Radio unit 2 pt 2

robbypowell's version from 2015-04-24 03:40

periodontal disease

Question Answer
What is D0180comprehensive periodontal exam
What are 4 qualities of a good diagnostic radiographsGood exposure and contrast, Proper placement, Open inter proximal contacts, Minimal foreshortening
What types of radiographs are used in periodonticsPeriapicals & BW's (NOT PAN)
What radiograph technique is normally used in periodonticsParalleling technique
Why does foreshortening occur?Poor paralleling technique, Occlusal aspect too close to teeth
Where is the location of the rinn which would indicate foreshortening?If RINN is ABOVE ZYGOMA
Where can the patient bite on a biteblock in the anterior to prevent foreshortening?near the edge, so that the film is further back in mouth
Two most common places for foreshortening error?Maxillary posterior & Maxillary anterior
What is hard about canine exposures? How can we make up for this?DISTAL CONTACT (difficult to capture as open), compensate with PREMOLAR PA
Why would you need vertical bitewings?EXCESSIVE BONE LOSS
How many vertical bitewings would you need to image the full mouth?7 instead of 4
Why does bone loss occurInflammatory response to chronic infection around tooth
When is bone loss reversible?Bone MINERAL loss (reversible)
When is bone loss Irreversible?Bone COLLAGEN loss (irreversible)
What does the bone loss look like in early periodontal disease?IMPOSSIBLE TO DETECT
What does a fuzzy crestal bone indicate?MINERAL LOSS (first sign of bone loss)
Why is loss of lamina dura so controversial?b/c it could just be radiographic artifact
What is the most important aspect of a radiograph we evaluate in periodontics?BONE HEIGHT
What does an alveolar crest to CEJ distance of less than 2mm indicate?no bone loss
Why can’t radiographs depict osseous defects?DEFECTS are 3D... so superimposition is problem
How are osseous defects classified?Number of remaining bone walls
What is worse, a 3 wall defect or 1 wall defect1 wall
Where does bone loss begin? Why?INTERPROXIMALLY (site for food and plaque accumulation)
Why is it hard to see a 3 wall defect?Superimposition of cortical plates
What osseous defect may appear to be horizontal bone loss?2 WALL
What osseous defect is associated with tooth mobility?Circumferential Defect OR Moat
Horizontal bone loss is a ___ wall defectZERO WALL
What is the prognosis of a tooth with Less than 25% of bone loss?GOOD
What is the prognosis of a tooth with 25-50% of bone loss?FAIR
What is the prognosis of a tooth with 50-75% of bone loss?POOR
What is the prognosis of a tooth with 75% of bone loss?HOPELESS
What is the difference between horizontal and vertical bone loss?CEJ is parallel to crestal bone in HORIZONTAL, it's not in VERTICAL
How many furcations are present on maxillary molars? Mandibular?3 max, 1 man
How does one diagnose a furcation invasion?PROBING (not radiographs, usually can't be seen)
What is a furcation arrow?TRIANGULAR SHADOW OVER ROOTS of max molars
What is a good crown to root ratio? What crown to root ratio has a poor prognosis?1:2 is good; 1:1 is bad
What causes a widened PDL space? What results from it?Occlusal trauma (cause) Mobility (result)
When is calculus visible on a radiograph?When it is heavily mineralized (and has been there a long time)
What are 4 secondary etiologies for periodontitis?Calculus, Overhangs, Caries, Open Contact
What should you do if endodontic therapy does not resolve a periapical lesion?Endo needs to be redone
What is a combined lesion?Endodontic & Periodontal lesion
What indicates this is the cause?Isolated Deep pocket w/ no plaque accumulation, no bone loss, & a NONVITAL PULP
What if the cause of combined lesion is periodontal; what normally happens then?Tooth needs extraction
Why are tori annoying?Interfere w/ radiographic interpretation & Make oral hygiene more difficult
What is a fenestration and dehiscence? Why can’t we see these on radiographs?these are both cortical plate defects overlying teeth, and so cannot be seen on radiograph
How much bone mineral and height loss must there be to be seen on radiographs?1.5-3mm
Why is it hard to differentiate between treated and untreated periodontitis using radiographs?radiographs just show bone loss... not whether active or inactive
What must be done to properly evaluate the success of treatment?Standardized radiographs
Why is it hard to evaluate if a bone graft was successful with radiographs?graft and remodeled bone look the same

periapical disease

Question Answer
What causes inflammatory periodical pathology?Pulp infection/necrosis
What are two radiographic signs of inflammatory periapical pathology?Discontinuity of LAMINA DURA & Widening of PDL space
What is the lamina dura?Cortical bone around tooth socket
When might the lamina dura be invisible despite being anatomically present?If it is thin (e.g. mandibular first premolars)
What is the peripheral egg shell effect?lamina dura only seen at periphery
What should you evaluate next if the lamina durra is not continuous before making a diagnosis of inflammatory periodical pathology?widening of PDL space
How should the PDL space present radiographically?radiolucency between tooth and Lamina Dura, continuous around tooth
Why might the PDL space expand other than pulpal necrosis?Orthodontic treatment, erupting teeth, occlusal trauma & superimposition of anatomical structures
How can one differentiate superimpositions of anatomical structures with actual PDL expansions or periodical lesions?SLOB technique
Where do immature teeth have wider PDL spaces?apically
How can you differentiate immature teeth from mature teeth?PULP CHAMBER, uniform width down root is IMMATURE, tapering apically MATURE
What is the best kind of radiograph for evaluating periapical pathology? Why?BITEWING, less likely to have VERTICAL ANGULATION ERROR
When does inflammatory periapical pathology become visible? Why?When cortical plate is partially demineralized
Why do overexposed radiographs prevent accurate diagnosis of periodical pathologybecause they appear normal even with periodical radiolucency
What are the clinical symptoms of acute apical periodontitis? How is this different than chronic apical periodontitis?PAINFUL, chronic is not... also... ACUTE appears normal on radiograph (chronic is clear on radiograph)
What does a positive percussion test mean for acute apical periodontitis? Negative?+, infection is past PDL; neg, infection is not past PDL
What other conditions may cause symptoms similar to acute apical periodontitis?Acute Apical ABSCESS
Why do radiographs for acute apical abscesses and periodontitis appear normal?infection has not had time to erode cortical bone
What is the difference in the clinical presentation of acute apical abscesses and periodontitis?NON-VITAL in abscess and with Purulent Exudate (pus)
What is the treatment of acute and chronic apical periodontitis?Root canal or Extraction
What is the radiographic presentation of chronic apical periodontitis?Radiolucency periapically
What is acute exacerbation of chronic apical periodontitis?when infection becomes very aggressive, causing pain
What are the four forms of chronic apical periodontitis? Which three are hard to differentiate? Which one is most common?Granuloma (most common), Chronic Apical Abscess (with and w/o sinus), Radicular Cyst
How might an apical granuloma appear on the lateral surface of a tooth?when infection exits via LATERAL ACCESSORY CANAL
What are the two types of chronic apical abscesses?WITH and WITHOUT SINUS
What is a parulis? What form of chronic apical periodontitis is it associated with?Chronic Apical Abscess with SINUS (opening into another space)
How does one track a sinus back to the chronic apical abscess it is coming from?GUTTA PERCHA
What is the difference radiographically between a chronic apical abscess and apical granuloma?DEFINITE borders granuloma, INDEFINITE IRREGULAR BORDERS for ABSCESS
Where do chronic apical abscesses from in primary molarsin furcation
What is the difference between a radicular cyst and apical granuloma in terms of formation and symptoms?Radicular cyst epithelial response, Granuloma immune response. RADICULAR --> RESORPTION
What is the most common cyst in the jaws? Where is it most common? Where would it occur most often on the maxilla? Mandible?RADICULAR; Anterior maxilla & posterior mandible
What is condensing/sclerosing osteitis? How is it different radiographically than other forms of chronic apical periodontitis?
What is a bone scarSCLEROSING OSTEITIS
What are the other periapical pathologies not associated with pulpal infection? Which ones don’t need treatment
Question Answer
What is a residual cyst? Why do they need to be removed?Resorption and Cancer-risk

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