Advanced technology for effective periodontal planning – Pete Higson
Featured Products Promotional FeaturesPosted by: Dental Design 2nd February 2018
In all four corners of the world periodontal disease continues to remain a leading concern for dental health professionals, with about 20-50% of the global population known to be affected.[i] This makes it not only one of the most common oral conditions, but one of the most prevalent diseases of mankind.
Lack of patient awareness and ongoing problems with access to care have, of course, played a significant role in the continued pervasiveness of the issue, as have a range of modifiable risk factors such as smoking, diabetes, stress, medication use, poor diet, alcohol and obesity. Advances are being made in this area and there can be no doubt that with sustained hard work, determination and time, the profession can help to minimise overall prevalence and/or the severity of the condition. As for non-modifiable factors such as genetics, adolescence, pregnancy and age there is naturally less that can be done to protect patients from suffering at the proverbial hands of periodontal disease, but as our understanding of the disease progresses, treatment is sure to become even more efficient.
In the meantime, the profession must continue to implement efficient diagnostic and treatment pathways in line with recommended practices and current research. The initial visual examination remains a vital element of periodontal diagnostics, though a study suggests that this initial inspection can occasionally be overlooked or inadequately performed. Indeed, according to a paper published in the British Dental Journal,[ii] only with sufficient illumination and the use of suction, (which is more effective than blowing compressed air) can one hope to visually determine if the marginal gingiva looks healthy. Furthermore, with an efficient enough inspection, clinicians can establish the extent of plaque, supragingival calculus, subgingival calculus and identify any gingival recession.
The Basic Periodontal Examination (BPE) is the next step recommended by the British Society of Periodontology, and is an effective screening tool for establishing both the level of examination needed and treatment pathway that is likely to be required. As for the use of radiographs, sources validate their use as an integral component of a thorough periodontal assessment, when a BPE Code 3, 4 or * is identified.
When used to assess the morphology of the teeth as well as the pattern and degree of alveolar bone loss, radiographs also have a role in treatment planning and the monitoring of the long-term stability of periodontal health. Indeed, there is no hard and fast rule when it comes to tracking the aggressiveness of the disease, as the progression pathway varies from patient to patient, so radiographs are a really useful way of tracking changes in bone levels accurately and predictably.
The million dollar question is, which type of radiograph is best for the diagnosis and treatment planning of periodontal disease? Views on this matter have changed somewhat over the years with a pragmatic shift away from traditional intra-oral periapical radiographs – which historically were considered to be the ‘gold standard’ for periodontal assessment – to either panoramic radiography or cone beam computed tomography (CBCT).
Panoramic radiographs have shown sufficient diagnostic accuracy in periodontal disease and provide the ability to detect more periodontal bone loss than periapical radiographs.[iii] The process is also more efficient and less intrusive than intra-oral imaging making the overall experience much more comfortable for the patient. This is always a bonus, but for children and individuals that have a fear of the dentist, the switch from intraoral radiography to panoramic imaging could actually make a world of difference to patient care.
CBCT imaging too has displayed superior results in the evaluation of infrabony defect morphology and prognosis of periodontal disease compared to conventional intraoral radiography,[iv] thanks to its high sensitivity and diagnostic accuracy.[v] Though, of course, radiation is significantly higher than panoramic radiography so it goes without saying that the benefits of a CBCT must outweigh the risks of increased exposure.
As both have been shown to be advantageous in the diagnosis and treatment planning of periodontal disease, it makes it very difficult to choose between the two. With the MyRay Hyperion X9 from RPA Dental, however, you don’t have to, thanks to the three-in-one technology of cone beam computed tomography, panoramic X-ray and cephalometric projections available; it’s the ideal all in one solution.
Periodontal disease remains a problem for a great many patients, but with effective multifunctional digital imaging equipment you should be able to diagnose and plan their short- and long-term treatment efficiently and to an exceptionally high standard.
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[i] Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci (Qassim) 2017 Apr-Jun; 11(2): 72-80. Accessed online 12 September 2017 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426403/
[ii] Corbet EF. Oral diagnosis and treatment planning: part 3. Periodontal disease and assessment of risk. British Dental Journal. 2012 Aug; 213: 111-121. Accessed online 12 September 2017 at https://www.nature.com/bdj/journal/v213/n3/full/sj.bdj.2012.666.html
[iii] Choi JW. Assessment of panoramic radiography as a national oral examination tool: review of the literature. Imaging Sci Dent. 2011 Mar; 41(1): 1-6. Accessed online 12 September 2017 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3174459/
[iv] Suphanantachat S, Tantikul K, Tamsailom S, Kosalagood P, Nisapakultorn K, Tavedhikul K. Comparison of clinical values between cone beam computed tomography and conventional intraoral radiography in periodontal and infrabony defect assessment. Journal of Head and Neck Imaging. 2017 March; 46 (6). Accessed online 12 September 2017 at http://www.birpublications.org/doi/abs/10.1259/dmfr.20160461
[v] Bagis N, Kolsuz ME, Kursun S, Orhan K. Comparison of intraoral radiography and cone-beam computed tomography for the detection of periodontal defects: an in vitro study. BMC Oral Health. 2015 May; 15: 64. Accessed online 1 September 2017 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446848/
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