introduction to radiographic interpretation and caries on radiographs Flashcards
where to start?
Identifying permanent and deciduous teeth
ID developing and erupted permanent teeth first
- Molar teeth – 6 at 6s, 7 at 12, 8 at 18
- Takes 3 years for root
age
permanent dentition - symmetrical
approx 18
age
mixed dentition - late
- Molar teeth – 6 at 6s, 7 at 12, 8 at 18
- Takes 3 years for root
Roughly 12-13 years
age
mixed dentition - early
6 years old
3 longest distance to travel so above premolar
what is different here
Supernumeray between central maxilla
what is different here
Only one premolar in maxilla right (no 2nds), no upper left canine
Lower left E severe caries
No lower right 5
common site for supernumeray and missing teeth
End of sets of teeth and midline common supernumeray and missing teeth
clinical evaluation report for radiographs
- legal requirement
- clinical evaluation of the outcome of each exposure is (must be) recorded in accordance with the employer’s procedures
- for normal radiographs in GDH&S the responsibility is the Referrer’s
- your patients – YOU
- complete in the patient’s written notes only
- write everything from meeting and condense when presenting to clinician
potential caries sites
- Pit and fissure
- Occlusal
- Buccal – may be confused radiographically with occlusal
- Smooth surface
- Interproximal
- Lingual – may be confused radiographically with occlusal and buccal
- Root – may be confused with “cervical burnout”
- Secondary/recurrent – under restorations
7 caries diagnosis methods
- Visual
- Dry
- Radiography
- Film
- Digital
- Elective temporary tooth separation
- Fibreoptic transillumination
- Electrical methods
- Laser fluorescence
- Calcivis® - detects calcium ion loss from demineralising tooth surfaces
locate caries and risk level
Female 15
previous restoration and other risk factors
caries 25M
high risk
describe OPT of 7 year old female
Extensive caries in deciduous molars
Erupted 1st molar
Problem with overlap on OPT so hard to detect caries
so take bitewings
- can see extensive caries 75M, 74D
- impact on pulpal tissues
describe features in periapical 36, 37, 38
- gross caries occlusal 38,
- enamel 37 mesial,
- dentine 36 distal
caries progression shape
cone-shape:
- broad at surface,
- point deeper;
- lateral spread on reaching dentine
how to ID caries easier on radiograph
adjust density and contrast on PACS to ID easier
cervical burnout
- Phenomenon caused by relative lower X-ray absorption on the mesial or distal aspect of teeth, between the edge of the enamel and the adjacent crest of the alveolar ridge. Because of the relative diminished X-ray absorption, these areas appear relatively radiolucent with ill-defined margins. Cervical burnout out may mimic root surface caries.*
- Exposure dependent
Saucer shaped radiolucency, premolars and molars
Smooth margins on 6 restoration – cast gold
secondary caries or deficient margins?
Sequelae of caries – circular of radiolucency at 22 root
Measure on radiograph bigger than real life (magnified in reality?)
what affects radiolucency on dental radiographs
bucco-lingual dimension of teeth variable
- Structures to be traversed variable:
- +/- enamel
- +/- surrounding bone
peridontal assessment - selection criteria recommendations
- Radiography secondary to clinical examination and full mouth periodontal assessment
- Pocketing 4-5 mm, horizontal bitewings
- Long axis of image receptor goes horizontal
- Not common in GDH
- Long axis of image receptor goes horizontal
- Pocketing =>6 mm, vertical bitewings + periapicals if bone not shown
- Irregular – may supplement with periapicals
- Panoramic useful for overview of all teeth, supplemented by periapicals if required, or full periapicals
- Periapicals for suspected perio/endo leasions
periodontal radiography
- If panoramic choose orthogonal projection (P4, button on machine)
- Beam angulation crucial
- Horizontal angle 90o to line of arch
- avoid overlaps of adjacent teeth, overlap = cannot see bone between teeth
- Vertical angle 90o to long axis of tooth
- Pockets may be difficult to show – consider GP point
- Clinical pocket depth examination crucial
Check all radiographs as teeth overlap in different full mouth periapical
describe some features
Crowns, root filling 21, lower left 7 and 8 wedge shape = food packing, lower right 6 radiolucency – bone loss after RCT
Check all radiographs as teeth overlap in different full mouth periapical
