To annotate bone level on dental X-rays, follow these steps:

1. Obtain a Clear Radiograph: Use high-quality periapical or bitewing radiographs where the alveolar bone crest is clearly visible.

2. Identify Key Landmarks:

   • Locate the cementoenamel junction (CEJ) of the teeth.

   • Identify the alveolar bone crest, which appears as a radiopaque (white) line adjacent to the tooth root.

3. Draw Reference Lines:

   • Draw a horizontal line connecting the CEJs of adjacent teeth.

   • Draw another line from the CEJ to the crest of the alveolar bone. This vertical distance represents the bone level.

4. Measure Bone Loss:

   • Measure the distance from the CEJ to the bone crest.

   • In healthy bone, this distance is typically 1–2 mm. Greater distances indicate bone loss and may be annotated accordingly (e.g., mild, moderate, or severe).

5. Document Findings:

   • Annotate the measurements on the radiograph or in clinical notes.

   • Note areas with horizontal or vertical bone loss and any furcation involvement.

6. Use Digital Tools:

   • If using digital radiography software, use the annotation and measurement tools to draw lines and label bone levels directly on the image.