1. Lecture 4: Radiographic Interpretation of Dental Caries
ODRP 755 Radiology II Theory & Interpretation
Heidi L. Christensen, DDS, MS

2. Dental Caries A process of decalcification
50% of calcium and phosphorus in a particular area must be destroyed before decreased density can be seen on radiographs

3. Radiographic Criteria
Description of Depth of Lesion
E0 = Sound, no caries
E1 = Caries in the outer 1/2 of enamel
E2 = Caries into the inner 1/2 of enamel to DEJ
D1 = Caries through DEJ, into the outer 1/3 of dentin
D2 = Caries into the middle 1/3 of the dentin
D3 = Caries into the inner 1/3 of the dentin

5. Occlusal Caries

6. Occlusal Caries

7. Interproximal Caries Most difficult to detect clinically
Interproximal caries usually begin just below the contact point

8. Caries Progression – Interproximal Caries

11. Interproximal Caries

12. Incipient Caries

13. Interproximal Caries

14. Interproximal Caries

15. Interproximal Caries

16. Interproximal Caries

17. Interproximal Caries

18. Facial or Lingual Caries

19. Facial or Lingual Caries

20. Facial or Lingual Caries

21. Recurrent Caries Caries immediately next to a restoration
Inadequate margins or excavation
Pulpal necrosis
Metallic restorations often hide
Clinical examination

22. Recurrent Caries

23. Recurrent Caries

24. Recurrent Caries

25. Recurrent Caries

26. Root or Cemental Caries

27. Root or Cemental Caries

28. Cervical Burnout
Often mistaken for root caries

29. Cervical Burnout Caused by
The great density difference between the cervical neck of the tooth and the tissues above and below it
Shape of CE contour
Root configurations
Poor horizontal angulation of the beam

30. Cervical Burnout Found between CEJ and alveolar crest
Diffuse radiolucency generally viewed on periapical but not on bitewing
Clinical evaluation important – lesion looks BIG, if it is decay, you would be able to find it!

31. Cervical Burnout

32. Cervical Burnout vs. Root Caries

33. Radiation Caries A result of therapeutic radiation
Caused by xerostomia, a common side effect
Caries begins at cervical region
Extensive decay very quickly
Pre-therapy dental evaluation and treatment is very important

34. Radiation Caries

35. Rampant Caries Children Poor dietary habits Extensive caries
Proximal and smooth surface
Socio-economic factors

36. Rampant Caries

37. Regressive and Traumatic Alterations of Teeth

38. Regressive Alterations
Attrition
Abrasion
Erosion

39. Attrition Physiologic wearing away
Incisal, occlusal and interproximal surfaces
Part of aging process
Bruxism – pathologic attrition

40. Attrition – Radiologic Features
Change in normal outline
Flat occlusal plane
Loss of mamelon
Pulp chamber, canal size
Hypercementosis

41. Attrition

42. Attrition

43. Attrition

44. Abrasion Non-physiologic wearing away Habits Toothbrush trauma
Dental floss injury
Occupational hazards

45. Abrasion – Radiologic Features
Radiolucent defects at the cervical region
Well-defined semilunar defects
Pulp chambers sclerosed
In case of dental floss injury, distal surfaces more involved

46. Abrasion

47. Abrasion

48. Abrasion

49. Erosion Chemical cause No bacteria involved Diet Regurgitation
Occupational hazards

50. Erosion - Radiologic Features
Radiolucent defects
Dietary acids – labial surface
Regurgitation – mandibular lingual surface
Occupational – all surfaces

51. Acid Erosion
Soft Drinks

52. Erosion

53. Erosion

54. Questions?