Table 4 Recommendations for radiographic assessment of periodontal status*

Patient in whom clinical examination indicates that it would be useful to assess all their teeth and their periodontal support

Full assessment of all teeth and alveolar bone status can be achieved by:

- an optimal quality panoramic radiograph alone

- an optimal quality panoramic radiograph with supplementary periapical radiographs depending on the clinical situation

- a complete series of periapical radiographs When determining which technique to use, consider the clinical situation, the required image quality, and the relative dose-benefit based on the radiographic equipment available.

Suspected periodontal/endodontic lesion

A periapical radiograph is indicated.

Specific periodontal scenario:patient with generalised probing depths of ≤ 3-4 mm

This level of probing depth is generally indicative of periodontal health. Radiographs are usually not indicated to routinely assess alveolar bone status in this situation.

Specific periodontal scenario: patient with generalised probing depths of ≈ 4-5 mm (e.g. CPI/BPE/PSR scores of code 3)

This level of probing depth is generally indicative of mild/moderate periodontitis. Alveolar bone levels may be adequately assessed by horizontal bitewings taken for routine caries assessment, supplemented by intraoral periapicals for selected teeth depending on the clinical situation. Alternatively, full assessment of all teeth and alveolar bone status may be undertaken as described above, if clinically indicated.

Specific periodontal scenario:patient with generalised probing depths of ≈ 6 mm or more (e.g. CPI/BPE/PSR scores of code 4)

This level of probing depth is generally indicative of advanced periodontitis. Full assessment of all teeth and alveolar bone status is indicated as described above. As an alternative, some authors advocate the use of vertical bitewing radiographs, supplemented by periapical views, e.g. for selected anterior teeth.

Cone beam computed tomography (CBCT)

Not indicated as a routine method for imaging alveolar bone levels as part of periodontal assessment. If CBCT images are obtained for other purposes, however, and they include the teeth, it is important that assessment of alveolar bone support is included in the radiographic report.