4Selection Criteria Concept Initial ExaminationRecall ExaminationPost-treatment Follow up
5Initial ExaminationThe type of radiographic examination must be specific for the patient and current oral conditionPanoramic radiograph, Bite-wing x-ray filmsbefore the patient is examinedPrimary teeth ,mixed denition,permenent teethunerpted,impacted teethPer apical radiographsWhich show the entire tooth surrounding bone
6Recall ExaminationThe 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
7Post treatment follow –up Root canal therapyRadiographic follow up ;interval of 3,6,12 monthsOral surgical procedure , such as ;Odontogenic cysts,tumors,should be followed annually for 5 years to detect and prevent recurrence
8Commonly used radiographs 1-Interaoral radiographsPeriapical,bitewing,occlusal2- Extraoral radiographs
9Intera-oral radiograph Bitewing radiograph ,Detection interproximal caries that would not be detected clinicallyEstimation 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).
10Periapical film of anterior teeth Bitewing film for posterior teeth
11Intera-oral radiograph Occlusal radiographWhich is a versatile study, examine large areas of the jawsIt 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
12Occlusal view demonstrating a calcified deposit in Wharthon’s duct
14Extra-oral radiographs All extraoral radiographs are used to examine larger areas of the head and neckPanoramic ,Lateral jawT.M.J (transcranial,transpharyngeal,trasorbital )CephalometricWaters’ view( occipital )Submentovertex (basilar)
22Film evaluationIf 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
24Any problems that compromise the overall film quality , Prevent the dentist from obtaining all the information and limit the usefulness of the radiographic examinationOne cannot interpret what one cannot see
25Errors make it necessary to retake the film Thus exposing the patient to unnecessaryx-radiation & increasing the risk of harm to the patient .A missed diagnosis because of improperfilm quality is as serious as failure to take a radiograph when one is indicated
261- the interest area represented in the film Overall film quality to ensure that the radiogrph is diagnostically acceptable1- the interest area represented in the film2- no additional film (s) needs to see the area complatelly3-no errors4- overall film density is acceptable5-the structure of interest free of distortion6- the film of sufficient quality that interpretition can lead to a diagnosis
27Radiographic interpretation It is that part of the discipline that identifiesor detects radiographic features or changes on the radiographThrough 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
28Radiographic interpretation A-Viewing MethodRadiologic interpretation must be systematic and sequential manner for each film entirety(horizontal bone ,periapical pathosis,interproximal caries,trabecular bone pattern ,maxillary sinus ) .
29Radiographic interpretation B-Viewing ConditionsRadiographs should also be interpreted orViewed under optimal viewing conditions( in room with subdued lighting & magnifying glass ,)Films of inferior quality, whatever the reason, should be retaken
30Radiographic interpretation C- Interpretive MethodsDental 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 presentationA 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
31Radiographic appearance of dental caries Bitewing radiographsPer apical radiographsRadiographic appearance of caries depends on the surfaceCaries on occlusal surface penetrates a pit or fissure andspreads 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 ) .
32Root 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 radiolucencyper apical involvement as a sequelae to caries is seen in acute apical pathosis & condensing osteitis .
33Radiographic appearance of periodontal disease Early changesBoth per apical & bitewing radiographs can be used to detect the subtle, early bone changes of periodontal disease.Anterior segmentsIt 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 localfactors such as calculus deposits, poor contacts, and overhangingRestorations.
34In posterior regionsInterdental septa are flat , early sign is the loss of crestal cortication .discontinuouswith the lamina dura .
35The information available from radiographs to assist in the determination of the patient’s overall periodontal1- status of the lamina dura2-crown-to-root ratio3-contact integrity4-presence or absence crystal cortication5-remining bone height6-changes of periodontal ligament space7-possible furcation involvement8-pattern or extent of the disease9- local irritant such as calculus or overhangs10-disease progression or remission by serial radiography
36Advanced changesSever horizontal bone loss,vertical bony defects,Periodontitis can also be detected by intra-oral radiographs.
37Differential diagnosis Lesion descriptionParameters 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 ?
38Pattern RecognitionPattern 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 systemicRadiologist now groups lesions by their most usual radiographic presentation (not all lesions always have these presentating patternsBecause many factors such as inflammation or the patient’s systemicCondition may modified the appearance of any lesion.