Authors: Ramadan AE, Mitchell DF.
Title: A roentgenographic study of experimental bone destruction.
Journal: Oral Surg Oral Med Oral Pathol
Date: Aug 1962
Citation: 15:934-43
Category: Radiology and Imaging
Evidence-based Ranking: 5
Purpose/Objectives: The purpose was to evaluate the ability of the roentgenogram (x-ray) to disclose the amounts of cortical and trabecular bone in relation to teeth, in detecting periodontal and periapical alveolar bone loss, and in determining if it is possible to register either the buccal or lingual alveolar plate with conventional x-rays.

Materials & Methods: One dry, human maxilla and mandible were sectioned into four and five blocks respectively. Defects were created with a dental bur to simulate periodontal and endodontic defects.

Results / Discussion: Buccal or lingual vertical defects of the alveolar crest only registered on x-rays when they were at least 3mm deep (1-2mm defects were not apparent). Removal of the buccal or lingual cortical plates does not alter an x-ray in either jaw. The paralleling technique and bite wing x-rays provide the best visualization of the alveolar crest. Defects of the alveolar cortical plates will only show on x-rays if they are in thick cortical bone (2-3mm of thickness) and will not appear in thin cortical bone, and therefore x-ray exam alone can not sufficiently diagnose a periodontal abscess. Removal of central trabecular bone, leaving the junctional trabecular bone will not appear on an x-ray, therefore a central lesion may cause destruction of the spongy bone without being detectable on radiographic exams.

Author’s Summary / Conclusion: Minor changes in the alveolar crest are not radiographically visualized; buccal from lingual destruction was not distinguishable; funnel-shaped destruction leaving the outer and inner alveolar plates intact will not register on x-rays; paralleling and bitewings reproduce the alveolar crestal bone best; removal of the buccal or lingual cortical plates do not alter the architectural pattern of bone on x-rays; bone destruction from a periodontal abscess does not show if the defect was superimposed by the roots especially when the cortical bone is thin; destruction of the central trabeculae that spares the junctional trabeculae will not affect the trabecular pattern – and the reverse situation holds true as well; removal of both central and junctional trabeculae will affect the architectural pattern.