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Interpreting Radiographs

Interpreting Radiographs. What to Look For. Dental caries Periapical pathology Calcified pulps Changes in alveolar bone pattern Alveolar bone height. What to Look For (Cont'd). Etiologic agents that promote dental disease Overhanging margins on restorations Calculus Open contacts.

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Interpreting Radiographs

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  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). Cervical Burnout 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

  11. Alveolar crests more pointed anteriorly

  12. Corticated alveolar crests

  13. 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).

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

  15. Periodontitis Involvement: Localized Generalized

  16. 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

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

  18. Gingivitis No bone loss No radiographic signs

  19. 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

  20. Earlymoderate adult periodontitis

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

  22. Moderate adult periodontitis

  23. Severe adult periodontitis

  24. Severe adult periodontitis

  25. Severe adult periodontitis

  26. 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.

  27. Gold crowns, amalgams

  28. Retention pins

  29. porcelain crowns

  30. crown crown amalgam cast post gutta percha silver points

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