable patients to understand the disease process, encouraging them to feel empowered and to support adherence to oral hygiene advice provided as part of their care. For clinicians, radiographs are pertinent to arriving at a diagnosis. It is important to use radiographs in conjunction with a clinical assessment of the patient, they should not be used in isolation to arrive at a diagnosis. Radiographs add value to clinical assessment to ascertain whether a patient is suffering from periodontitis and the complications arising from it. This underpins and strengthens information collected as part of the history and clinical examination.
Key feature of periodontitis A key feature of periodontitis is bone loss, and without radiographs this cannot be established just by looking at the patient. It is important to try and establish a diagnosis from the outset and to see how much bone has been lost, and also to re-evaluate the diagnosis and periodontal status at recall or re-evaluation appointments. According to the BSP Guidelines, the choice of radiograph is dependent on clinical judgement. Following the history and clinical assessment, radiographic assessment helps in terms of
determining the staging and grading which then fits into the diagnosis statement.
manipulation is possible and the images are easily shared. Physical storage space is also not required.
Radiography
Computerised tomography
There are two main types of radiography: • Conventional radiographs - X-rays (Analogue or Digital) • Computerised Tomography - CT scans Analogue radiographs are easily tolerated by patients but are cumbersome to handle and are more prone to processing errors. Images are not immediately available to view as they require development and space is required to physically store them. Image manipulation is not possible i.e. it is not possible to alter the contrast or brighten the image. Digital radiographs, on the other hand, are easy to handle. Images are immediately available, image
Conventional radiographs have their limitations because they provide a 2D representation of a three-dimensional object. Computerised Tomography (CT) produces 2D and 3D cross sectional images of an object from a flat radiographic image and visualises internal structures such as the shape and severity of the morphology or bony defect. The major challenge is the high radiation dose that conventional CTs produce, which limits their use in periodontics. In recent years, Cone Beam Computed Tomography (CBCT) has become increasingly used in dentistry, enabling investigations to be undertaken at a lower radiation dose than a typical CT scan,
To complete the questions and gain one hour of Enhanced CPD, visit cpd.the-probe.co.uk log in and find this course under the title ‘The role of radiographs in periodontal patient management’
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