Hirschmann P N
Int Dent J. 1987 Mar;37(1):3-9.
There has recently been a substantial change in our concept of periodontal disease and particular attention is now focused on that small proportion of the population who appear susceptible to its more aggressive forms rather than the majority in whom bone loss progresses very slowly. It is also apparent that the presently available clinical parameters are of little value in predicting future destructive activity. Under these circumstances, the aim of this paper is to review the contribution of radiography to the diagnosis of chronic periodontitis as traditionally perceived and then reassess its status in the light of these newer concepts. Panoramic radiography, followed by the appropriate periapical radiographs (taken with the paralleling technique), is proposed as an alternative to complete mouth intra-oral surveys on grounds of both diagnostic yield and radiation thrift. The five areas to which radiography, despite its limitations, can make a significant contribution are in the assessment of bone loss, mobility, occlusal trauma, calculus and marginal overhangs and crown-root ratio. The validity of the three criteria that have been proposed for the radiographic assessment of early periodontitis, loss of crestal bone height, marginal widening of the periodontal ligament and crestal irregularity, is evaluated in detail and it is concluded that only the first is of any diagnostic worth, providing at least two sequential radiographs are available. While there is an urgent need to develop techniques of greater sensitivity for the early identification of periodontal bone loss, there must be some doubt as to the value of any bone imaging technique in predicting the susceptible patient. Follow-up radiography should be limited to these sites showing clinical evidence of further disease activity.
最近，我们对牙周病的概念有了重大改变，现在特别关注的是一小部分似乎易患侵袭性更强形式牙周病的人群，而非大多数骨质流失进展非常缓慢的人群。目前可用的临床参数在预测未来破坏活动方面价值不大，这一点也很明显。在这种情况下，本文旨在回顾传统观念中放射成像对慢性牙周炎诊断的贡献，然后根据这些新观念重新评估其地位。基于诊断效果和辐射剂量节省两方面原因，建议采用全景放射成像，随后拍摄适当的根尖片（采用平行投照技术），以此替代全口口腔内检查。尽管存在局限性，但放射成像能在五个方面做出重要贡献，即评估骨质流失、牙齿松动、咬合创伤、牙石和边缘悬突以及冠根比。详细评估了为早期牙周炎的放射成像评估所提出的三个标准（牙槽嵴顶骨高度丧失、牙周膜边缘增宽和牙槽嵴顶不规则）的有效性，得出的结论是，只有第一个标准具有任何诊断价值，前提是至少有两张连续的放射片。虽然迫切需要开发更敏感的技术以早期识别牙周骨质流失，但对于任何骨成像技术在预测易感患者方面的价值一定存在疑问。随访放射成像应仅限于那些有进一步疾病活动临床证据的部位。
