Utility of radiographic crestal lamina dura for predicting periodontitis disease‐activity

Abstract

The relationship between radiographic crestal lamina dura and periodontitis disease-activity was studied longitudinally in 51 treated adult patients on a systematic 3-month maintenance program. The presence or absence of crestal lamina dura at 1809 interproximal sites was scored from periapical and bitewing radiographs taken at baseline of a 36-month maintenance care period. Semi-annual clinical evaluations by 2 independent examiners were carried out on each patient, with disease recurrence defined as sites revealing a > or = 3 mm increase in probing depth from baseline, or a > or = 2 mm increase in probing depth together with a > or = 2 mm loss of relative attachment level from an occlusal reference stent. Over the 36-month study period, 23 (45%) patients exhibited disease recurrence at 55 (3%) interproximal tooth sites scored for baseline crestal lamina dura. Absence of detectable baseline crestal lamina dura yielded high sensitivity (87-100%), but low specificity (17%) and low positive predictive values (0.8-3.2%), for localized periodontitis recurrence. In contrast, no sites exhibiting an intact baseline crestal lamina dura demonstrated periodontitis recurrence up to 24 months from baseline (100% positive predictive values). Presence of radiographic crestal lamina dura was positively associated with clinical periodontal stability (summary odds ratio for sites = 2.6, P = 0.0004), and negatively associated with periodontitis recurrence (summary odds ratio for sites = 0.4, P = 0.0004), for the 36-month study period. Evaluation of radiographic crestal lamina dura status appears valuable for assessing the risk of periodontitis disease-activity at inter-proximal tooth sites in patients on maintenance care programs.

Aggregatibacter actinomycetemcomitansand Its Relationship to Initiation of Localized Aggressive Periodontitis: Longitudinal Cohort Study of Initially Healthy Adolescents

“…It is thought that periodontal disease is initiated by extension of supragingival plaque to the subgingival space, forcing the margin of the junctional epithelium to migrate in an apical direction to form a periodontal "pocket" (42). Our rationale for using pocket depth end points as a sign of disease initiation was based on the well-recognized concept that pocket depth can proceed to more advanced attachment loss, which can then lead to bone loss (19,39). Thus, in students who were healthy at baseline, the assumption was made that finding two or more pockets of 5 mm or greater at a subsequent examination is indicative of the possible initiation of periodontal disease.…”

“…Because of the rapidly progressive nature of LAP and our desire to detect disease as early as possible, we used Loe and Brown's definition of incipient disease in the cross-sectional phase of the study for comparison to the NIDCR epidemiological database (32). As such, for the LoeBrown criteria, we referred any students with attachment loss of Ͼ2 mm at a molar plus an incisor and/or one other tooth for radiographs to assess alveolar bone levels in order to confirm or reject a diagnosis of LAP (39).…”

Concordancia entre nivel de inserción clínico y examen radiográfico para diagnóstico de periodontitis crónica

“…Estos hallazgos fueron similares a los encontrados por Greenstein (24) quien reportó que la presencia de la lámina dura no parece tener relación con la presencia de inflamación clínica, sangrado después del sondaje y bolsas periodontales. En este sentido, este concepto es relevante desde la clínica, debido a que la presencia de la lámina dura en las imágenes radiográficas, se utiliza como un indicador de salud periodontal, el cual debe ser corroborado con la utilización sistematizada del examen clínico; uso de sonda periodontal calibrada, para establecer un diagnóstico adecuado desde lo periodontal y clínico (12,16,23).…”

“…Desde el momento en el que se desarrollaron las investigaciones clásicas de Akesson (13,14) y Persson (15) para la estimación de la enfermedad periodontal, se han observado cambios en las tecnologías para la obtención de las imá-genes; tanto en radiografías como en tomografías computarizadas, este avance ha brindado la oportunidad de crear nuevos esquemas investigativos, donde se verifique el conocimiento científico que ha sido utilizado como verdad durante todos estos años, lo cual necesita ser contrastado o comparado en presencia de la tecnología actual. Con respecto al hueso alveolar y a la lámina dura, si no se realiza un tratamiento de esta alteración, el progreso natural puede producir con el tiempo disminución de estos soportes del órgano dental, evidencián-dose otras características tanto clínicas como radiográficas (16). En este sentido, con la evaluación de la presencia y estado de la lámina dura parece evaluarse el riesgo de la actividad de periodontitis, logrando predecir la evolución de la patología (17)(18)(19).…”

Bone formation with disruption of the lamina dura in the mandibular third molar

“…1 The lamina dura is influenced by dental diseases and marked occlusion, 1 and the presence of a radiographic crestal lamina dura is positively associated with clinical periodontal stability. 2 The lamina dura is affected by not only odontogenic infections but also systemic diseases such as hyperparathyroidism, 1,3 renal osteodystrophy, 1,4 hypophosphatasia, 1 and hypophosphatemia. 1 Thus, although the state of the lamina dura could be valuable for diagnosis, identification of its disruption is frequently difficult because small variations and disruptions in its continuity may result from superimpositions of cancellous bone and small nutrient canals passing from the marrow spaces to the periodontal ligament.…”