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PERIODONTAL BONE LESIONS an Experimental Study of Interdental Bone Changes VRIJE UNIVERSITEIT TE AMSTERDAM

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PERIODONTAL BONE LESIONS an Experimental Study of Interdental Bone Changes VRIJE UNIVERSITEIT TE AMSTERDAM TALBONE \ .*•—-• \ I A- PERIODONTAL BONE LESIONS An experimental study of interdental bone changes VRIJE UNIVERSITEIT TE AMSTERDAM PERIODONTAL BONE LESIONS AN EXPERIMENTAL STUDY OF INTERDENTAL BONE CHANGES. ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad van doctor in de geneeskunde aan de Vrije Universiteit te Amsterdam, op gezag van de rector magnificus dr. P.J.D. Drenth, hoogleraar in de faculteit der sociale wetenschappen, in het openbaar te verdedigen donderdag 28 november 1985 te 13.30 uur in het hoofdgebouw der universiteit, De Boelelaan 1105 door LEO WILLEM JACOB VAN DER LINDEN geboren te 's-Gravendeel Printed by van den Berg & Versluijs BV, Dordrecht, the Netherlands, 1985. PROMOTOR PROF. DR. C. O. EGGINK COPROMOTOR DR. P. F. VAN DER STELT REFERENT PROF. G. DEKKER . I \ -i- STELLINGEN i Aan de hand van één röntgenfoto is niet vast te stellen of bij een angulair botdefect de vestibulaire of orale wand verloren is gegaan. dit proefschrift II Afbraak van spongieus bot van het coronaire deel van het interdentale septum beïn- vloedt de zwarting en het trabekelpatroon op de röntgenfoto. dit proefschrift III De uitbreiding van angulaire botdefecten op de röntgenfoto is met digitale beeld- verwerkings- en patroonherkenningstechnieken te bepalen. dit proefschrift IV De frequentie voor het vervaardigen van bitewing röntgenopnamen ten behoeve van cariesdiagnostiek dient aan de snelheid van het voortschrijden van caries gekoppeld te zijn en niet aan een tijdsnorm. Gezondheidsraad 1982 Bij het vervaardigen van intra-orale röntgenopnamen dient met het ALARA-principe (the dosis as low as reasonably achievable, economie and social factors being taken into account) rekening te worden gehouden. ICRP26 VI De tandarts-radioloog ziet het parodontium te veel zwart-wit. VII Vanuit parodontaal opzicht verdient een uitgebreide composietrestauratie in front- elementen de voorkeur boven een totale kroon. VIII De tandarts dient zich ervan bewust te zijn dat het tijdstip van het behandelen van een proximale caviteit afhankelijk is van de grootte van de caviteit en de caries- progiessie. ••< IX Een histologisch preparaat is een weergave van een moment en belemmert longitudi- naal onderzoek in tegenstelling tot klinisch en röntgenologisch onderzoek. Eenvoudige orthodontische afwijkingen, waar vaste apparatuur is geïndiceerd, die- nen door de tandarts algemeen practicus te worden behandeld. XI Een tandwortelimplantaat dient eenvoudig aangebracht te kunnen worden, opdat de tandarts algemeen practicus het toe kan passen. XII Een tandarts die deeltijds medewerker is aan een subfaculteit der tandheelkunde leidt (üjdt) een dubbel leven. XIII De stellingname van veel leden van de Nederlandse Maatschappij tot Bevordering der Tandheelkunde jegens het instituut van de mondhygienisten staat op gespannen voet met één der doelstellingen van deze beroepsorganisatie, n.l. "het bevorderen van de tandheelkundige gezondheidsvoorlichting en opvoeding van de bevolking, alsmede het bevorderen van de preventie". XIV De term "openbare belijdenis des geloofs" dient verandert te worden in "openbare christus belijdenis". XV Een schaatstourtocht is in vergelijking met een fietstourtocht een volkshappening. For Judith, Arie, Angelique en Willem. This thesis was prepared at the Department of Operative Dentistry, section of Dental Radiology, of the Free University, Amsterdam. VOORWOORD Het verschijnen van dit proefschrift biedt mij de gelegenheid om degenen die direct of indirect aan het tot stand komen hebben bijgedragen te bedanken. Een aantal van hen wil ik graag met name bedanken. Prof. dr. C. O. Eggink, u hebt mij de gelegenheid geboden tot het verrichten van dit onderzoek. Uw helder inzicht en uw waardevolle adviezen zijn bij het schrijven van dit proefschrift voor mij een grote steun geweest. Ondanks uw vele andere werk- zaamheden wist u voor mij toch tijd vrij te maken. Dr. P. F. van der Stelt, de prettige samenwerking in de afgelopen jaren heb ik erg op prijs gesteld. Uw constructieve opmerkingen tijdens het onderzoek, de vele gesprek- ken over het onderwerp van ons beider interesse zijn voor mij waardevol geweest. Uw verblijf in de U.S.A. was voor mij een groot gemis. Prof. G. Dekker, ik dank u voor de belangstelling die u toonde en de prettige wijze waarop u uw op- en aanmerkingen op mijn werk overbracht. Prof. J. van Aken, u wil ik in het bijzonder noemen, want u bent het geweest, die mijn, op de praktijk gerichte, belangstelling hebt omgebogen naar een meer weten- schappelijk gerichte. Dr. J. G. A. Advokaat, dr. H. B. M. Akerboom en dr. P. J. Borgmeijer, Joop, Harry en Peter, het vervaardigen van de röntgenfoto's voor het onderzoek naar het botniveau was alleen mogelijk dank zij een goede samenwerking. Ik ben jullie daarom zeer er- kentelijk. Drs. P. G. G. L. van de Avoort en drs. J. P. Rodenburg, Gordon en Hans, dank zij jul- lie medewerking was het mogelijk de botregeneratie bij patiënten met juveniele pa- rodontitis te onderzoeken. Dr. P. F. van der Stelt en drs. K. van der Heijden, Paul en Klaas, jullie wil ik danken dat je bereid was om tijd vrij te maken om nauwgezet de röntgenfoto's te beoordelen. Drs. C. L. Alons, hartelijk dank dat u bereid was tijd vrij te maken de beeldverwer- kings- en patroonherkenningsprogramma's uit te voeren. Drs. W. Geraets, Wil, hartelijk dank voor adviezen op het gebied van de statistiek en de fysica. E. J. Windgassen, u dank ik voor de preciese wijze waarop u de instelapparatuur ten behoeve van de röntgenfoto's hebt gemaakt. Mw. G. B. van den Bovenkamp, mw. C. Keus en mw. M. Kuiper, Gusta, Corry en Matty, jullie ben ik veel dank verschuldigd voor het invoeren van de tekst in de tekst- verwerker en de vele wijzigingen die aangebracht moesten worden. Th. C. C. van Winsen, u dank ik voor de hulp bij het vertalen van het manuscript. J. Minnaard, mw. J. A. Slingerland en L. Weijers, Jan, Joke en Lotte, dank ik voor het vervaardigen van de foto's en afbeeldingen. T. Rijsdijk, Medische Faculteit Erasmus Universiteit, u dank ik voor de voorbewer- king van de röntgenfoto's voor het drukprocedé. De medewerkers van de afdeling Tandheelkundige Radiologie ben ik erkentelijk, dat zij mij zoveel mogelijk in de gelegenheid hebben gesteld dit werk te voltooien. Judith, jou wil ik danken datje mij in de gelegenheid stelde in een rustige omgeving dit proefschrift te voltooien en bovendien een aantal taken van mij overnam. CONTENTS 1. INTRODUCTION, AIM AND DESIGN OF THIS STUDY 13 1.1 The position of the radiograph in dentistry and more especially in periodontology 13 1.2 The reason for this study 14 1.2.1 Introduction 14 1.2.2 Changes in bone height in the course of time, without treatment 15 1.2.3 The effect of various methods of treatment 16 1.2.4 The effect of non-surgical methods of treatment 16 1.2.5 The effect of surgical methods of treatment 17 1.2.6 Comparison of the effects of surgical and non-surgical methods of treatment 17 1.2.7 Longitudinal study ofperiodontal bone loss in which systemic diseases play a role 18 1.2.8 Conclusions and discussion 18 1.3 The aims of this study 19 1.4 The design of this study 20 2. STRUCTURE, FUNCTION AND RADIOGRAPHIC FEATURES OF THE PERIODONTIUM 22 2.1 Introduction 22 2.2 The anatomy of the periodontium 22 2.2.1 Thegingiva 22 2.2.2 Theperiodontal ligament space 24 2.2.3 The cementum 26 2.2.4 The alveolar process 28 2.3 The periodontium on the radiograph 30 2.3.1 Theperiodontal ligament space 30 2.3.2 The alveolar process 32 2.3.3 The influence of the various bone structures on image formation 34 3. PERIODONTAL DISEASES 36 3.1 Introduction 36 3.2 Gingivitis 36 3.3 Periodontitis 36 3.3.1 Experimental periodontitis 37 3.3.2 Periodontitis in adults 37 3.3.3 Juvenile periodontitis 41 3.4 Periodontal lesions and the radiographic features 41 3.4.1 Widening of the periodontal ligament space 42 3.4.2 Changes of the alveolar crest 43 3.4.3 Periodontal bone loss 43 3.4.4 Classification of periodontal bone loss on the radiograph 44 3.5 Conclusions and discussion 44 4. EXPERIMENTAL BONE LESIONS 46 4.1 Introduction 46 4.2 Review of the literature 46 4.3 Study design 48 4.4 Materials and methods 48 4.4.1 The radiographic procedure 48 4.4.2 The lesions 51 4.4.3 Registration by means of impressions 51 4.4.4 Assesment of the registrations 52 4.5 Results 52 4.6 Conclusions 67 4.7 Discussion 69 5. STANDARDIZATION OF THE RADIOGRAPHIC TECHNIQUE 71 5.1 Introduction 71 5.2 The radiograph of the alveolar bone 71 5.3 The standardized reproducible radiograph 73 5.3.1 Criteria to be met by standardized reproducible radiographs 74 5.3.2 Applications in the literature 74 5.4 Reason to design a new aiming device 75 5.4.1 Criteria to be met by the aimingdevice 75 5.4.2 Design of the device 76 5.5 The positioning error and the error of observation 78 5.5.1 Measurements on radiographs made on an optical bench to determine the error of observation 78 5.5.2 Measurements on radiographs of patients to determine the positioning error 80 5.5.3 Determination of the magnitude of acceptable positioning errors 81 5.5.4 Measuring method and determination of the accuracy of the enlargement technique 81 5.6 Results 82 5.6.1 Themeasuringerror 82 5.6.2 The error in the photographic printing of the radiograph 83 5.6.3Themarkingerror 84 5.6.4 The enlargement error 84 5.6.5 The positioning error in radiographs of patients 85 5.6.6 The magnitude of acceptable positioning errors 86 5.7 Conclusions 91 5.8 Discussion 91 6.
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