Periodontal disease is a chronic inflammatory condition characterized by the progressive destruction of the supporting structures of the teeth, ultimately resulting in alveolar bone loss. Diabetes mellitus, a globally prevalent metabolic disorder, is well recognized as a major systemic risk factor that influences both the initiation and progression of periodontitis. Radiographic imaging plays a pivotal role in the diagnosis, monitoring, and evaluation of periodontal bone loss, providing objective evidence of disease severity and distribution. This narrative review aims to comprehensively evaluate and compare radiographic patterns of periodontal bone loss in diabetic and non-diabetic patients. A structured literature search was conducted across major databases(Medline/PubMed, Embase, Scopus) from 2000 to 2025, focusing on studies that utilized conventional and advanced imaging modalities such as bitewing radiographs, periapical radiographs, panoramic radiographs, and cone-beam computed tomography (CBCT). Evidence consistently demonstrates that diabetic patients, particularly those with poor glycemic control, exhibit greater severity and extent of alveolar bone loss than non-diabetic individuals. Differences in bone loss patterns, including generalized horizontal bone loss and increased prevalence of vertical defects, have been reported. The underlying mechanisms involve hyperglycemia-induced inflammatory dysregulation, advanced glycation end-product accumulation, impaired bone remodeling, and altered host immune responses. Despite substantial evidence linking diabetes with increased radiographic periodontal destruction, heterogeneity in study design, imaging protocols, and confounding variables limits definitive conclusions. This review highlights existing evidence, discusses biological and radiographic correlations, and identifies gaps in current research that warrant further investigation.

Keywords
Periodontal bone loss; Diabetes mellitus; Radiographic patterns; Alveolar bone; Panoramic radiography; Bitewing radiography; Cone-beam computed tomography.