To compare the diagnostic accuracy of extra-oral x-rays with intra-oral x-rays, in contrast to clinically observed measurements, for the detection of calculus and bone loss of either the suprabony or infrabony types in patients undergoing periodontal surgery.

Inclusion Criteria:

• Patients must be active patients of record at CU School of Dental Medicine
• Patients will have an active treatment plan for periodontal open flap surgery
• Patients will be classified as either ASA I or ASA II
• Patients must have periodontal probing depths >/= 5mm and radiographic sings of marginal bone loss (supra or infra bony)

Exclusion Criteria:

• Less than 18 years of age
• ASA III or above
• Emergency patients
• Pregnant patients
• Patients who are not patients of record at the CU School of Dental Medicine
• Patients with a recent panoramic radiograph that contraindicates the need for new imaging in the form of extra-oral bitewings

Approximately 40 individuals who are currently active patients at the University of Colorado School of Dental Medicine Graduate Periodontics Department. Intra-oral x-rays will be taken on examination, which is the standard of care. Patients who require periodontal surgery and have signed treatment plans to undergo the surgery will be asked to participate in the study. Extra-oral x-rays will be taken at that time, which is for research purpose. This is the same exposure as a panoramic x-ray, which is the standard of care to receive along with the intra-oral x-rays. Patients will be excluded if they have a recent panoramic x-ray.