ARTÍCULO 3 - Gabriela Molina Cevallos - Paralelo 2

1
Universidad de Guayaquil
Facultad Piloto de Odontología
PERIODONCIA I
ARTÍCULO 3- UNIDAD 4
Tema: Evaluación radiográfica periodontal: Técnicas

intraorales
Segundo Parcial
Sexto Semestre- Paralelo #2
Estudiante
Molina Cevallos Lilia Gabriela
Docente:
Dra. Pilar Pantoja R.
Fecha:
12 de julio del 2024
2024 – 2025 CI
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Universidad De Guayaquil.
Misión.
Generar, difundir y preservar conocimientos científicos, tecnológicos, humanísticos y

saberes culturales de forma crítica, creativa y para la innovación social, a través de las funciones
de formación, investigación y vinculación con la sociedad, fortaleciendo profesional y éticamente
el talento de la nación y la promoción del desarrollo, en el marco de la sustentabilidad, la justicia
y la paz.
Visión
Ser una Universidad reconocida nacional e internacionalmente por su calidad académica,
de emprendimiento, producción científica y tecnológica, con enfoque de responsabilidad social
sustentable.
Facultad Piloto de Odontología.
Misión.
La facultad piloto de odontología en la universidad de Guayaquil, es un centro de

educación superior con alto grado de excelencia académica e interdisciplinaria en salud, que a
través de la docencia investigación, practica pre-profesionales y vinculación con la comunidad, se
encarga de la formación integral de profesionales con alta capacidad científica y humanista para
la resolución de los problemas de salud buco dental, coordinando programas de salud, ´para
mejorar la calidad de vida de la sociedad.
Visión
La facultad de odontología de la universidad de Guayaquil, será la institución líder en la

formación de estudiantes con conocimientos específicos del sistema estomatognático y su
relación el resto del organismo, a través de la capacitación permanente mediante programas de
educación continua, postgrados, investigación y extensión, con responsabilidad en la prevención,
promoción, protección de la salud y resolución de los problemas que allí se presenten, con
valores éticos, morales y de alto compromiso social.
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EVALUACIÓN RADIOGRÁFICA PERIODONTAL: TÉCNICAS INTRAORALES
DEFINICIÓN
La enfermedad periodontal es una alteración que provocará un daño fundamental a nivel
de los tejidos de soporte y protección de las piezas dentarias, como ocurre con: la encía, el
ligamento periodontal, el cemento y el hueso alveolar. (Ortiz Vásquez & Flores Arcani, 2013)
En este contexto, la evaluación precisa de los tejidos blandos y duros que componen el
aparato periodontal es crucial para tomar decisiones precisas con respecto al tratamiento
periodontal.
Las radiografías intraorales, incluidas las radiografías periapicales y de aleta de mordida,
sirven como las técnicas empleadas con más frecuencia para evaluar los dientes, el hueso alveolar
circundante, el espacio del ligamento periodontal (PLS) y la lámina dura (LD). Esta preferencia
se atribuye a su capacidad para proporcionar los niveles más altos de resolución espacial y de
contraste mientras se mantienen bajos niveles de dosis de radiación para los pacientes entre las
diversas modalidades de imágenes radiográficas. (Jacobs et al., 2024)
Características radiográficas del periodonto sano
Para llegar a un buen diagnóstico de las enfermedades que afectan al periodonto se debe
reconocer en primera instancia las estructuras normales que posee el mismo, de este modo se
describen:
1. El proceso alveolar Esta estructura se encuentra en ambos maxilares y está constituida
por tejido óseo, su principal función es mantener a los alveolos de las diferentes piezas dentarias
en una correcta posición.
2. La lamina dura, que representa al espesor de la pared alveolar y al examen
radiográfico, que se observa como una línea radiopaca que delimita el espacio periodontal.
3. El tabique interdental, que se forma por la proximidad de las láminas duras de dos
alveolos contiguos y en el examen radiográfico suele presentarse como un borde radiopaco fino
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en proximidad al ligamento periodontal.
4. El ligamento periodontal, formado por tejido conectivo y constituido por fibras que se
encargan de unir al diente con los procesos alveolares. En la radiografía el ligamento no se puede
observar, debido a que se trata de un tejido blando, sin embargo, se observará la presencia de un
espacio radiolúcido que rodea a la raíz de la pieza dentaria y es conocido como espacio
periodontal. (Ortiz Vásquez & Flores Arcani, 2013)
Interpretación radiológica de la enfermedad periodontal
El dato de mayor relevancia será el grado de pérdida ósea el mismo que se define por
altura de la cresta ósea, donde se puede mencionar tres aspectos fundamentales:
A. Patrón
Las características morfológicas del tejido óseo son alteradas por la enfermedad
periodontal, desencadenando así en la pérdida de la altura del tejido óseo, la misma puede
producirse en dos direcciones, horizontal y vertical.
a. Pérdida ósea horizontal. Se observa de forma más frecuente que la pérdida ósea
vertical, en esta clasificación la altura ósea disminuye en sentido transversal y el margen de la
estructura ósea permanece un tanto perpendicular a la superficie de la estructura dentaria.
b. Pérdida ósea vertical. Conocida también como defectos angulares, son aquellos que
dejan un surco socavado alrededor de la raíz debido a la dirección oblicua que sigue la
destrucción ósea.
B. Distribución
La pérdida ósea puede presentarse en diferentes regiones de la cavidad bucal ya sea en el
maxilar superior o maxilar inferior, también puede observarse en una hemiarcada sea esta derecha
o izquierda y en casos más severos puede observarse en toda la cavidad bucal, donde se tratará de
una patología generalizada en la mayoría de los casos de avance crónico y en los casos en que se
vea exclusivamente en un sectante en particular se la considerara localizada.

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C. Gravedad
Se clasifica según el nivel de agresión que ha sufrido el periodoncio en:
 Leve: La pérdida ósea es de más del 30% y abarca únicamente el tercio cervical de
la raíz dentaria.
 Moderada: Donde la pérdida ósea es del 30 al 50% y se extiende hasta llegar al
tercio medio radicular.
 Grave: Cuando la pérdida ósea que se registra es mayor al 50% y el tercio apical
radicular se ve comprometido.
TIPOS
Se puede mencionar diversas técnicas como son: la técnica de bisectriz, la técnica del
paralelaje y la técnica interproximal.
Las tres son de mucha utilidad en la detección de la enfermedad periodontal debido a que
se obtienen imágenes más isomorfas e isométricas. Presenta diversas ventajas como son:
 Medir la distancia vertical entre la UCE y la cresta alveolar, alineándola con el eje
largo de los dientes vecinos. Cuando esta medida excede los 1,9 mm, dentro de un
intervalo de confianza que varía de 0,4 a 1,9 mm, puede indicar la presencia de pérdida
ósea. (Jacobs et al., 2024)
 Permite al clínico identificar factores predisponentes locales a las enfermedades
periodontales, como depósitos de sarro subgingival, anomalías en la morfología
radicular y restauraciones dentales salientes. (Jacobs et al., 2024)
 Permite establecer la continuidad del espacio periodontal.
 Establecer la longitud radicular (relación corono radicular) o determinar el grado de
rizálisis que ha sufrido la pieza dentaria debido a la afección que presenta.
 En caso de tratarse del maxilar superior, la relación que exista entre el seno maxilar
con la enfermedad periodontal ya que existe una comunicación de importancia con

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esta cavidad puede desencadenarse problemas severos como infecciones e inclusive
llegar a la producción de una sinusitis. (Ortiz Vásquez & Flores Arcani, 2013)
Técnica de Bisectriz
En la técnica de bisectriz, el haz de rayos X no siempre es perpendicular al receptor de
imagen, lo que puede causar distorsiones y mediciones menos precisas del hueso periodontal.
En esta técnica, el rayo central incide a nivel del ápice de las piezas dentarias formando
un ángulo de 90 grados con respecto a la bisectriz imaginaria formada entre el objeto a
radiografiar y la película, con una distancia de 20 cm. (Vázquez Diego et al., 2009)
Técnica de Paralelismo
Esta técnica se basa en el hecho de lograr una proyección con la menor distorsión
geométrica posible, cumpliendo los requisitos de una radio proyección ideal: el rayo central debe
incidir de forma perpendicular al objeto y la película siendo éstos paralelos, pasando por el centro
de la estructura de interés con una distancia mínima desde la salida anódica de la radiación al
objeto a radiografiar de 40 cm, el doble que las demás técnicas retroalveolares. De esta manera
disminuye el ángulo de radio proyección obteniendo así una imagen isométrica e isomorfa. Dada
la distancia empleada, el tiempo de exposición deberá aumentarse 4. Cabe destacar que la
utilización de películas de alta velocidad como F o G, puede minimizarse esta proporción. La
imagen resultante presentará entonces una menor distorsión geométrica respecto a la que se
obtiene con la técnica de la bisectriz, por lo que debiera ser la técnica de elección. Una tercera
condición técnica indica que el rayo central debe incidir a la altura de las crestas óseas
interalveolares, es por eso que es un método ideal para el diagnóstico de las lesiones óseas en la
enfermedad periodontal. (Vázquez Diego et al., 2009)
Para asegurar esta relación espacial geométrica precisa, el uso de soportes de
posicionamiento juega un papel crucial en la evaluación radiográfica periodontal a través de
radiografías periapicales y de aleta de mordida. Estos soportes ofrecen consistencia y

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estandarización en la obtención de imágenes de rayos X, lo que reduce la necesidad de
repeticiones. (Jacobs et al., 2024)
Técnica interproximal
Se la realiza con la película radiográfica conocida como aleta de mordida, las cuales
permiten representar con precisión la distancia entre la unión amelocementaria (UEC) y el hueso
crestal. Esta precisión se logra alineando el haz de rayos X casi perpendicularmente con los ejes
longitudinales de ambos dientes y el hueso circundante. Su uso es respaldado en pacientes con
bolsas periodontales generalizadas de <5 mm de profundidad.
Cuando los pacientes presentan bolsas que superan constantemente los 5 mm o
profundidades de bolsa irregulares, las radiografías de aleta de mordida convencionales pueden
no capturar adecuadamente toda la extensión del hueso de soporte. En tales casos, se pueden
considerar las radiografías de aleta de mordida verticales complementadas con radiografías
periapicales. Para las radiografías de aleta de mordida verticales, el receptor de imagen se puede
orientar en dirección vertical después de reorientarlo 90°. Esto garantiza el mantenimiento de la
geometría de la imagen y la cobertura de una región de interés más grande, que abarca todo el
proceso alveolar. (Jacobs et al., 2024)

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Diagnóstico radiográfico de enfermedades periodontales: evidencia actual versus
innovaciones
Radiographic diagnosis of periodontal diseases – Current evidence versus innovations
Autores: Reinhilde Jacobs | Rocharles Cavalcante Fontenele | Pierre Lahoud | Sohaib Shujaat |
Michael M. Bornstein
Publicado por primera vez:03 de junio de 2024
Abstract
Accurate diagnosis of periodontal and peri-implant diseases relies significantly on
radiographic examination, especially for assessing alveolar bone levels, bone defect morphology,
and bone quality. This narrative review aimed to comprehensively outline the current state-of-
the-art in radiographic diagnosis of alveolar bone diseases, covering both two-dimensional (2D)
and three-dimensional (3D) modalities. Additionally, this review explores recent technological
advances in periodontal imaging diagnosis, focusing on their potential integration into clinical
practice. Clinical probing and intraoral radiography, while crucial, encounter limitations in
effectively assessing complex periodontal bone defects. Recognizing these challenges, 3D
imaging modalities, such as cone beam computed tomography (CBCT), have been explored for a
more comprehensive understanding of periodontal structures. The significance of the
radiographic assessment approach is evidenced by its ability to offer an objective and
standardized means of evaluating hard tissues, reducing variability associated with manual
clinical measurements and contributing to a more precise diagnosis of periodontal health.
However, clinicians should be aware of challenges related to CBCT imaging assessment,
including beam-hardening artifacts generated by the high-density materials present in the field of
view, which might affect image quality. Integration of digital technologies, such as artificial
intelligence-based tools in intraoral radiography software, the enhances the diagnostic process.
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The overarching recommendation is a judicious combination of CBCT and digital intraoral
radiography for enhanced periodontal bone assessment. Therefore, it is crucial for clinicians to
weigh the benefits against the risks associated with higher radiation exposure on a case-by-case
basis, prioritizing patient safety and treatment outcomes.
KEYWORDS: CBCT, intra-oral radiography, panoramic radiography, periodontal
disease, artificial intelligence

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PREGUNTAS 0
1. ¿Cuál de los siguientes tejidos no se puede observar directamente en una radiografía
periapical debido a su naturaleza?
A. Cemento
B. Ligamento periodontal
C. Lámina dura
D. Proceso alveolar
Respuesta Correcta: B. Ligamento periodontal
Justificación: En la radiografía el ligamento no se puede observar, debido a que se trata de un
tejido blando, sin embargo, se observará la presencia de un espacio radiolúcido que rodea a la raíz
dentaria y es conocido como espacio periodontal. (Ortiz Vásquez & Flores Arcani, 2013)
2. ¿Qué técnica radiográfica se realiza con una película conocida como aleta de mordida?
A. Técnica de bisectriz
B. Técnica del paralelaje
C. Técnica interproximal
D. Técnica apical
Respuesta Correcta: C. Técnica interproximal
Justificación: La técnica interproximal se realiza con la película radiográfica conocida como
aleta de mordida, que permite representar con precisión la distancia entre la UCE y el hueso
crestal. (Jacobs et al., 2024)
3. ¿Cuál es la distancia mínima desde la salida anódica de la radiación al objeto a
radiografiar en la técnica del paralelaje?
A. 10 cm
B. 20 cm
C. 30 cm
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D. 40 cm 1
Respuesta Correcta: D. 40 cm
Justificación: La técnica del paralelaje requiere una distancia mínima desde la salida anódica de
la radiación al objeto a radiografiar de 40 cm para minimizar la distorsión geométrica. (Vázquez
Diego et al., 2009)
4. ¿Qué ventaja ofrece el uso de soportes de posicionamiento en la evaluación radiográfica
periodontal?
A. Aumenta la dosis de radiación necesaria
B. Genera imágenes con mayor distorsión
C. Reduce la necesidad de repeticiones
D. Limita la cobertura de la región de interés
Respuesta Correcta: C. Reduce la necesidad de repeticiones
Justificación: El uso de soportes de posicionamiento ofrece consistencia y estandarización en la
obtención de imágenes de rayos X, lo que reduce la necesidad de repeticiones. (Jacobs et al.,
2024)
5. ¿Cuál es una característica distintiva de la técnica de bisectriz?
A. El rayo central siempre es perpendicular al receptor de imagen
B. El rayo central forma un ángulo de 90 grados con respecto a la bisectriz imaginaria
C. Utiliza una distancia mínima de 40 cm desde la salida anódica
D. No causa distorsiones ni mediciones imprecisas
Respuesta Correcta: B. El rayo central forma un ángulo de 90 grados con respecto a la bisectriz
imaginaria
Justificación: En la técnica de bisectriz, el rayo central incide a nivel del ápice de las piezas
dentarias formando un ángulo de 90 grados con respecto a la bisectriz imaginaria formada entre
el objeto a radiografiar y la película. (Vázquez Diego et al., 2009)

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BIBLIOGRAFÍAS 2
Jacobs, R., Fontenele, R. C., Lahoud, P., Shujaat, S., & Bornstein, M. M. (2024). Radiographic
diagnosis of periodontal diseases – Current evidence versus innovations. Periodontology 2000.
https://doi.org/10.1111/prd.12580
Ortiz Vásquez, S., & Flores Arcani, M. (2013). Radiologia de la Enfermedad Periodontal. Umsa.bo.
http://revistasbolivianas.umsa.bo/scielo.php?script=sci_arttext&pid=S2304-
37682013001100006&lng=en&nrm=iso&tlng=es
Vázquez Diego, J., Errecaborde, M., Estévez, A., Osende, N., Ramírez, M. J., & Carvajal, E. (2009).
Utilización de la técnica radiográfica de Fitzgerald como método de diagnóstico en
implantología oral y periodoncia. Avances en odontoestomatologia, 25(4), 203–208.
https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-12852009000400005
Universidad de Facultad Piloto de
Guayaquil Odontología
RADIOGRAPHIC DIAGNOSIS OF
PERIODONTAL DISEASES – CURRENT
EVIDENCE VERSUS INNOVATIONS
Estudiante: Lilia Gabriela Molina Cevallos
PERIODONCIA I
Docente: Dra. Pilar Pantoja R.
DIAGNÓSTICO RADIOGRÁFICO DE
ENFERMEDADES PERIODONTALES:
EVIDENCIA ACTUAL VERSUS
INNOVACIONES
RADIOGRAPHIC DIAGNOSIS OF
PERIODONTAL DISEASES – CURRENT
EVIDENCE VERSUS INNOVATIONS
Autores: : Reinhilde Jacobs | Rocharles Cavalcante Fontenele | Pierre
Lahoud | Sohaib Shujaat | Michael M. Bornstein
Fecha de publicación: 03 de junio de 2024
EVALUACIÓN RADIOGRÁFICA PERIODONTAL:
TÉCNICAS INTRAORALES
Definición ¿Que se evalúa con las
Técnicas mas empleadas
técnicas radiográficas?
La enfermedad periodontal es una alteración que Las radiografías intraorales, incluidas las
provocará un daño fundamental a nivel de los radiografías periapicales y de aleta de Los dientes, el hueso alveolar circundante,
tejidos de soporte y protección de las piezas mordida. el espacio del ligamento periodontal
dentarias. (PLS) y la lámina dura (LD).
Esta estructura se
encuentra en ambos
maxilares y está
constituida por tejido
óseo, su principal
función es mantener se observa como
a los alveolos de las una línea radiopaca
diferentes piezas que delimita el
dentarias en una espacio periodontal.
correcta posición.
1. El proceso alveolar 2. La lamina dura
CARACTERÍSTICAS RADIOGRÁFICAS DEL

PERIODONTO SANO
4. El ligamento periodontal 3. El tabique interdental
se observará la se forma por la proximidad

presencia de un de las láminas duras de dos
espacio radiolúcido alveolos contiguos y en el
que rodea a la raíz examen radiográfico suele
de la pieza dentaria presentarse como un borde
y es conocido como radiopaco fino en
espacio periodontal proximidad al ligamento
periodontal.
INTERPRETACIÓN RADIOLÓGICA DE LA
ENFERMEDAD PERIODONTAL
Patrón
Pérdida de la altura del tejido óseo

a. Pérdida ósea horizontal. Se observa de forma
más frecuente que la pérdida ósea vertical, en esta
clasificación la altura ósea disminuye en sentido
transversal y el margen de la estructura ósea
permanece un tanto perpendicular a la superficie
de la estructura dentaria.
b. Pérdida ósea vertical. Conocida también como
defectos angulares, son aquellos que dejan un surco
socavado alrededor de la raíz debido a la dirección
oblicua que sigue la destrucción ósea.
Distribución
La pérdida ósea puede presentarse en diferentes regiones de la cavidad bucal ya sea en el

maxilar superior o maxilar inferior, también puede observarse en una hemiarcada sea esta
derecha o izquierda y en casos más severos puede observarse en toda la cavidad bucal, donde se
tratará de una patología generalizada
Gravedad
Leve: La pérdida ósea es de más del 30% y

abarca únicamente el tercio cervical de la raíz
dentaria.
Moderada: Donde la pérdida ósea es del 30 al
50% y se extiende hasta llegar al tercio medio
radicular.
Grave: Cuando la pérdida ósea que se registra
es mayor al 50% y el tercio apical radicular se
ve comprometido.
TIPOS
Se puede mencionar diversas técnicas como son: la técnica de bisectriz, la técnica del paralelaje y la técnica interproximal.
Medir la distancia vertical entre la UCE y la cresta alveolar,

1 alineándola con el eje largo de los dientes vecinos 4 Establecer la longitud radicular (relación corono radicular) o
determinar el grado de rizálisis que ha sufrido la pieza dentaria
Permite al clínico identificar factores predisponentes

2 locales a las enfermedades periodontales
5 La relación que exista entre el seno maxilar con la enfermedad
periodontal
3 ·Permite establecer la continuidad del espacio periodontal.

TIPOS
Técnica de Bisectriz Técnica de Paralelismo
El haz de rayos X no siempre es perpendicular Esta técnica se basa en el hecho de lograr una proyección con la menor distorsión geométrica
al receptor de imagen, lo que puede causar posible, cumpliendo los requisitos de una radio proyección ideal.
distorsiones y mediciones menos precisas del Disminuye el ángulo de radio proyección obteniendo así una imagen isométrica e isomorfa.
hueso periodontal. El rayo central debe incidir a la altura de las crestas óseas interalveolares
Técnica interproximal
Se la realiza con la película radiográfica conocida

como aleta de mordida, las cuales permiten
representar con precisión la distancia entre la
unión amelocementaria (UEC) y el hueso crestal.
Para las radiografías de aleta de mordida
verticales, el receptor de imagen se puede orientar
en dirección vertical después de reorientarlo 90°.
Esto garantiza el mantenimiento de la geometría
de la imagen y la cobertura de una región de
interés más grande, que abarca todo el proceso
alveolar.
BIBLIOGRAFÍAS
Jacobs, R., Fontenele, R. C., Lahoud, P., Shujaat, S., & Bornstein, M. M.
(2024). Radiographic diagnosis of periodontal diseases – Current evidence
versus innovations. Periodontology 2000. https://doi.org/10.1111/prd.12580
Ortiz Vásquez, S., & Flores Arcani, M. (2013). Radiologia de la Enfermedad
Periodontal. Umsa.bo. http://revistasbolivianas.umsa.bo/scielo.php?
script=sci_arttext&pid=S2304-
37682013001100006&lng=en&nrm=iso&tlng=es
Vázquez Diego, J., Errecaborde, M., Estévez, A., Osende, N., Ramírez, M. J.,
& Carvajal, E. (2009). Utilización de la técnica radiográfica de Fitzgerald
como método de diagnóstico en implantología oral y periodoncia. Avances
en odontoestomatologia, 25(4), 203–208.
https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-
12852009000400005
IMÁGENES
Espinoza, C. A. (2020). Signos Radiográficos de la Enfermedad Periodontal
– Dento Metric. Dentometric.com. https://dentometric.com/signos-
radiograficos-de-la-enfermedad-periodontal/
MUCHAS
GRACIAS
Received: 7 February 2024 | Revised: 23 April 2024 | Accepted: 16 May 2024
DOI: 10.1111/prd.12580
REVIEW ARTICLE
Radiographic diagnosis of periodontal diseases – Current

evidence versus innovations
Reinhilde Jacobs1,2,3 | Rocharles Cavalcante Fontenele1,2 | Pierre Lahoud1,2,4 |

Sohaib Shujaat5 | Michael M. Bornstein6
1
OMFS IMPATH Research Group,
Department of Imaging and Pathology, Abstract
Faculty of Medicine, KU Leuven, Leuven,
Accurate diagnosis of periodontal and peri-implant diseases relies significantly on
Belgium
2
Department of Oral and Maxillofacial
radiographic examination, especially for assessing alveolar bone levels, bone defect
Surgery, University Hospitals Leuven, morphology, and bone quality. This narrative review aimed to comprehensively outline
Leuven, Belgium
3
the current state-of-the-art in radiographic diagnosis of alveolar bone diseases, cover-
Department of Dental Medicine,
Karolinska Institute, Stockholm, Sweden ing both two-dimensional (2D) and three-dimensional (3D) modalities. Additionally,
4
Periodontology and Oral Microbiology, this review explores recent technological advances in periodontal imaging diagnosis,
Department of Oral Health Sciences, KU
focusing on their potential integration into clinical practice. Clinical probing and in-
Leuven, Leuven, Belgium
5
King Abdullah International Medical traoral radiography, while crucial, encounter limitations in effectively assessing com-
Research Center, Department of plex periodontal bone defects. Recognizing these challenges, 3D imaging modalities,
Maxillofacial Surgery and Diagnostic
Sciences, College of Dentistry, King such as cone beam computed tomography (CBCT), have been explored for a more
Saud bin Abdulaziz University for Health comprehensive understanding of periodontal structures. The significance of the ra-
Sciences, Ministry of National Guard
Health Affairs, Riyadh, Saudi Arabia diographic assessment approach is evidenced by its ability to offer an objective and
6
Department of Oral Health & Medicine, standardized means of evaluating hard tissues, reducing variability associated with
University Center for Dental Medicine
manual clinical measurements and contributing to a more precise diagnosis of peri-
Basel UZB, University of Basel, Basel,
Switzerland odontal health. However, clinicians should be aware of challenges related to CBCT im-
aging assessment, including beam-hardening artifacts generated by the high-density
Correspondence
Reinhilde Jacobs, OMFS IMPATH materials present in the field of view, which might affect image quality. Integration of
Research Group, Department of Imaging
digital technologies, such as artificial intelligence-based tools in intraoral radiography
and Pathology, Faculty of Medicine,
University of Leuven and Department software, the enhances the diagnostic process. The overarching recommendation is
of Oral & Maxillofacial Surgery,
a judicious combination of CBCT and digital intraoral radiography for enhanced peri-
University Hospitals Leuven, KU Leuven,
Kapucijnenvoer 7, 3000 Leuven, Belgium. odontal bone assessment. Therefore, it is crucial for clinicians to weigh the benefits
Email: [email protected]
against the risks associated with higher radiation exposure on a case-by-case basis,
prioritizing patient safety and treatment outcomes.
KEYWORDS
CBCT, intra-oral radiography, panoramic radiography, periodontal disease, artificial intelligence
Reinhilde Jacobs and Rocharles Cavalcante Fontenele are co-f irst authors, both equally contributed to this work
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction
in any medium, provided the original work is properly cited and is not used for commercial purposes.
© 2024 The Author(s). Periodontology 2000 published by John Wiley & Sons Ltd.
Periodontology 2000. 2024;00:1–19. wileyonlinelibrary.com/journal/prd | 1

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2 JACOBS et al.
1 | I NTRO D U C TI O N modalities. Firstly, these methods yield two-dimensional renderings

of three-dimensional (3D) objects, leading to the superimposition of
In accordance with the groundbreaking new classification for anatomical structures, which may obscure pivotal details, potentially
periodontal and peri-implant diseases, jointly established by the hampering the precision of the assessment.12–14 Additionally, the
American Academy of Periodontology (AAP) and the European measurement of alveolar bone loss and bone defects is confined to
Federation of Periodontology (EFP), periodontal diseases are de- the parasagittal plane, which may not fully capture the 3D osseous
fined as inflammatory conditions affecting the supporting tissues of architecture of the alveolar bone ridge.6
the teeth, caused by specific microorganisms or groups of micro- To address these inherent limitations, 3D imaging techniques,
organisms. This results in progressive destruction of the periodon- whether utilizing ionizing radiation or not, have been emerging as a
tal ligament and alveolar bone.1–3 Conversely, peri-implantitis is an promising alternative and adjunctive diagnostic method. Moreover,
inflammatory condition impacting soft and hard tissues surround- contemporary periodontal therapy has evolved into an interdisciplin-
ing dental implants, typically triggered by specific microorganisms. ary approach that encompasses both soft and bone tissue regener-
Although it shares similarities with periodontitis, peri-implantitis oc- ative treatments, necessitating a 3D assessment of the periodontal
curs in the context of dental implants, leading to bone loss, pocket apparatus. In this context, cone beam computed tomography (CBCT)
formation, and other clinical signs of inflammation around the im- serves as a promising tool to assist clinicians in achieving precise di-
plant site.3,4 agnoses, planning patient-specific treatments, and attaining predict-
This novel classification emphasizes a comprehensive and mul- able clinical outcomes.6 This is particularly relevant in cases where
tidimensional assessment for the diagnosis of periodontal disease, the acquisition of intricate and detailed information is pivotal to the
highlighting both the severity and complexity of its management. diagnostic process and the formulation of treatment plans.
The primary objective of the classification is to precisely determine This narrative review aimed to provide a comprehensive over-
both the stage and grade of periodontal disease. When evaluating view of the current state-of-the-art in the radiographic diagnosis
the staging of periodontal disease, categorized on a scale from 1 to of periodontal diseases. This includes an exploration of the indica-
4, it is essential to consider several anamnestic, clinical, and imaging tions, advantages, and disadvantages of various imaging modalities,
factors with meticulous care.1,2,5 These factors encompass probing taking into consideration their diagnostic value and radiation dose.
depth, clinical attachment loss, extent of bone loss, as well as the Furthermore, it will also briefly discuss technological advances in
presence and extent of bone defects and furcation involvement. periodontal imaging diagnosis and their potential integration into
In this context, the precise evaluation of both the soft and hard clinical practice.
tissues comprising the periodontal apparatus is crucial for making
accurate decisions regarding periodontal treatment.6 Concerning
soft-tissue assessment, pocket depth and the percentage of bleed- 2 | E LI G I B LE I M AG I N G M O DA LITI E S
ing upon probing serve as the two primary indicators of periodontal
health status.1,6 However, the measurement of these parameters is The choice for an appropriate imaging modality is pivotal for the
susceptible to inherent inter- and intra-examiner variability, which precise diagnosis of periodontal conditions. Selecting the right im-
can lead to overestimation or underestimation of these clinical aging method is crucial to guarantee accurate diagnosis, effective
7,8
parameters. To address these inherent limitations of clinical as- treatment planning, and the delivery of high-quality dental care. It is
sessment, it is essential to consider complementary radiographic imperative to consider the technical aspects, advantages, disadvan-
evaluation. Radiographs offer an objective and standardized means tages, and limitations of each imaging modality. This knowledge is
of assessing the condition of hard tissues, including alveolar bone essential for making informed decisions and ensuring the most suit-
6,9
levels, bone defects, and furcation involvement. This additional able imaging technique is applied in each specific clinical scenario.
diagnostic information significantly reduces the impact of variability
associated with manual clinical measurements and contributes to a
more precise and reliable assessment of periodontal health. 2.1 | 2D imaging modalities – intraoral radiographs
In addition to clinical examination, bidimensional (2D) imaging
modalities (e.g. periapical, bitewing, and panoramic radiographs) are Among ionizing imaging modalities, intraoral radiographs, including
the preferred diagnostic tools for both initial assessments and fol- periapical and bitewing radiographs, serve as the most frequently
low-up evaluations of clinical attachment loss and alveolar bone lev- employed techniques for evaluating teeth, surrounding alveolar
5
els around dental roots. Several reasons support the preference for bone, periodontal ligament space (PLS), and lamina dura (LD). This
these imaging modalities, including their accessibility, affordability, preference is attributed to their capacity to deliver the highest lev-
and high-resolution capabilities.10–12 This evaluation entails the iden- els of spatial and contrast resolution while maintaining low levels of
tification and quantification of alveolar bone loss through the mea- radiation dose to the patients among the various radiographic imag-
surement of linear bone height and width, which are subsequently ing modalities.6,12,15,16 In the pursuit of minimizing radiation expo-
compared to established normal or baseline values. However, it is es- sure, the incorporation of digital image receivers, such as phosphor
sential to acknowledge certain limitations intrinsic to these imaging storage plates (PSP) or solid-state detector, is indispensable. These
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JACOBS et al. 3
technologic advances enhance the efficiency of radiographic pro- crestal bone height obtained during intraoperative procedures.6
cedures while reducing radiation dose. Previous investigations17,18 Furthermore, periapical radiograph assessment enables the clinician
have shown that both digital image receptors can accurately meas- to identify local predisposing factors to periodontal diseases, such as
ure periodontal bone levels, even when using low exposure times subgingival calculus deposits, root morphology anomalies, and over-
(e.g. ranging from 20 to 40 ms), especially for the solid-state de- hanging dental restorations.
tector, underscoring their greater sensitivity. Thus, prioritizing the While the primary emphasis of this review is not on peri-implant
lowest exposure time and the lowest tube current levels, while main- diagnosis, it is important to note that a significant number of pa-
taining diagnostic efficacy, ensures that patients are exposed to the tients in need of periodontal diagnosis would also find value in an
least possible radiation, a fundamental principle in radioprotection. assessment of peri-implant disease. Parallel to the discussions on
Additionally, the use of rectangular collimators aids in precise X-ray periodontal assessment, periapical radiography emerges as the
beam focusing on the targeted area, effectively reducing patient ra- predominant imaging method in routine clinical practice for peri-
diation exposure by at least 40%.19 implant diagnosis, as highlighted by previous systematic reviews
For patients with generalized periodontal pockets measuring with meta-analyses. 23–25 However, it is crucial to recognize that
<5 mm in depth, guidelines from the Faculty of General Practitioners lesion size significantly influences accurate detection, irrespective
in the United Kingdom support the use of bitewing radiographs.20 of the chosen imaging modality, as radiography assessments tend
Indeed, bitewing radiographs allow to accurately depict the distance to underestimate it. 23,25 Despite its effectiveness, the inherent 2D
between cementoenamel junction (CEJ) and crestal bone. This pre- nature of radiographs confines the assessment of periapical radio-
cision is achieved by aligning the X-ray beam almost perpendicularly graphs to the detection and measurement of mesiodistal periodontal
with the long axes of both teeth and surrounding bone. However, when bone loss, as illustrated in Figure 1, showing different degrees of
patients exhibit pocketing consistently exceeding 5 mm or irregular horizontal bone loss.
pocket depths, conventional bitewing radiographs may not adequately The accuracy and reliability of intraoral radiographs in assessing
capture the entire extent of the supporting bone. In such cases, ver- periodontal and peri-implant diseases critically hinge on the stan-
tical bitewings supplemented with periapical radiographs can be con- dardization of technical and X-ray geometry factors, specifically the
sidered. For vertical bitewings, the image receptor can be oriented in spatial alignment among the image receptor plane, teeth, and central
the vertical direction after reorienting it by 90°. This ensures the main- X-ray beam (Figure 2A,B). 26 Optimal results are achieved when the
tenance of image geometry and coverage of a larger region of interest, X-ray beam is directed perpendicularly to the long axis of the teeth
encompassing the entire alveolar process. Furthermore, in accordance and the plane of the image receptor, resulting in minimal distor-
with the American Dental Association's guidance, a comprehensive tion of the teeth and surrounding periodontal structures (Figure 3).
full-mouth intraoral radiographic examination is advised for patients Consequently, the use of the paralleling technique for acquiring
21
displaying signs of generalized periodontal disease. periapical radiographs is strongly recommended over the bisecting-
In the routine analysis of intraoral radiographs, it is common angle technique due to its superior geometric configuration, which
practice to measure the vertical distance between the CEJ and alve- yields reduced distortion and more precise diagnostic information.
olar crest, aligning it with the long axis of neighbor's teeth. When this To ensure this precise geometric spatial relationship, the use of
measurement exceeds 1.9 mm, within a confidence interval ranging positioning holders plays a crucial role in radiographic periodontal
22
from 0.4 to 1.9 mm, it may indicate the presence of bone loss. It assessment through periapical and bitewing radiographs. These
is essential to recognize, however, that this radiographic measure- holders offer consistency and standardization in obtaining X-ray im-
ment appears smaller than the physical measurement of alveolar ages, reducing the need for retakes (Figure 2C,D).6
F I G U R E 1 Periapical radiographs
illustrating the assessment of different
degrees of mesiodistal periodontal bone
loss considering a reference line (RL) at
the level of the cemento-enamel junction
and the thirds of the root canal involved.
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4 JACOBS et al.
F I G U R E 2 Schematic drawing illustrating the alignment between the positioning device, teeth, and image receptor according to the
paralleling radiographic technique for periapical (A) and bitewing (B) radiographs. Examples of radiographic positioning systems: (C)
positioners for periapical radiographic techniques for anterior and posterior teeth, respectively; (D) positioners for bitewing radiographic
techniques. (Illustrations with courtesy of Dr Cascante-Sequeira).
F I G U R E 3 Comparison between
the paralleling technique and bisecting
angle techniques regarding the distance
between the cementoenamel junction and
the interradicular crestal bone.
Previous studies17,18,27 have explored the impact of certain tech- only after 30%–50% of bone resorption. 28 Furthermore, numerous
nical parameters related to digital radiographs on the measurement studies29–32 have demonstrated that intraoral radiographs tend to
of alveolar bone height. One critical parameter is contrast resolution, underestimate alveolar bone loss, especially in the early stages of
which refers to the ability to display and differentiate various shades the disease. Conversely, in severe cases of periodontal disease, there
of gray in radiographic images. It is expected that digital radiographic is a tendency to overestimate the extent of bone loss. Lastly, radio-
systems with higher contrast resolution would offer improved visu- graphic images do not provide information regarding the detection
alization of the alveolar crest. Vandenberghe et al.18 demonstrated of periodontal pockets or tooth mobility, which are essential clinical
that a contrast resolution of up to 12 bits led to greater accuracy aspects for periodontal diagnosis.
when measuring alveolar bone height using the Vistascan system
(Dürr Dental GmbH, Bietigheim-Bissingen, Germany). Furthermore,
the use of a dedicated periodontal filter has been shown to enhance 2.2 | 2D imaging modalities – panoramic
accuracy in alveolar bone height measurement. Conversely, for radiography
solid-state detector, the radiographic system with 14 bits exhibited
superior performance compared to another with lower contrast res- Panoramic radiography, a widely used imaging modality in den-
olution (12 bits) when undertaking the same task. tistry, provides a comprehensive assessment of the dentition, al-
However, clinicians should be aware of the significant limitations veolar bone, and surrounding structures of both jaws through a
inherently associated with intraoral radiographs. First, radiographic single curved tomographic image. Esteemed for its low-d ose radi-
assessment does not provide a complete view of the bucco-lingual ation exposure and cost-effectiveness, this technique stands as an
aspects of the interproximal bone, and early lesions are often chal- attractive option for periodontal imaging assessment, especially
lenging to diagnose accurately since radiographic evidence appears when complemented with intraoral radiographs. 6,33 However,
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JACOBS et al. 5
clinicians should be aware of several challenges that can impair compared to intraoral bitewing. Despite these findings, future in-
its diagnostic performance when evaluated alone (i.e. without vestigations can delve into the clinical applicability of this technol-
supplemented with intraoral radiograph assessment). Beyond ogy for other aspects of periodontal, considering that this imaging
the common limitations associated with 2D projections (e.g. the modality is reasonable for being employed for patients who can-
superposition of anatomical structures), panoramic radiography not tolerate intraoral radiography examination. Figure 4 shows a
introduces nonuniform magnification and distortion, compromis- comparison between conventional panoramic radiography and the
ing the reliability of linear measurements. Furthermore, the thin respective EBR.
image layer accentuates the significance of minor discrepancies Commonly, the combination of panoramic and periapical radiog-
between the jaws, impacting image quality and diminishing their raphies is frequently employed for assessing periodontal status.40,41
diagnostic value. However, clinicians should be aware that panoramic radiography
Conventionally, the X-ray beam angulation is not parallel, featur- might not be considered the primary imaging modality of choice.6
ing an upward angulation of 8° relative to the teeth and supporting The literature is inconclusive regarding its accuracy for radiographic
bone structures. This misalignment induces horizontal overlap and assessment of periodontal disease. Several studies assert that, when
distortion, which decrease the visibility of fine structures related to compared to panoramic radiography, intraoral radiographs prove
the periodontal apparatus, such as the periodontal ligament space, to be more accurate methods for assessing periodontal bone loss,
especially in the premolar region. Furthermore, panoramic acquisi- especially in cases of initial defects. 29,31,40,41 Nevertheless, others
tion presents additional technical challenges, considering that pre- mention a similar performance between these imaging techniques,
cise alignment of the patient's dentition within the image layer is specifically for intrabony defects.42–44
6,15,29,33
mandatory. Consequently, positioning errors and artifacts
(e.g. ghosting images) are commonly observed in the obtained im-
ages, potentially leading to misrepresentations of anatomical struc- 2.3 | 3D imaging modalities – cone beam
tures, especially in the anterior region. computed tomography
Recently, advancements in panoramic imaging technology have
been introduced to overcome specific technical limitations, as previ- In the late nineties, the introduction of cone beam computed to-
ously emphasized. Notable devices, including Instrumentarium imag- mography (CBCT), a cutting-edge 3D imaging technique, marked
ing (Tuusula, Finland), Orthophos SL (Dentsply Sirona Deutschland, a revolutionary advancement in dentistry, impacting fields such as
Bensheim, Germany), ProVecta SPan (Air Techniques Inc., Melville, periodontology and implant dentistry. A recent comprehensive re-
NY, USA), and Pax-i plus (Vatech Co., Hwaseung Si, Korea), have in- view identified a total of 279 CBCT models available in the market,
corporated tomosynthesis technology.6,34–36 This involves acquiring revealing significant variations in both physical and technical specifi-
sequential radiographic projections during a single rotational move- cations.45 These specifications play a crucial role in determining the
ment of the X-ray tube, resulting in multiple parallel image layers. radiation dose to which patients are exposed and influence the over-
This innovative approach enables buccolingual depth assessment of all image quality. It is imperative to obtain diagnostically acceptable
the region of interest without any increase in radiation dose com- images personalized to each patient while simultaneously minimiz-
pared to conventional panoramic radiography. Previous studies ing the radiation dose administered, as highlighted by the ALADAIP
have explored the feasibility of this technology for assessing root radioprotection principle.46 Consequently, clinicians must be well-
34 35 37
resorption, proximal caries lesions, and third molar evaluation. informed regarding adjustable image acquisition factors that influ-
However, to the best of our knowledge, there are no studies yet in- ence both image quality and the level of radiation dose to which the
vestigating the applicability of this technology for the periodontal patient is exposed. These factors include tube current, kilovoltage-
and peri-implant radiographic diagnoses. Consequently, future stud- peak, field of view, the number of basis images, and, indirectly, the
ies are encouraged to explore the potential applications of this inno- voxel size.
vation for these diagnostic tasks. The CBCT volume is acquired through a single, partial, or full
Furthermore, another relatively recent technology incorpo- rotation of the unit around the patient's head. On one side of the
rated into panoramic devices is extraoral bitewing radiographs unit is the X-ray source with a divergent pyramidal-or cone-shaped
(EBR), offering images that display crowns, roots, and surround- beam, while on the other side is the synchronized rotating image de-
ing anatomical structures from the posterior region of the jaws. tector. The CBCT unit features an adaptable collimator that adjusts
While manufacturers do not provide detailed information on how the field of view based on clinical indications. It should be restricted
this technology works, it is hypothesized that a correction in the to the clinical area under investigation to minimize the volume of
scan rotation angle (i.e. X-r ay direction more perpendicular) is the patient's tissue exposed to radiation and, indirectly, improve the
implemented to reduce the overlapping of tooth crowns, as com- image quality due to the lower scatter radiation.47–49 Throughout
monly observed in conventional panoramic radiography. 38 A pre- the rotation, a sequence of 2D projections, referred to as basis im-
vious investigation39 demonstrated that EBR exhibited excellent ages, is acquired (ranging from 150 to over 1000 per scan), forming
sensitivity but low specificity for the assessment of crestal bone the raw primary data.6 Subsequently, these planar projection images
loss, primarily due to a higher percentage of false-p ositive cases are reconstructed to generate a 3D volumetric data set consisting of
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6 JACOBS et al.
F I G U R E 4 Comparison between
a panoramic radiograph (A) and its
corresponding extraoral bitewing
radiographs (B).
cuboidal volume elements (i.e. voxels) that can be reconstructed in radiographic diagnosis of periodontal diseases, especially for pre-
orthogonal reconstructions, commonly known as axial, sagittal, and surgical treatment planning for complex periodontal defects as well
coronal reconstructions by applying different software algorithms. as for implant placement.55 While intraoral radiography provides
Additionally, transversal views of the acquired volume can be recon- valuable 2D visualization of the teeth and supporting structures, it
structed from these primary reconstructions. often lacks the ability to accurately depict the complex 3D anatomy
While intraoral radiographs combined with clinical probing pa- of periodontal tissues. CBCT, on the other hand, offers detailed 3D
rameters are considered gold standards for a typical periodontal images that enable precise assessment of bone morphology, bone
examination, the 2D nature of radiographs introduces several lim- defects, and the spatial relationship between teeth and surround-
itations in certain aspects of radiographic assessment of periodon- ing structures. By combining these modalities, clinicians can obtain
tal and peri-implant diseases.50 These limitations include the lack of a comprehensive understanding of periodontal disease severity,
buccal and/or lingual cortical plate visualization and the common extent, and progression. This integrated approach has the potential
underestimation of proximal periodontal and peri-implant bone to enhance diagnostic accuracy, facilitates treatment planning, and
loss.51–53 In this context, CBCT has been pointed out as an alter- allows for more predictable treatment outcomes. Additionally, the
native for overcoming these limitations in assessing the morphol- complementary nature of intraoral radiography and CBCT helps cli-
ogy and extent of alveolar bone destruction without superposition nicians identify periodontal diseases at various stages, from early
of anatomical structures, even in an early stage.54 Consequently, onset to advanced stages, enabling timely intervention and im-
these factors directly affect the establishment of precise treatment proved patient care.
planning and prediction of outcomes. In this sense, CBCT presents However, in 2017, the American Academy of Periodontology,
a higher sensitivity (ranging from 80% to 100%) for detecting peri- based on existing literature, did not endorse the routine use of
odontal bone defects compared to intraoral radiographic modalities CBCT in managing periodontal diseases.50 However, it is suggested
14,55
(ranging from 63% to 67%). that CBCT may be beneficial for periodontal diagnosis when com-
Figure 5 illustrates an example of periodontal bone loss with fur- bined with 2D imaging assessment and clinical probing, especially
cation involvement at an early stage, assessed using various imaging in cases of advanced periodontal diseases with concurrent end-
modalities. As seen in the referred figure, the combination of intra- odontic conditions or in patients being considered for dental im-
oral radiography and CBCT could hold significant importance for the plant placement. Therefore, CBCT may provide valuable insights
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JACOBS et al. 7
F I G U R E 5 Series of images illustrating a clinical scenario of early periodontal bone loss with furcation involvement (indicated by the
arrows). (A) An upper left first molar in panoramic radiograph; (B) an upper right second molar in periapical radiograph; (C) an upper left first
molar in cone-beam computed tomography.
F I G U R E 6 Cone beam computed

tomography images illustrating complex
vertical bone defects with 2-wall
involvement (A) and 3-wall involvement
(B). (Illustrations with courtesy of
Dr Cascante-Sequeira).
and offer additional clinical benefits in evaluating the morphology procedures and contribute to assessing the associated prognostic
of furcation involvement or intrabony defects, as seen in Figure 6. surgical outcomes. Notably, CBCT demonstrated an 84% accuracy
This, in turn, can aid in determining the applicability of regenerative rate in detecting furcation involvement in maxillary molars, using
|
8 JACOBS et al.
intra-surgical assessments as a reference.56 Furthermore, variations 2.4 | Radiation dose comparison among ionizing
in treatment recommendations were observed for the majority of imaging modalities for dento-maxillofacial indications
maxillary molars with furcation involvement, compared to decisions
based on conventional assessments like clinical and 2D imaging as- Intraoral radiographs typically deliver lower radiation doses (ap-
sessments.57 Walter et al.58 concluded that CBCT assessments of proximately 1 μSv) compared to panoramic radiographs (approxi-
maxillary teeth with furcation involvement resulted in reduced costs mately 10 μSv) and CBCT scans (10–1200 μSv). 68–70 Panoramic
and treatment time in Switzerland. radiographs, offering a broader maxillofacial view, generally en-
The literature surprisingly reveals a lack of knowledge regarding tail a higher radiation dose than intraoral radiographs due to their
the influence of different acquisition parameters in CBCT on radio- extended imaging range. In contrast, CBCT scans are associated
graphic periodontal assessment. Nonetheless, specific parameters, with a higher equivalent radiation dose compared to 2D imaging
such as voxel size and field of view, have been the focus of some modalities. Nevertheless, the effective radiation doses of differ-
studies. Smaller voxel sizes are expected to yield higher image res- ent dental CBCT devices and protocols can significantly vary, with
olution and greater detail. Supporting this, one study revealed that equivalent doses ranging between 2 and 200 panoramic radio-
a larger voxel size (0.4 mm) overestimated alveolar bone height loss graphs, ideally preferable to be an equivalent of 2 to maximally 10
compared to a smaller voxel size (0.25 mm), using direct measure- panoramic radiographs (20–100 μSv). 68–71 Despite this variability,
59
ments as a reference. ongoing technological advancements have spurred the develop-
Another study60 explored the impact of different voxel sizes ment of dose-reduction strategies and protocols aimed at minimiz-
(0.15 and 0.30 mm) on detecting various periodontal defect types, ing radiation exposure.
recommending the smallest voxel size for dehiscence and grade I When considering the radiation dose, practitioners must weigh
furcation. In contrast, it suggested opting for the highest voxel size the diagnostic advantages of each imaging modality against the po-
when assessing other bone defects (e.g. fenestration and grades tential risks. Intraoral radiographs are often preferred for routine
II and III furcation defects). This recommendation is based on the periodontal examinations due to their lower radiation doses, while
consideration of higher radiation doses associated with smaller panoramic radiographs offer a wider perspective. CBCT becomes
voxel sizes, taking into account the high values of milliamperage particularly valuable when 3D visualization is essential, such as in
and kilovoltage-p eak inherent to high-resolution protocols. In a complex periodontal or peri-implant clinical cases, to assess the
61
different approach, Icen et al. demonstrated that a smaller voxel need for surgical intervention or tooth removal.71 Furthermore,
size (0.160 vs. 0.125 mm) and field of view (8 × 8 vs. 8 × 10 cm) CBCT acquired for dental implant placement or therapy-resistant
improved the sensitivity and accuracy of detecting various peri- endodontic conditions, may also be used for concurrent periodon-
odontal defects. However, several other studies12,62,63 found no tal diagnosis. CBCT may indeed provide valuable insights and offer
significant differences among various voxel sizes smaller or equal additional clinical benefits in evaluating the morphology of furcation
than 0.2 mm for detecting fenestration defects. Nonetheless, involvement or intrabony defects, surely when combined with 2D
smaller voxel sizes (0.08 and 0.125 mm) enhanced inter-observer imaging assessment and clinical probing.55
62,63
agreement for detecting this task. Ultimately, the choice of imaging modality should align with the
While the advantages of CBCT are evident, it is crucial that the specific diagnostic need of the patient clinical condition, taking into
clinicians should be informed about the various limitations associ- account both clinical requirements and radiation safety consider-
ated with this imaging modality. One notable challenge is the pres- ations. Regular assessment and adherence to dose optimization
ence of beam-hardening artifacts caused by high-density materials, guidelines contribute to achieving a judicious balance between diag-
such as titanium and zirconia implants, dental fillings, metal posts, nostic efficacy and patient safety regardless of the clinical indication.
and amalgam. These artifacts generate hypodense and hyperdense
streaks or bands not restricted to the artifact-generator area, which
might lead to misdiagnosis of hypodense peri-implant defects and, 2.5 | 3D imaging modalities
conversely, impair the early detection of these hypodense intraos- – nonionizing techniques
seous defects.64 Additionally, these artifacts contribute to image
distortion (i.e. blooming), further complicating the accuracy of iden- Nonionizing imaging methods provide high-resolution, radiation-
tifying peri-implant defects involving the buccal and lingual cor- free insights into periodontal structures, detecting pre-clinical in-
tical plates, as highlighted by a recent investigation that assessed flammatory changes before visible bone loss. These techniques
65
blooming expression on 13 different CBCT devices. Finally, pa- focus on soft tissue components during a reversible stage, making
tient movement during the imaging acquisition introduces an ad- them valuable for safer, comprehensive monitoring of periodontal
ditional artifact source that undeniably hampers the image quality and peri-implant diseases.72–75 Among the nonionizing imaging mo-
even more. 23,66 However, it is worth noting that some CBCT devices dalities, three prominent techniques – magnetic resonance imaging
already have automated movement artifact algorithms available. (MRI), ultrasound, and optical coherence tomography (OCT) – stand
These tools have demonstrated improvements in CBCT image qual- out for their unique capabilities in providing insights into soft tissues
ity and interpretability.67 related to periodontal structures.
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JACOBS et al. 9
MRI, with robust magnetic fields and radio waves, offers detailed Currently, clinical periodontal probing and intraoral radiography
3D assessments of soft tissues, including the gingiva, providing high stand as primary diagnostic tools for detection of periodontal dis-
tissue contrast.76 While valuable in diagnosing inflammatory diseases. However, numerous studies have revealed limitations in both
eases involving soft and hard tissues, its dental application is limited techniques for assessing periodontal bone loss.30,96-102 A major draw-
due to device accessibility for dentists and artifacts from metallic back is the absence of 3D information for evaluating and classifying
72
dental materials affecting image quality. Recent studies confirm periodontal bone defects, particularly infrabony defects and furcation
MRI's reliability in diagnosing periodontal disease, aligning well involvements. Infrabony defects, also known as bony craters, typically
with CBCT measurements and clinical assessments, showcasing exhibit a saucer-shaped configuration with 3 or 4 remaining bony walls,
its potential in improving diagnosis and treatment for periodontal while furcation involvements pertain to defects among multi-rooted
77–80
diseases. However, more studies are needed to define its true teeth with diverging roots. Accurate diagnosis and interpretation of
diagnostic applicability in periodontal diagnosis, especially consider- these defects are crucial for predicting prognosis of involved teeth and
ing the lack of clinical studies. devising appropriate treatment plans.17,96,103 Figure 8 shows a set of
Ultrasound is a promising tool for noninvasive periodontal di- images with depiction of a patient with periodontal disease, including
agnosis, offering real-time visualization of structures using high- 3D models generated by artificial intelligence (AI).
frequency sound waves.81 It provides insights into soft tissue Yet, both prime periodontal diagnostic means suffer some draw-
thickness, bone density, and inflammatory changes, along with dy- backs. Indeed, clinical probing relies on probing force and is prone
namic assessments of blood flow for a better understanding of peri- to human variability. At the same time, intraoral radiography, a key
82,83
odontal health. Its portability and cost-effectiveness make it a diagnostic tool for periodontal diseases, may inaccurately estimate
convenient chairside diagnostic tool for various clinical settings.84 A bone loss considering the inherent 2D anatomical overlap and addi-
recent meta-analysis suggests that ultrasonography may be a viable tional projection errors. These limitations hamper distinguishing be-
diagnostic approach for assessing buccal soft tissue and bone thick- tween buccal and lingual cortical plate, complicating assessment of
ness in both periodontal and peri-implant conditions compared to buccal and lingual bone levels overlapping with the respective teeth
CBCT and clinical measurements.81 as well as periodontal bone defects like infrabony lesions (i.e. bone
OCT, using near-infrared light, creates detailed cross-sectional craters) and furcation involvements.17,55,57,103
images with superior resolution by reflecting low-coherence light It can thus be stated that clinical and intraoral radiographical mea-
beams.85 It proves versatile in visualizing critical periodontal struc- surements fail to provide sufficient information on the 3D nature and
tures, detecting subgingival dental calculus, and conducting precise morphology of infrabony defects and furcation involvement, which
morphometric analyses.86–89 Contact-free, it enhances reproduc- are critical for effective and targeted periodontal therapy. Indeed, the
ibility and reliability in periodontal assessments.90 OCT also serves diagnosis of distinct types and degrees of infrabony and furcation de-
as an alternative for implant probing, but limitations include limited fects may have specific prognoses, necessitating varying treatment
tissue penetration, lack of comprehensive 3D imaging, operator de- approaches.104 Unfortunately, especially in the case of upper molars,
pendence, restricted applicability in certain areas, high costs, and diagnosis, treatment planning on 2D images is often linked to chal-
limited clinical trial investigations.91,92 lenges due to root morphology and radiographical overlap with the
maxillary sinus, resulting in anatomical masking.33,105,106
Balancing advantages, limitations, and risks, it is advisable to use
3 | C LI N I C A L D I AG N OS I S O F CBCT for more complex periodontal treatment planning, such as
PE R I O D O NTA L B O N Y D E FEC T S surgical planning of complex defects including furcations. While fur-
ther research, is needed to expand CBCT's applicability in periodon-
3.1 | Periodontal diagnosis tal therapy, it has been shown to allow accurate assessment of bone
craters and furcation involvements, offering valuable insights in
The primary objective of radiographic examination in periodontal periodontal diagnosis, treatment planning, and follow-up.55,103,107,108
diagnosis is to measure clinical attachment loss and/or the level of CBCT is thus shown to allow for a more accurate assessment
alveolar bone relative to the roots. This assessment, as highlighted of periodontal bone defects compared to intraoral radiography103
33,93–96
by several studies not only influences treatment decisions given that 2D techniques have inherent limitations in presenting
but also enables the visualization of subtle bony changes over time. three-dimensional periodontal defects, particularly on buccal and
Figure 7 shows a visual representation of images depicting a patient lingual bone loss.30,100,109 CBCT's superiority lies in its provision of
with periodontal healthy bone tissues. multi-planar reconstructions and 3D information, enabling more ac-
Radiographs therefore provide valuable information on the PLS, curate assessment due to CT technology.
the LD, periapical regions, and other variables such as subgingival To this day, diagnosis of periodontal bone defects in the day-to-
calculus. In situations where the complex topography of alveolar day clinical practice still relies predominantly on intraoral radiogra-
bone loss is involved, complementing clinical tools with other imag- phy. However, being 2D in nature, intraoral radiography may lead
ing modalities often becomes desirable.17,96,97 to underestimation of bone loss due to projection errors12,30,109
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10 JACOBS et al.
F I G U R E 7 Set of images showing: (A) panoramic radiograph of a periodontally healthy patient. (B) illustrates a 3D rendering from
the CBCT of the patient. In contrast, (C) depicts the virtual patient model obtained by AI-driven segmentations of the different oral and
maxillofacial structures. On (D), the bone level of the mandible can be clearly seen on the 3D model of the patient's mandible; and while (E)
shows a peri-apical radiograph of the patient's lower left premolar region, (F) shows an AI-driven 3D model of the same region.
|
JACOBS et al. 11
F I G U R E 8 Set of images showing:

(A) Panoramic radiograph of a
periodontally compromised patient.
(B) 3D rendering from the CBCT image
in frontal and lateral views. (C) Same
angles using patient-specific AI-driven
segmentations of the different oral and
maxillofacial structures. (D) Periapical
radiographs of the upper molar regions,
specifically shown using virtual patient
creation in (E). (F) Periodontal bone level
and defects anatomy on the 3D models
of the patient’s upper and lower jaws.
[Correction added on June 13, 2024,
after first online publication: The Figure
8 legend has been corrected in this
version.]
|
12 JACOBS et al.
or observer errors in identifying reliable anatomical reference for cases where a peri-implant bone defect significantly influences
95,96
points. Assessment of pre-surgical bone levels and post- implant survival rates.97,113
periodontal treatment changes therefore often necessitates 3D
information. Early studies have demonstrated that combining 2D
with 3D imaging enhances pre-operative assessment of periodontal 4 | FU T U R E PE R S PEC TI V E S O N
structures and implant sites. 110
CU T TI N G - E D G E N OV E LTI E S FO R
It is important to keep in mind that while CBCT offers multi- PE R I O D O NTA L D I AG N OS I S
planar reconstructions and 3D information, depicting bone craters
and furcation involvements more effectively than intraoral im- 4.1 | Advantages and challenges of CBCT within
ages, 12,55
lower resolution in CBCT impacts its performance in terms the digital workflow
of contrast, bone quality, and delineation of LD, suggesting that it
currently cannot fully replace intraoral radiography for periodontal The shift from traditional dentistry, which relies on 2D images
assessment. Instead, a combination of both modalities remains the to depict 3D dentomaxillofacial anatomical structures, to digital
gold standard to enhance periodontal bone assessment and aid pre- workflows represents a notable evolution in the field.117 A cru-
surgical treatment planning. cial facet of this transformation resides in the development of
While CBCT demonstrates higher quality in assessing bone patient-specific 3D virtual models generated from CBCT scans.118
craters and furcation involvement, digital intraoral radiography These detailed virtual representations, encompassing anatomi-
55
still excels in terms of contrast, bone quality, and LD delineation. cal structures such as maxillary and mandibular crestal bone and
Nowadays, emerging digital technologies, including AI-based teeth, serve as indispensable tools for clinicians. By facilitating
tools implemented in intraoral radiography software, might offer precise diagnosis and obtaining predictable treatment outcomes,
several functions to assist periodontal diagnosis. Yet, one should these models elevate the standard of dental care. In the fields of
be cautious with clinical interpretation, as these are inherently tied periodontology and implant dentistry, virtual 3D modeling plays
to 2D imaging with inherent limitations in presenting the 3D nature a multifaceted role. It aids clinicians in enhancing the predicta-
of periodontal defects, especially those on the buccal and lingual bility and reliability of presurgical planning, guiding the creation
aspects.30,100,109,111 of surgical guides that ensure precise execution and predictable
treatment outcomes.119 Additionally, these models enable clini-
cians to monitor patient progress post-t reatment by overlaying
3.2 | Peri-implant bone diagnosis 3D models from different time points, allowing for comprehensive
assessment and timely interventions if needed. Moreover, virtual
Accurate detection and classification of bone defects play a crucial 3D modeling facilitates effective communication with patients,
role in dental implant cases, influencing treatment planning and providing visual insights into proposed treatments and fostering
prognosis. 23,71,112 Song et al.113 demonstrated that CBCT has greater greater understanding and collaboration throughout the treat-
reliability and diagnostic accuracy in detecting and classifying peri- ment process.117–119
implant defects compared to intraoral images. While intraoral CBCT image acquisition is a crucial component of the digital
imaging is commonly used for routine dental examinations post- workflow, serving as the initial stage of the entire process.118 With
treatment due to its low dose and cost, it has limitations such as fail- ongoing technological advancements, CBCT devices can offer high-
ure to detect bucco-lingual defects and the risk of underestimating resolution images at a low radiation dose, coupled with the flexibility
bone defects. This advocates for adopting CBCT as a recommended of small field of view options. However, the pursuit of minimizing
alternative in regular post-dental implant treatment examinations radiation exposure, crucial for patient safety, sometimes comes with
and for other bone diseases.12,113 a challenge: the trade-off with image quality, as efforts to decrease
Precise diagnosis on 2D images is limited to horizontal and me- radiation dose can inadvertently increase image noise levels. To ad-
siodistal 1-wall vertical bone defects, while CBCT shows signifi- dress these inherent limitations, adjustments to acquisition param-
cantly enhanced diagnostic accuracy compared to digital periapical eters are recommended to strike a balance between radiation dose
radiography, particularly for identifying fenestration, dehiscence, and image quality. Currently, the market boasts 279 CBCT devices,
and three-walled periodontal, and peri-implant defects.111,114,115 each offering a diverse array of acquisition parameters. Even within
Identification, classification, and accurate measurement of de- the same device, significant variability in these parameters may be
fects are critical parameters impacting the success and/or survival observed.45 Consequently, establishing a standardized protocol
116
rate following implant and/or regenerative periodontal therapy. presents a real challenge, given the variability among CBCT devices.
In comparison to intraoral imaging, CBCT surpasses in diagnostic Among acquisition parameters, the field of view size stands
accuracy and reliability for peri-implant bone defects, providing out as one of the most critical considerations. Ideally, it is recom-
essential information for diagnosis and decision-making that con- mended to use the smallest field of view possible, tailored to the
ventional intraoral imaging cannot achieve. However, the bene- specific region of interest. This limits the area exposed to X-rays,
fit–risk ratio should be considered, and CBCT should be reserved thus minimizing radiation dose exposure to the patient. However, in
|
JACOBS et al. 13
certain cases, a larger field of view may be necessary for integrating Apart from AI-assisted periodontal diagnosis, computational
118
CBCT into the digital workflow effectively. This is because more AI-based image analysis, encompassing machine and deep learning,
data points are needed to accurately perform other steps within the may also support monitoring disease progression, treatment deci-
digital workflow, such as fusion, registration of both hard and soft sions, and treatment outcomes. Thus, AI has the potential to au-
tissue imaging data, and for the precise design and stable placement tomatically identify periodontal pathologies that might otherwise
of surgical guides. go unnoticed.124,127 Yet, rigorous validation studies are required
When selecting the ideal patient-specific field of view, atten- to confirm the effectiveness, generalizability, and safety of these
tion should be paid to voxel size, as it greatly influences both image advancements.
quality and radiation dose. While smaller voxels (i.e. smaller than The updated periodontal classification introduced in 2017 rein-
0.1 mm) increase detail, they also elevate radiation exposure to the forces the significance of considering the radiographic alveolar bone
patient.120 Thus, it is crucial to strike a balance between radiation loss in achieving a thorough periodontal diagnosis. Recent advance-
safety and the level of detail required for precise diagnosis, particu- ments have leveraged AI, particularly convolutional neural networks,
larly in cases involving early periodontal and peri-implant bone de- to automate the detection of periodontal bone loss, classification
fects assessment. Additionally, it is essential to consider the partial of periodontal bone defects, and subsequently stage periodontal
volume effect, where small structures may appear misrepresented disease using periapical and panoramic radiographs.128,129 These AI
or blurred when voxel size exceeds the object's dimensions, poten- models exhibit remarkable precision and efficacy, comparable to cli-
tially compromising diagnostic accuracy.119,121 nician performance, in identifying periodontal bone loss in individual
One persistent challenge in the accurate utilization of CBCT im- teeth and evaluating overall radiographic periodontal health, espe-
ages within the digital workflow is the presence of artifacts, partic- cially with the utilization of panoramic radiographs.128,130 However,
ularly those stemming from high-density materials. These artifacts it is crucial to emphasize that despite the assistance of AI, the inher-
can significantly degrade image quality by introducing hyperdense ent limitations associated with panoramic radiograph assessment for
and hypodense streaks, thereby obscuring anatomical structures periodontal diagnosis remain relevant (e.g. overlapping anatomical
64
near the artifact-generator area. Even with advanced automatic structures, low resolution, and image distortion).131 Furthermore,
segmentation approaches, these artifacts pose a considerable ob- beyond its application in analyzing radiographic imaging data, AI
stacle to achieving accurate segmentation results.122 The repercus- also demonstrates the capability to identify gingival inflammation
sions of inaccurate segmentation extend beyond the initial stage, on intraoral images with accuracy comparable to that of visual ex-
affecting subsequent steps in the digital workflow. For instance, aminations by dentists.124,132 Yet, the synergy between both types
the registration process between CBCT and intra-oral scan data, of imaging data (i.e. intraoral images and radiographic assessments)
as well as the design of surgical guides, can be compromised. Such and the patients' clinical information (e.g. clinical attachment loss
inaccuracies heighten the risk of errors and diminish the preci- and percentage of bleeding upon probing) has the potential to en-
sion of the 3D-printing process, ultimately impacting the overall hance the performance of AI algorithms in diagnosing periodontal
effectiveness. conditions.
Potential solutions for overcoming these limitations lie in the These deep learning algorithms operate by discerning crucial
development of AI networks dedicated to performing accurate seg- tooth features essential for diagnosing periodontal bone loss, includ-
mentations on CBCT images, even in the presence of artifacts.122,123 ing the teeth segmentation, level of periodontal bone, position of the
Advanced AI algorithms have shown promise in effectively mitigat- CEJ, and orientation of the tooth's long axis.131,133 Alternatively, they
ing the impact of artifacts, thus enhancing the precision and reli- conduct intricate feature extraction directly from radiographic im-
ability of segmentation results of surgical planning and treatment ages. However, both approaches encounter limitations that impact
outcomes. the performance of AI models. Methods reliant on human labeling
are inherently susceptible to human subjectivity, and the accuracy
of labeling depends on the expertise of the annotators (i.e. human
4.2 | Artificial intelligence for radiographic intelligence), as the AI learns from their inputs. Conversely, the au-
diagnosis of periodontal diseases tomated feature extraction process faces challenges in precisely de-
termining which features were included as input for the AI model,
For 2D imaging modalities, the introduction of AI has been sug- as this process is automated. Therefore, it is highly recommended to
gested as a supportive tool for clinicians in diagnosing periodonti- integrate both approaches with clinical information to develop ro-
tis and automatically identifying peri-implant tissue and marginal bust AI algorithms for detecting periodontal bone loss and staging
bone remodeling.124 Despite the advantages, such as minimizing periodontal disease. This fusion of methods enhances the reliability
human error, aiding in diagnosis, and streamlining data analysis and and accuracy of AI models in periodontal diagnosis, ultimately bene-
task execution, its implementation is not without challenges.125 It fiting patient care and treatment planning.
is essential to standardize methodologies and reporting to facilitate These systems possess the capability to recognize subtle al-
meaningful comparisons among different algorithms, which has terations in bone density and evaluate the degree of alveolar bone
been disregarded majorly in prior studies.125,126 loss, all of which serve as crucial indicators of periodontal disease
|
14 JACOBS et al.
advancement. Furthermore, diagnostic tools driven by AI hold the with larger sample sizes and external validity are required before
potential to support clinicians in making well-informed treatment clinical implementation. To enhance the generalizability of AI, it is
decisions by furnishing objective and quantitative evaluations of advisable to incorporate data sets that exhibit variability in CBCT im-
periodontal health. Through the utilization of AI, dental profession- aging quality and scanning parameters. Additionally, future research
als can refine the accuracy and efficiency of periodontal disease should focus on the development of an AI-based accurate system
diagnosis, thereby leading to enhanced patient outcomes and the for multimodal registration and fusion. This proposed systems and
implementation of more personalized treatment approaches. prospective research should not solely rely on pristine dentition or
Apart from periodontal diagnosis, AI is anticipated to improve high-quality images, but rather, it should be capable of fusing partial
surgical decision-making before, during, and after a periodontal and completely edentulous images that might also exhibit scattering
surgical procedure by integrating information from radiological and due to fillings, orthodontic appliances, and/or motion artifacts.
126,127
clinical data sources. Indeed, integrating other data types, such
as patient history, genetic information, and lifestyle factors, could
offer a more comprehensive view of a patient's periodontal health, 5 | CO N C LU S I O N S
125–127
disease progression, and treatment needs. Such hybrid data
AI strategies involving radiographs can be denoted as radiomics.126 • Digital intraoral radiographs remain the preferred choice for peri-
One novel example of multimodal automation for periodontal odontal disease assessment, providing high image resolution with
diagnosis and treatment planning would be the use of AI-assisted minimal radiation exposure.
segmentation and registration of CBCT and intra-oral scanning for • While CBCT is offering multiplanar reconstructions and 3D infor-
periodontal diagnosis and follow-up. It can indeed assist profession- mation, its lower resolution might impact contrast, bone quality
als in obtaining an accurate 3D image in a reduced period of time assessment, and lamina dura delineation.
and is being employed in a clinical setting for virtually assessing peri- • CBCT should be reserved for cases where a comprehensive eval-
odontal tissue. However, the future of AI-based ionized and nonion- uation of periodontal conditions significantly impacts treatment
ized image fusion in periodontology, particularly in the context of decisions.
segmented CBCT and intraoral scans, is still evolving, and its full po- • CBCT is valuable for complex periodontal treatment planning, ex-
tential in this domain is yet to be realized.134–137 The AI-based fusion celling in bone crater and furcation involvement assessment. In
has already been proven to provide clear and accurate structural in- such cases, CBCT may be preferred to assess the need for surgical
formation of periodontal tissue (Figure 9). However, future studies intervention or tooth removal.
• Also, CBCT acquired for dental implant placement or therapy-
resistant endodontic conditions, may be concomitantly used for
periodontal diagnosis.
• Ultimately, an optimal periodontal diagnosis might be obtained from
available 2D and CBCT imaging assessment and clinical probing.
• Nonionizing imaging modalities, such as intra-oral scanning,
should still prove their clinical viability for periodontal diagnosis
and monitoring treatment. Further validation studies are neces-
sary to establish their use in clinical practice.
• AI holds promise for improving radiographic diagnosis in peri-
odontal conditions, representing a future perspective for en-
hanced accuracy and time-efficiency of periodontal diagnosis and
assessment of the periodontal treatment needs.
C O N FL I C T O F I N T E R E S T S TAT E M E N T
The authors declare that there are no conflicts of interest regarding
the current review.
DATA AVA I L A B I L I T Y S TAT E M E N T

This article does not involve the creation or analysis of new data;
therefore, data sharing is not applicable.
ORCID
F I G U R E 9 AI-based registration (Relu, Leuven, Belgium) of a
3D-segmented jawbone showing the intimate relation between Reinhilde Jacobs https://orcid.org/0000-0002-3461-0363
periodontal bone tissue and gingival tissues (with courtesy of Drs Rocharles Cavalcante Fontenele https://orcid.
Bahaa Elgarba). org/0000-0002-6426-9768
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JACOBS et al. 15
17. Vandenberghe B, Corpas L, Bosmans H, Yang J, Jacobs R. A

Pierre Lahoud https://orcid.org/0000-0001-5555-2185 comprehensive in vitro study of image accuracy and quality for
Sohaib Shujaat https://orcid.org/0000-0002-6250-2650 periodontal diagnosis. Part 1: the influence of X-ray genera-
Michael M. Bornstein https://orcid.org/0000-0002-7773-8957 tor on periodontal measurements using conventional and digi-
tal receptors. Clin Oral Investig. 2011;15:537-549. doi:10.1007/
s00784-010-0 416-8
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1

Facultad Piloto de Odontología

Tema: Evaluación radiográfica periodontal: Técnicas

Sexto Semestre- Paralelo #2

Molina Cevallos Lilia Gabriela

Dra. Pilar Pantoja R.

12 de julio del 2024

Generar, difundir y preservar conocimientos científicos, tecnológicos, humanísticos y

Ser una Universidad reconocida nacional e internacionalmente por su calidad académica,

de emprendimiento, producción científica y tecnológica, con enfoque de responsabilidad social

Facultad Piloto de Odontología.

La facultad piloto de odontología en la universidad de Guayaquil, es un centro de

La facultad de odontología de la universidad de Guayaquil, será la institución líder en la

EVALUACIÓN RADIOGRÁFICA PERIODONTAL: TÉCNICAS INTRAORALES

La enfermedad periodontal es una alteración que provocará un daño fundamental a nivel

Las radiografías intraorales, incluidas las radiografías periapicales y de aleta de mordida,

diversas modalidades de imágenes radiográficas. (Jacobs et al., 2024)

Características radiográficas del periodonto sano

1. El proceso alveolar Esta estructura se encuentra en ambos maxilares y está constituida

en una correcta posición.

2. La lamina dura, que representa al espesor de la pared alveolar y al examen

en proximidad al ligamento periodontal.

periodontal. (Ortiz Vásquez & Flores Arcani, 2013)

Interpretación radiológica de la enfermedad periodontal

altura de la cresta ósea, donde se puede mencionar tres aspectos fundamentales:

producirse en dos direcciones, horizontal y vertical.

vertical, en esta clasificación la altura ósea disminuye en sentido transversal y el margen de la

estructura ósea permanece un tanto perpendicular a la superficie de la estructura dentaria.

La pérdida ósea puede presentarse en diferentes regiones de la cavidad bucal ya sea en el

vea exclusivamente en un sectante en particular se la considerara localizada.

Se clasifica según el nivel de agresión que ha sufrido el periodoncio en:

 Moderada: Donde la pérdida ósea es del 30 al 50% y se extiende hasta llegar al

tercio medio radicular.

paralelaje y la técnica interproximal.

ósea. (Jacobs et al., 2024)

 Permite al clínico identificar factores predisponentes locales a las enfermedades

periodontales, como depósitos de sarro subgingival, anomalías en la morfología

radicular y restauraciones dentales salientes. (Jacobs et al., 2024)

 Permite establecer la continuidad del espacio periodontal.

 Establecer la longitud radicular (relación corono radicular) o determinar el grado de

rizálisis que ha sufrido la pieza dentaria debido a la afección que presenta.

con la enfermedad periodontal ya que existe una comunicación de importancia con

esta cavidad puede desencadenarse problemas severos como infecciones e inclusive

En la técnica de bisectriz, el haz de rayos X no siempre es perpendicular al receptor de

un ángulo de 90 grados con respecto a la bisectriz imaginaria formada entre el objeto a

la distancia empleada, el tiempo de exposición deberá aumentarse 4. Cabe destacar que la

utilización de películas de alta velocidad como F o G, puede minimizarse esta proporción. La

enfermedad periodontal. (Vázquez Diego et al., 2009)

Para asegurar esta relación espacial geométrica precisa, el uso de soportes de

posicionamiento juega un papel crucial en la evaluación radiográfica periodontal a través de

radiografías periapicales y de aleta de mordida. Estos soportes ofrecen consistencia y

estandarización en la obtención de imágenes de rayos X, lo que reduce la necesidad de

repeticiones. (Jacobs et al., 2024)

longitudinales de ambos dientes y el hueso circundante. Su uso es respaldado en pacientes con

bolsas periodontales generalizadas de <5 mm de profundidad.

Cuando los pacientes presentan bolsas que superan constantemente los 5 mm o

profundidades de bolsa irregulares, las radiografías de aleta de mordida convencionales pueden

considerar las radiografías de aleta de mordida verticales complementadas con radiografías

orientar en dirección vertical después de reorientarlo 90°. Esto garantiza el mantenimiento de la

Periodontology 2000. 2024;00:1–19. wileyonlinelibrary.com/journal/prd | 1

1 | I NTRO D U C TI O N modalities. Firstly, these methods yield two-dimensional renderings