Often dental radiographs will not reveal the extent of periodontal involvement even those that are taken at a correct right angle to the teeth.
Here’s an example of a gentleman who’s been maintained in the practice for a number of years. His history was somewhat of a refractory-type periodontal condition where despite good oral hygiene, he would develop isolated defects due primarily to an uncontrolled subgingival biofilm. These patients have to be maintained and insidiously probed carefully since radiographs don’t always reveal the extent of the disease.
The first radiograph reveals the area prior to the surgical procedure. I was probing deeply but the x-rays did not reveal any significant bone loss except for perhaps the mesial of Tooth #5.
The following photograph shows a very good view of the defect between #5 and #6 as well as subgingival calculus. Some of the stain on the teeth is due to Chlorhexidine. His supragingival plaque control was excellent but you could still have subgingival slight like calculus which had not been removed. Obviously access to these defects is limited. If you look at the defect of #5 mesially, you can see the root fluting which makes careful debridement impossible. Subsequently, these areas were treated with bone grafts.
As always, your input is appreciated and valued.
Victor Sternberg, D.M.D.
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