The usefulness of radiographs in diagnosis and management of periodontal diseases: a review

Objectives: To review the periodontally significant diagnostic information obtainable from radiographs and the stages during periodontal therapy when the information may influence patient management and treatment outcomes. Data: Confined to studies involving conventional radiography, as this remains the commonest imaging method in clinical dental practice and primary dental care setting. Sources: Literature was reviewed using Medline and manual tracing of references cited in key papers not otherwise elicited. Study selection: Studies were selected in order to (i) define the role of radiographs in periodontal diagnosis and management at the initial, corrective and supportive (maintenance) phases of periodontal therapy and (ii) critically review the evidence for the value added by radiographs. Conclusions: Radiographs provide diagnostic information on alveolar bone levels, plaque retention factors, caries, furcation defects, subgingival calculus and additional pathology. Features visualised are dependent on the radiographic view. A relationship exists between probing attachment loss and radiographic bone height, with a range in level of correlation; clinical attachment may correspond more closely to surgical measurements of bone height. Radiographs can be used in planning initial, corrective and supportive phases of therapy, though some decisions may be made on clinical assessments alone. Evidence in the literature on benefit gained from radiographs taken for periodontal patients is sparse; the extent to which they influence the treatment provided and treatment outcomes is poorly addressed. Further research is indicated to define the role of radiographs when managing the periodontal patient to maximise the potential gain for the patient.