Radiographic

1. Radiographic Interpretation

2. Dental Radiography • Questions • How does the radiographic examination contribute to the detection of caries? • What factors may influence caries interpretation? • What is the radiographic appearance of: incipient, moderate, advanced and severe caries?

3. Detection of Caries • Clinical examination and radiographs are necessary to detect dental caries • Radiographs enable the dental professional to identify carious lesions that are not visible clinically • It also allows the dental professional to evaluate the extent and severity of carious lesions

4. Clinical Examination • Some carious lesions can be detected simply by looking in the mouth, and others cannot • The mirror can be used to reflect light, allow for indirect vision, and retract the tongue • The explorer can be used to detect changes in consistency in pits, grooves, and fissures of teeth

5. Clinical Examination • Color changes may be observed • Occlusal surfaces may show dark staining in fissures, pits, and grooves • Smooth surfaces may exhibit a chalky white spot or opacity • An interproximal ridge may appear discolored

7. Radiographic Examination • A carious area appears radiolucent because decreased density allows for greater penetration in the carious area • The bite-wing radiograph provides the dental professional with the greatest amount of diagnostic information • A periapical radiograph taken with paralleling technique may also be used

8. Factors Influencing Caries Interpretation • Radiographs must be of diagnostic quality • Examples may include • Improper horizontal angulation on a bitewing film • Errors in exposure with improper contrast and density

9. Interproximal Caries • Interproximal • Between two adjacent surfaces • Typically seen on dental radiographs at or just below the contact point • As caries progresses through the enamel, it typically assumes a triangular configuration • When it reaches the DEJ, it spreads laterally and progresses through dentin • Classified as incipient, moderate, advanced, and severe

14. Incipient Interproximal Caries • Extends less than halfway through the thickness of enamel • An incipient or Class I lesion is seen only in enamel

17. Moderate Interproximal Caries • Extends more than halfway through enamel but does not involve the DEJ • A moderate or Class II lesion is seen only in enamel

20. Advanced Interproximal Caries • Extends to or through the DEJ and into dentin, but does not extend into dentin more than half the distance toward the pulp • An advanced or Class III lesion affects both enamel or dentin

23. Severe Interproximal Caries • Extends through enamel and dentin more than half the distance toward the pulp • A severe or Class IV lesion involves both enamel and dentin and may appear clinically as a cavitation in the tooth

26. Occlusal Caries • Caries that involve the chewing surface of posterior teeth • “A thorough clinical exam is the method of choice for the detection of occlusal caries” • Early occlusal caries is difficult to see on a dental radiograph

31. Incipient Occlusal Caries • Cannot be seen on a dental radiograph • Must be detected with an explorer or DiagnoDent

32. Buccal and Lingual Caries • These are difficult to detect on radiograph because they are superimposed on tooth structure • If seen on film, they appear as a circular radiolucent area

35. Root Surface Caries • Ivolves only the roots of teeth • On radiograph, it appears as a cupped-out or crater-shaped radiolucency below the CEJ • Early lesions may be difficult to detect on radiograph

38. Recurrent Caries • Occurs adjacent to an existing restoration • It appears as a radiolucent area just beneath a restoration • It is most often located beneath the interproximal margins of a restoration

40. Rampant Caries • Advanced and severe caries affecting a number of teeth • Associated with children with poor diets and adults with decreased salivary flow