PMC4141417_01
Photo of the (a) Dental X-ray machine (Planemeca, Finland, 70 Kv, 8 mA), and (b) a charged coupling device (Kodak, RVG5100, size 35 x 15 mm).
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F1
27-yearold male patient with 2-year history of loosening of teeth diagnosed with generalized aggressive periodontitis (GAP).(a) 3D Panoramic volumetric reconstructive CBCT image of maxillary arch and (b)3D Panoramic volumetric reconstructive CBCT image of mandibular arch reveal the severity of alveolar bone destruction and loss of alveolar bone from cemento-enamel junction till its base mainly in the molar and premolar region of both the arches. The red line depicts the passage of inferior alveolar nerve in the mandibular arch.
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F2
Panoramic volumetric reconstructive CBCT image of maxillary and mandibular jaws [Figure 2a and b] and volumetric rendering (VR) images of maxillary and mandibular teeth [Figures 3 and 4] were procured.
27-year old male patient with 2-year history of loosening of teeth diagnosed with generalized aggressive periodontitis (GAP). 3D Volumetric reconstructive CBCT images of the different sections of maxillary arch, a, b and c (top) are labial and buccal view and d, e, and f (bottom) are palatal views. (a) Right posterior region of the jaw reveals advance periodontal bone destruction tillapical root regions in relation to maxillary first molar (tooth 16) (Black arrow) and middle third of the root of the premolars (teeth 14, 15) and canine (tooth 13) (White arrows). (b) Anterior region shows bone destruction around incisors (arrow). (c) Left posterior jaw region shows alveolar bone destruction till the apical third of the first molar (tooth 26) (black arrow), premolars (teeth 24, 25) and canine (tooth 23) (white arrow) with the involvement of the buccal cortical plate. (d, e and f) Palatal view show same areas of osseous defects in Generalized Aggressive Periodontitis with severe bone destruction seen in the maxillary arch (arrows).
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F3
Panoramic volumetric reconstructive CBCT image of maxillary and mandibular jaws [Figure 2a and b] and volumetric rendering (VR) images of maxillary and mandibular teeth [Figures 3 and 4] were procured.
27-year old male patient with 2-year history of loosening of teeth diagnosed with generalized aggressive periodontitis (GAP). 3D Volumetric reconstructive CBCT images of different sections of mandibular arch of the a, b and c (top) are buccal and labial view and d, e, and f (bottom) are lingual views. (a) Right posterior jaw shows arc shaped bone loss (arrow) in relation to first molar extending from second premolar to second molar. (b) Anterior region shows severe bone destruction till the apical third of all the central and lateral incisors (arrow) including canines. (c) Left posterior jaw region shows bone destruction in relation to first molar (only the root stumps are seen as shown with arrows) and around premolars. (white arrow) (d, e, and f) Lingual view images show same areas of severity of osseous defects in Generalized Aggressive Periodontitis.
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F4
Panoramic volumetric reconstructive CBCT image of maxillary and mandibular jaws [Figure 2a and b] and volumetric rendering (VR) images of maxillary and mandibular teeth [Figures 3 and 4] were procured.
27-year old male patient with 2-year history of loosening of teeth diagnosed with generalized aggressive periodontitis. Photo of the teeth during flap surgery reveals osseous defect around mandibular first molar. Measurement of defect in furcation area done with UNC 15 periodontal probe from cementoenamel junction till the base of the defect (arrows).
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F5
Measurements of the osseous defects were carried out with UNC15 probe taking CEJ (cemento-enamel junction) as a reference point and measuring till the base of the defect [Figure 5].
27-year old male patient with 2-year history of loosening of teeth diagnosed with generalized aggressive periodontitis.3D volumetric rendered images (a, b, c, d), (i) and (k) in the areas of the both maxillary and mandibular arch as shown in Figures 3 and 4 compared with 2D digital Periapical Radiographs (e, f, g, h) and (j and l) show underestimation of the amount of bone loss in digital radiographs due to projection errors and also due to lack of 3D information that help in distinguishing the buccal and the lingual cortical plates (arrows).
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F6
Measurements of periodontal defects after surgical exposure when compared with measurements taken on the CBCT images showed 100% accuracy in the morphological description of periodontal bone crater, furcation involvements, and 3-walled osseous defects [Figures 6 and 7].
27-year old male patient with 2-year history of loosening of teeth diagnosed with generalized aggressive periodontitis (GAP). (a) Direct digital radiograph of the mandibular first olar (tooth 46) shows the osseous defect, (b) 3D volumetric rendering of the same tooth shows the osseous defect, (c) CBCT sagittal view of right mandibular first molar shows measurement of bone loss done by the CBCT software, and (d) Photo of the same tooth (tooth 46) during intraoral procedure for measuring bone destruction in furcation area using UNC 15 probe reveals the measurement to be exactly same as the measurement obtained in CBCT image c.
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F7
Measurements of periodontal defects after surgical exposure when compared with measurements taken on the CBCT images showed 100% accuracy in the morphological description of periodontal bone crater, furcation involvements, and 3-walled osseous defects [Figures 6 and 7].