g5 - radio graphic examination

8/4/2019 G5 - Radio Graphic Examination

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Radiographic Examination


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Outline

Introduction Interpretation of Normal Radiographs

Normal Landmarks Periapical

Radiographs Complete Mouth Radiographs

Posterior Bitewing Radiographs

Supplemental Radiographs Radiographs for Children

Dangers from Radiation


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Introduction


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Introduction

Radiographic Examination - most commonly omitted

- (initial examination) completemouth radiograph, posterior bitewingradiographs

- separate fee is charged


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Interpretation of NormalRadiographs

- normal should always beunderstood

- it is the architecture of the hard

tissues - radiopacity or radiolucency may beseen

- two-dimensional shadow of

structures - superimposition may occur

Radiopaque areas appear lighter,shadow of dense structures


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Normal Landmarks PeriapicalRadiographs

The Maxilla.1 Incisive

Foramen

Oval shaped radiolucent area between the roots of themaxillary incisor teeth


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The Maxilla.2 Nasal Septum

Vertical Radiopaque band above the apices ofthe central incisors


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The Maxilla. /3 Incisive Fossa Lateral

Fossa

Radiolucent area between the roots of the cuspid andcentral incisor and over the apex of the lateral

incisor


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The Maxilla.4 Maxillary Sinus

Radiolucent area extending from the Premolar Areaposteriorly to the second molar region


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The Maxilla.4a Sinus Septa

Radiopaque lines running throughthe maxillary sinus

.4b Antral Y

Radiopaque line marks theseparation of the anterior portion

of the maxillary sinus from the

nasal cavity

l d k i i l


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The Maxilla.5 Malar Bone

-U shaped radiopaque band at the maxillary first molar;area frequently superimposed on the roots of it

N l L d k P i i l


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The Maxilla.6 Coronoid Process

Fingerlike projection seen when the second molarregion is radiographed

N l L d k P i i l


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The Maxilla.7 Hamulus

Small projection of bone posterior to the maxillarytuberosity on radiographs of the second molar region

N l L d k P i i l


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The Maxilla.8 Confusing Areas

Maxillary sinusmistaken for cystic area

Incisive Fossamistaken for a

rarefied area aboutthe lateral incisor

root apex

Incisive foramen( )if large suggest

the presence ofincisive canal cyst

or bone refraction if

superimposed on the

apex of the incisor

N l L d k P i i l


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The Mandible.1 Lingual Foramen

A small dot inferior to the apices of the central; .incisors 0 5 mm radiolucent center lined with

radiopaque border

N l L d k P i i l


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The Mandible.2 Genial Tubercles

Sharp radiopaque projections from the lingual corticalplate of bone



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The Mandible.3 Mental Foramen

Radiolucent area licated near the apices of the;mandibular bicuspids multiple foramina may also occur



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The Mandible.4 Mental Ridge

-Definite linear structures that appears an inverted Vshaped radiopacity and may be superimposed on incisor

roots



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The Mandible.5 Submaxillary Fossa

;Radiolucent area beneath the mandibular molar rootsoccupied by the submaxillary salivary gland



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The Mandible.6 Mandubular Canal

Horizontal linear radiolucent band bordered by two,radiopaque lines beneath the first second and third

molar roots



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The Mandible.7 External Oblique Ridge

Radiopaque linear structure immediately superior tothe mandibular canal



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The Mandible.8 Confusing Areas

Mental Foramen mistakenfor a cyst when it is

superimposed over the apexof one of the bicuspids

Submaxillary Gland Fossamistaken for a bone

rarefaction



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General Landmarks.1 Alveolar process

Trabecular bone that surrounds the roots of the teeth



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General Landmarks.2 Alveolar Bone and Crest

( )Alveolar Bone Lamina Dura cortical bone that

immediately surrounds the;teeth radiopaque line of

uniform thickness

Alveolar Crest mostcoronal portion of thealveolar process that

occupies the space between;adjacent teeth normally.within 1 or 1 5 mm above

the CEJ



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General Landmarks.3 Periodontal Space

Radiolucent line between the root of the tooth and the

;alveolar bone represents the space occupied by the

periodontal ligament


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Complete Mouth

Radiographs

Complete Mouth Radiographs


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La m in a D u ra co n tin u ity a n dth ickn e ss

C o n tin u o u s lin e a ro u n d th e ro o ts o f th e te e th a n d o v e r th ea lve o la r cre st

B e st se e n in p e ria p ica lfilm sPathologie:s

. 1 Lack of continuity ActivePeriodontal Disease

.2 Break in the continuity at theapical area inflammatory

reaction of the periapicaltissue of a nonvital pulp

.3 Interruption at the lateralaspect of the root of a tooth

extension of periodontal disease

. 4 Resorption Acute periodontaldisease

.5 Disappearance with noperiodontal pocket or abscess

formation on the lateral rootsurface ,trauma lateral root

cyst formation or neoplasm

1

2

3

4 5

C l h di h


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Pe rio d o n ta l sp a ce s v a ria tio n sin w id th

. .S p a ce a v e ra g e s fro m 0 1 8 0 2 5 m m( )Kronfeld

Pathologie:s

.1 Widening of the cresttraumatized tooth fromocclusion

.2 Excessive widening at the-apical region

periapical reactions ofnon vital pulps

.3 Widening in the bifurcation

and trifurcation of molars advance periodontaldisease

2

3

C l M h R d i h


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Level of alveolar crest in relation to thecementoenamel junction

normal level of the alveolar creast is 1 to 1.5mmapical to the cementoenamel junction.

The level of the alveolar crest is a very importantconsideration in the selection of teeth to be retained

in periodontal treatment and in the selection ofabutment teeth for prosthetic appliances.

The terms horizontal and vertical have been

applied loosely to the two patterns of bone loss in thereduction of the alveolar crest.

C o m p le te M o u th R a d io g ra p h s

C l M h R d i h


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Periapical Radiolucency

A periapical radiolucency usually indicates a nonvital tooth.

Periapical radiolucencies may be the result of a chronicperiapical granuloma, radicular cyst, periapical abscess,or neoplasm.


C l t M th R d i h


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Pathologic conditions of theteeth.


P th l i C d iti f T th


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Calcification of the Pulp

occurs for the most part in the incisor and cuspid teeth.

In most cases, trauma is involved.

Pa th o lo g ic C o n d itio n s o f Te e th

P th l i C d iti f T th


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Pulp Stones

Pulp stones are frequently seen in various places in thepulp.

Pulp stones, as well as the amount of secondary dentin thatcan be seen radiographically in the pulp canals, are of

importance when a tooth is being evaluated for rootcanal therapy.




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Caries

most common pathologic change seen radiographically inthe teeth.


P th l g i C n d iti n f T th


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Attrition

Occlusal attrition may be confusedwith extensive caries in theradiograph.




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Calculus projections near the proximocervical aspect of the tooth

or as a linear radiopaque line running from themesial to the distal aspect of the tooth andrepresenting the buccal or lingual aspect,

Calculus that has been altered in contour with a scaler

but incompletely removed loses its angularapprearance radiographically ang appreas as asomewhat rounded elevation along the root surfaceof the tooth.




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Conditions caused by overhangingrestorations.

Easy to detect in the radiograph when the filling material isradiopaque.

Buccal/lingual overhanging are difficult to detectradiographically .




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Resorption

Internal/external When resorption has occurred to a

somewhat advanced degree atthe apex, it may give theimpression that the apical portionof the tootht has been cut off.

Root resorption that occurs in anarea where the periodontalmembrane is intact is almostalways caused by trauma of sometype from occlusion, othodontic

treatment, or prosthetic abutmentoverload.




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Internal Resorption

Internal resorption less frequent that external resorption.

Always occurs somewhere along the pulp canal or adjacentto the pulp chamber.

radiolucency and maybe confused with dental caries if thethe coronal pulp is involved.




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Hypercementosis

Excessive cementum deposition on the roots of the teeth.

Easily detected radiographically




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Dilaceration

Angular curvature of the roots

Readily detected on periapical radiographs.

Common area: apical third of the maxillary lateral incisors.

Important consideration in the diagnosis of teeth that

require endodontic treatment or extraction.




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Abnormalities of Root Form

Important considerations in the Selection ofthe abutment teeth for dental prosthesis.

Root form and length Number of roots on teeth Portion of the root supported by bone

-- discernible by on properly taken periapical

radiographs

Important considerations in EndodonticTreatment

The degree of calcification of the radicularportion of the pulp canal.

The degree of curvature of the pulp canal. The number of pulp canals present




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Pathologic Condition

of the Jaws

O

Pa th o lo g ic C o n d itio n s o f Ja w s


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Osseousradiolucencies

The ff. should consider:

1. Location and extent of the radiolucency in reference of the teeth,normallandmarks,and anatomic region -it is important to note wether a radiolucent zone is associated

with an area from which teeth has been extracted or are congenitallyabsent. Certain pathologic conditions of the jaws have tendency tooccur in in a certain area of either jaw or one jaw in particular.

-extremely important in considering the type of treatment andthe prognosis

2. Relative degree of radioluscency -depends upon the nature of the pathologic process3. Presence or absence of radiopaque areas or lines in the

substance of the lesion

- ossification center or sequestra.4 The nature of the borders of a lesion -radiolucency relates in some degree of the growth

characteristics of certain lesions of the jaws.


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4 The nature of the borders of a lesion

-radiolucency relates in some degree of the growth characteristics ofcertain lesions of the jaws.

5. Apparent effect of the process that is producing radioluscency on the teethand the anatomic landmarks.

-that cause root resorptionof the teeth adjacent to,or involved in the

process. Effects on landmarks such asobliteration of normal detail or expansionof normal boundaries of the jaws must also considered as evidence ofpathologic proce of an extensive and serious nature

6. Possible origin of the lesion - determine from its location and general characteristics.

A Osteolystic



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A.OsteolysticlesionI. CYST - are ostoelystic lesion that they destroy bone by expansion

vary in sized.

- very radiolucent,limited buccolingual spaces in the jaws usually little orno normal trabecular pattern superimposed of the cyst.the central portion may showssigns of septal separation of locules or compartments.

-Cyst other than radicular arise from residual epithelium lines of fusion of thejaws and are known as fissural cyst.

Nasopalatine cyst Residual cyst



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II. Neoplasm a. Benign 1. Odontogenic neoplasm- those do not have the ability to form calcified

tissue Ameloblastoma-usually arise in the mandibular third molar

2. Non-odontogenicneoplasm- their general characteristic may be similar tothose attributed to a multilocular cystic lesion or a soft odontogenic tumor.

A.Osteolysticlesion


l i


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b. Malignant

1. primary malignant neoplasm - rapid growth and their abilty to

invade surrounding tissue andbecome wide spread. Arise fromconnective tissue.

- the primary radiolucent leionare usually fibrosarcoma and multiplemyeloma

Fibrosarcoma- widespread or diffuseinvolvement. Often punched-out

2. Secondary - involve by local invasion or by

metastasis, epithelial origin 3. Endocrinopathic bone dysplasia - seen in endocrine dysfunction

result of Hyperparathyroidism.

Histologic findings must be supported

A.Osteolysticlesion



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B. Systemic disease

-produceradiolucency includeeosinophilic granuloma andHand-Cristian disease.

-the radiolucencentzone is not trabeculated and

show some angularity of theoutline. Often teeth areinvolve and radiographicallylost of bony support.

-Hand-Schller-

Christian diease involvedeveloping teeth, resultingand destruction malformationof the follicle



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D. Residual postoperative osseous defect -seen after extraction of mandibular third

molars. - incomplete repair of osseous defect in the

maxilla result round radiolucent area that is well

defined and surrounded by normal bone.

C. Osteomyelitis-suppurative inflammatoryprocess,accompanied bychanges in radiolucencyin its earlier stages whiledestroyed.- bone appears to be

mothened, and zones ofradiolucency surround islandsof necrotic bone or sequestra.

-later stages show newbone formation with areasof destruction.



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II. Osseous Radiopacities ff. should be consider in evaluating radiopacities

1. Location and extent

2. relative degree of radiopacity3. Variations in radiopacity within the lesion

4. Nature of the area immediately surrounding the radiopacity and

5. Possible origin of the lesion A. Tumors 1. Odontogenic -hard odontomas.itis produce by a calcified mass made

up of enamel,dentin,and cementum. -relative degree is variable throughout the mass. The

enamel in the mass is more radiopaquethan the dentin orcementum

- degree of involvement varies from 1cm.



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Enamel pearl-misplaced spherical masses of enamel thatappear at the cervical areas of teeth especially in thetrifurcation and bifurcation areas of molars. pearls are samedegree of radiopacity and relatively greater opacity to dentinand cementum.

Cementoma- irregular radiopaque mass involving the apex ofone or more teeth.



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2. Non-odontogenic 1.Bone whorls-islands of

compact bone reffered to cleroticbone or bonescars. Irregularoutline and clear cut margins.

2.Enostoses- inwardgrowth, similar to bone whorls

Exostoses- outwardsovergrowths of bone include toriinthe mandible andmaxilla. Appears increasedradiopacitysuperimposed on theroots of the mandibularpre-molars.



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B. Foreign bodies1. Root tips-root tips usually

associated with edentulouarea. May or may notsuroundedby thin radiolucentline comparable to theperiodontal sp ace.

2. Metallic objects- as result of

frequent accidentaldeposition of amalgamin a extraction socket.

3. Silver amalgam fragments-appear a small granularradiopaque deposits or large

angular pieces.



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C. Bone dyplasia Include Leontiasis osea and osteopetrosis Generalized radiopacity of the jaws- generalized obliteration of the

marrow spaces by osteosclerosisshould suggest to the examiner a

generalized bone dysplasia such as leonista osea and osteopetrosis.

III. Combination Osseous radiolucency and radiopacity1. Location and extent

2. relative degree of radiolucency3. relative degree of radiopaque4. variations in the radiopacity within the radiopaque part of the area in

question5. nature of the borders of the areas in question6. apparent effect of the lesion on the teeth and anatomic landmarks

7. possible origin of the lesion



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A. Neoplasm 1. Benign a.Odontogenic b.Non-odontogenic

2. Malignant- primary B. Bone dysplasia -that cause a combination of RO & RL are generalized process Pagets diease or oteites deformansgeneralized process that may affect

the jaw in its involvementof the bones of the head . Usually descrbed as cotton wool

Bone enlargement, hypercementosis and resorptiom of teeth mayseen if jaw is involve



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Fibrous dysplasia- characterizedradiographically only by achange In trabecular pattern

C. Osteomyelitis D. Foreign bodiesIV. Other dental findings impacted

teeth, supernumerary teeth, root

canal fillings


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POSTERIOR BITE-WINGRADIOGRAPHS

Po ste rio r B ite w in g


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are used to:1. determine the continuity of the lamina dura at the

alveolar crest- it is less difficult in posterior bitewing radiographs than

periapical radiographs- recognition of early periodontal disease is aided by

careful inspection of the lamina dura

2. estimate the alveolar crest level in relation to CEJ

Po ste rio r B ite w in g

R a d io g ra p h s

Po ste rio r B ite w in g R a d io g ra p h s


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3. evaluate tooth crown shape and formative defects

of the crown- the level and the vertical lenght of the contact or the lack

of a contact between two adjacent posterior teeth are

detemined through bitewing radiograph- local formative defects such as hypoplastic pits andalteration of crown form can be seen readily



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4. determine pulp size and degree of calcification

-pulp size determines thetype of restoration that can

be placed in a tooth- degree of pulpal calcificattion representsd the

response of the pulp to occlusal functions,restorations, and dental caries



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5. evaluate existing restorations

-marginal fit, recurrence of dental caries,adequacy of contact points, and depthinvolvement are important factors in

examining restorations.



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6. locate calculus

- interproximal subgingival calculus appears asspurlike projection on the proximal surface of a

tooth- buccal or lingual surface calculus has linearappearance- but not all calculus can be seen radigraphically,

bitewing is just supplemental



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7. locate carious lesions

- interproximal carious lesions that have progressedthrough the enamel to involve the DEJ are best viewed

through bitewing radiograph- recurrent caries are may be detected more readily- should be inspected in a routine manner, the maxillaryteeth should be thoroughly inspected in sequence,followed by mandibular teeth


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SUPPLEMENTAL RADIOGRAPHS

S u p p le m e n tal R ad iog rap h s


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Indications:

- suspected bone fracture- salivary calculus is suspected- extent of radiographic lesioncannot bedetermined by means periapical radiographs- the exact location of a radiographic lesion, foreign

body, or tooth cannot be determined from

periapical radiographs- the patient is unable to tolerate intraoral films- suspicion of TMJ changes



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Types:1. Occlusal films

a. Max. and Man. topographic occlusal viewsb. Max. and Man. anterior occlusal viewsc. Max. posterior occlusal views

2. Lateral films of the body of the mandible

3. Lateral film of the condyle4. Temporomandibular joint films5. Panographic films



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The basic requirement for children is posteriorbitewing radiograph, supplemented by lateral films of

the jaw and anterior radiographs.

Interpratation of radiographs require additionalconcern that the permanent tooth buds are present.

R a d io g ra p h s fo r C h ild re n


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Hazards to the patient.

It is well established that the routine

dental radiographs taken from diagnosticpurposes do not endanger the patient, when aproperly filtered x-ray machine, a diaphragm tolimit the size of the x-ray beam and fast x-ray

film are used.

D a n g e rs Fro m R a d ia tio n

D a n g e rs fro m R a d ia tio n


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Hazards to the dentist.

Dentists are subject to exposure in varying quantities

of radiation.

Adequate protection from exposure is easily obtained

by proper shielding and properr use of x-ray machine.Whenever possible, a lead-lined shield should be installed in

the office, behind this the dentist is completely protected.

g5 - radio graphic examination

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