Initial Examination The type of radiographic examination must be specific for the patient and current oral condition Panoramic radiograph, Bite-wing x-ray films before the patient is examined Primary teeth,mixed denition,permenent teeth unerpted,impacted teeth Per apical radiographs Which show the entire tooth surrounding bone
Recall Examination The recall or follow up examination of a patient has no ‘’specified’’rules for radiographic survey. Posterior bitewing examination at 6-month intervals or until no carious lesions are evident
Post treatment follow –up Root canal therapy Radiographic follow up ;interval of 3,6,12 months Oral surgical procedure, such as ; Odontogenic cysts,tumors,should be followed annually for 5 years to detect and prevent recurrence
Commonly used radiographs 1-Interaoral radiographs Periapical,bitewing,occlusal 2- Extraoral radiographs
Intera-oral radiograph Bitewing radiograph, Detection interproximal caries that would not be detected clinically Estimation the horizontal level of bone between the posterior teeth (periodontal status ) Complete-radiographic survey ( with per apical radiograph ) Full-mouth x-rays(FMX), Full –mouth series (FMS) Complete-mouth x-ray (CMX).
Periapical film of anterior teeth Bitewing film for posterior teeth
Intera-oral radiograph Occlusal radiograph Which is a versatile study, examine large areas of the jaws It allows examination of structures or lesions in a third dimension by radio graphing the object at right angles to the initial radiograph. Remember, a typical per apical of bitewing radiograph is only a two-dimensional representation of three-dimention structures
Occlusal view demonstrating a calcified deposit in Wharthon’s duct
Extra-oral radiographs All extraoral radiographs are used to examine larger areas of the head and neck Panoramic, Lateral jaw T.M.J (transcranial,transpharyngeal,trasorbital ) Cephalometric Waters’ view( occipital ) Submentovertex (basilar)
Posteroanterior radiograph (PA)
Modified schuller for T.M.J.Radiograph
Spiral projection of the left T.M.J
Axial skull radiograph (T.M.J)
Film evaluation If the intraoral or extraoral radiograph is to be a useful diagnostic aid, it must be free of errors of film positioning, exposure and processing. The ultimate is to interpret the radiographic features or findings from the film.& avoid any problem that compromise the overall film quality e.g. Artifacts, motion, distorted anatomic structures, overlapped interproximal contacts, underexposed ( light ) or overexposed (dark)films
Any problems that compromise the overall film quality, Prevent the dentist from obtaining all the information and limit the usefulness of the radiographic examination One cannot interpret what one cannot see
Errors make it necessary to retake the film Thus exposing the patient to unnecessary x-radiation & increasing the risk of harm to the patient. A missed diagnosis because of improper film quality is as serious as failure to take a radiograph when one is indicated
Overall film quality to ensure that the radiogrph is diagnostically acceptable 1- the interest area represented in the film 2- no additional film (s) needs to see the area complatelly 3-no errors 4- overall film density is acceptable 5-the structure of interest free of distortion 6- the film of sufficient quality that interpretition can lead to a diagnosis
Radiographic interpretation It is that part of the discipline that identifies or detects radiographic features or changes on the radiograph Through interpretation, the findings support the eventual diagnosis of disease. The dentist must always interpret the findings in conjunction with historical and clinical information (anatomy, physiology,pathology, immunologic & systemic conditions ) Diagnostic radiology is a true ‘’bridging science ‘’ a cognitive discipline that demands experience and training in many related areas of medicine and dentistry
Radiographic interpretation A-Viewing Method Radiologic interpretation must be systematic and sequential manner for each film entirety(horizontal bone,periapical pathosis,interproximal caries,trabecular bone pattern,maxillary sinus ).
Radiographic interpretation B-Viewing Conditions Radiographs should also be interpreted or Viewed under optimal viewing conditions ( in room with subdued lighting & magnifying glass,) Films of inferior quality, whatever the reason, should be retaken
Radiographic interpretation C- Interpretive Methods Dental disease processes,odontogenic, cyst, and tumors, and systemic conditions have radiolographic features or characteristics(multilocular radiolucencies) that allow the dentist to group them according to their more common clinicoradiographic presentation A process called ‘’pattern matching ‘’ Differential diagnosis (Additional characteristics, about each of the lesions to narrow the choice to one of two more probable diagnoses ) ( lab. Investigation, biopsy,histopathology or clinical pathologic test ) treatment based on final diagnosis
Radiographic appearance of dental caries Bitewing radiographs Per apical radiographs Radiographic appearance of caries depends on the surface Caries on occlusal surface penetrates a pit or fissure and spreads in a triangular shape with the base to the dentin. Once the dentin is involved,the lesions continuous to the pulp with another triangle area. Carious involvement of the proximal enamel can appear triangular,bandlike,linear(active lesions ) or cupped out(arrested caries ).
Root caries seen radiographically on the proximal surfaces when enamel is involved (cupped out ) Facial or lingual caries(cervical area) appears within the crown of the tooth as light radiolucency per apical involvement as a sequelae to caries is seen in acute apical pathosis & condensing osteitis.
Radiographic appearance of periodontal disease Early changes Both per apical & bitewing radiographs can be used to detect the subtle, early bone changes of periodontal disease. Anterior segments It is difficult to its long embrasure form and closeness of adjacent roots. Early radiographic changes in the anterior segments of the maxilla and mandible including blunting of the interdental septa,specifically the cortical crest, horizontal bone loss up to 3-4 mm from the cementoenamel junction (CEJ) and the presence or absence of local factors such as calculus deposits, poor contacts, and overhanging Restorations.
In posterior regions Interdental septa are flat, early sign is the loss of crestal cortication.discontinuous with the lamina dura.
The information available from radiographs to assist in the determination of the patient’s overall periodontal 1- status of the lamina dura 2-crown-to-root ratio 3-contact integrity 4-presence or absence crystal cortication 5-remining bone height 6-changes of periodontal ligament space 7-possible furcation involvement 8-pattern or extent of the disease 9- local irritant such as calculus or overhangs 10-disease progression or remission by serial radiography
Advanced changes Sever horizontal bone loss, vertical bony defects, Periodontitis can also be detected by intra- oral radiographs.
Differential diagnosis Lesion description Parameters of a lesion’s size,shape,outline,radiodensity,(radiolucent, or radiopaque) and secondary, features such as resorption or displacement that affect adjacent structures of teeth and bone. Margin(well-defined or ill-defined,sclerotic;corticated or no corticated ) Does the lesion look expansible ? Is that solitary or one of multiple lesions ? Does it affect more than one bone in the body ? Is it producing bone or other products within itself or at its periphery ? Does it have a characteristic appearance such as :- multilocular or per coronal ? Where is the lesion located ?
Pattern Recognition Pattern recognition or pattern matching is a unique method of teaching radiologic interpretation. The pathologist groups diseases into several large categories such as development,neoplastic,inflammatory or reactive, and systemic Radiologist now groups lesions by their most usual radiographic presentation (not all lesions always have these presentating patterns Because many factors such as inflammation or the patient’s systemic Condition may modified the appearance of any lesion.