Periodontal Bone Level Radiographs — ORE Part 1 MCQ

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EasyRadiology & ImagingPeriodontal Bone Level RadiographsORE Part 1

A patient has generalised periodontal pocketing of 4–5 mm, with little or no gingival recession. Radiographs are required to assess interproximal alveolar bone levels. Which investigation is most appropriate?

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Correct answer: B — Horizontal bitewing radiographs

Horizontal bitewing radiographs are most appropriate where probing depths are 4–5 mm and there is little or no recession, because they can show the interproximal crestal bone level. SDCEP advises considering bitewings in this situation, provided they will capture the bone crest. Periapical views may be needed when recession, irregular defects or greater pocketing require visualisation of the full root length. A panoramic radiograph alone has lower detail for routine assessment of crestal bone levels. Lateral cephalometric and occlusal radiographs do not assess periodontal bone support adequately. CBCT is not indicated as routine first-line imaging for periodontal bone assessment.

Reference: Scottish Dental Clinical Effectiveness Programme. Prevention and Treatment of Periodontal Diseases in Primary Care, 2nd edition: Use of radiographs, 2025. https://www.periodontalcare.sdcep.org.uk/guidance/assessment/special-tests/use-of-radiographs/