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Not only does this book show how to do periodontal procedures, it describes how to best manage the outcomes and explains the evidence supporting each treatment. Written by leading experts Michael Newman, Henry Takei, Perry Klokkevold, and Fermin Carranza, along with a pool of international contributors, this edition also discusses the close connection between oral health and systemic disease.
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Inappropriate horizontal angulation results in tooth overlap, changes the shape of the interdental bone image, alters the radiographic width of the PDL space and the appearance of the lamina dura, and may distort the extent of furcation involvement see Figure Periapical radiographs frequently do not reveal the correct relationship between the alveolar bone and the CEJ.
This is particularly true in cases in which a shallow palate or floor of the mouth does not allow ideal placement of the periapical film. Bite-wing projec- Figure Crest of interdental bone normally parallel to a line drawn between the cementoenamel junction of adjacent teeth arrow. Note also the radiopaque lamina dura around the roots and interdental bone.
For bite-wing radiographs, the film is placed behind the crowns of the upper and lower teeth parallel to the long axis of the teeth. The x-ray beam is directed through the contact areas of the teeth and perpendicular to the film. If the periodontal bone loss is severe and the bone level cannot be visualized on regular bite-wing radiographs, films can be placed vertically to cover a larger area of the jaws Figure More than two vertical bite-wing films might be necessary to cover all the interproximal spaces of the area of interest.
Radiographs are an indirect method for determining the amount of bone loss in periodontal disease; they image the amount of remaining bone rather than the amount lost.