The emerging role of maxillofacial radiology in the diagnosis and management of patients with complex periodontitis

Contemporary periodontal therapy has evolved to become more interdisciplinary and increasingly involves more complex treatments, including bone and soft-tissue regenerative procedures. Therapeutic options require an imaging modality or combination of techniques that are capable of providing a diagnostic osseous baseline and facilitating quantification of smaller increments of bony change, both loss and additive, which are comparable over time. Intra-oral and panoramic radiography are the modalities most commonly used to identify the location, quantify the amount and the pattern of alveolar bone loss and determine response to therapy. Cone-beam computed tomography imaging offers specific advantages for periodontal diagnosis in that three-dimensional images of dental and alveolar bone structures can be rendered with accuracy. Cone-beam computed tomography has been shown to be clinically efficacious in demonstrating localized defects, such as furcation involvement and intrabony vertical and buccal/lingual defects, and in assessing the effects of regenerative therapy. In these situations, limited-field-of-view, high-resolution protocols are indicated.