1. Interpreting Radiographs

2. What to Look For Dental caries Periapical pathology Calcified pulps
Changes in alveolar bone pattern
Alveolar bone height

3. What to Look For (Cont'd)
Etiologic agents that promote dental disease
Overhanging margins on restorations
Calculus
Open contacts

4. Root caries may be confused with cervical burnout (see below).
Cross-section
(red line at right)

5. Cervical burnout
Radiolucency seen above left (arrow) disappears on periapical film of same tooth (above right).

6. Anterior Cervical Burnout
bone level
cervical burnout area

7. Cervical burnout in the anterior region due to gap between enamel (red arrows) and alveolar bone over root (blue arrows).

8. Normal Alveolar Bone Height 1.5 to 2 mm below CEJ of adjacent teeth
Bone forming alveolar crest should be smooth and intact
Slight radiolucent space adjacent to the root surface
Visible distinct crestal lamina dura

9. CEJ
1-1.5 mm

10. Normal Alveolar Bone Height

12. Alveolar crests more
pointed anteriorly

14. Corticated alveolar crests

16. Periodontal Disease
Vertical Bitewings or paralleling PA’s best for diagnosis.
Higher kVp recommended (long scale, low contrast).
Compare images from different
visits (using same technique).

17. Limitation of Radiographs
Two-dimensional film with
overlapping bony walls,
superimposed roots
Clinical picture more advanced
Relationship of hard to soft
tissues not evident

20. Periodontitis
Involvement:
Localized
Generalized

21. Horizontal bone loss: Parallel to line drawn between adjacent CEJ’s
Vertical (Angular) bone loss: More bone destruction on interproximal aspect of one tooth than on the adjacent tooth

24. Contributing Factors Occlusal trauma Open contacts
Overhangs, poor contours
Calculus
Post-extraction defects
Systemic involvement (diabetes,
blood disorders, hormonal
changes, stress, AIDS)

25. Gingivitis
No bone loss
No radiographic signs

33. Recognizing Early Alveolar Bone Loss
Increasing area of radiolucency where the alveolar crest and PDL meet
Widening periodontal ligament space
Loss of integrity of crestal lamina dura

35. Early moderate adult periodontitis

37. Moderate adult periodontitis
(red arrows point to calculus)

39. Moderate adult periodontitis

40. Severe adult periodontitis

41. Severe adult periodontitis

42. Severe adult periodontitis

45. Restorative Materials
Radiopaque: Structures with higher object density, such as amalgam, gold, silver points, pins, gutta percha, porcelain.
Radiolucent: Structures with lower object density, such as older composites and bonding agents.

46. Gold crowns, amalgams

47. Retention pins

48. porcelain
crowns

49. crown
crown
amalgam
cast post
gutta percha
silver points

54. Red arrows point to bases
Green arrow indicates recurrent caries with
fractured restoration

55. old
new
Composites

59. Proceedure for radiographic critiques
And interpretations.

60. Assessing Radiographs
Determine if the radiographs are diagnostically acceptable
Look for technique errors
Look for processing errors
Recognize normal structures
Systematically assess teeth and supporting structures
Place radiographs in patient chart