Endodontic radiography..................

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1. Endodontic radiography BY: Mohamed Salim I brahim. Mohamed Sadiq Kadhim . Mohamed Raad Ghani.

2. . Introduction 01 . Periapical X-ray 03 Types and techniques of dental radiographs 02 CBCT in endodontic treatment 04 Content:

3. INTRODUCTION The dental radiology allows indirect vision to the dentition and supporting structures , and provides standardization of intracanal procedures. As a result ,radiographs are a very important aid for endodontic diagnosis and treatment.

4. RADIOGRAPHIC IMAGE Its depend on the absorption of the x-rays by the different tissues of the body .Tissues that cannot absorb x-rays appear black on the radiograph such as pulp chamber and canals, and periapical abscess, while tissues that absorb X-rays appear white on the radiograph such as, enamel and dentin, bone, gutta-percha, and some restorative material.

5. ENDODONTIC RADIOGRAPHY Radiography help endodontist in two phases ;- Diagnosis -number , size , location and direction of the roots.

6. -canal state Sclerosis and resorption of root canals. Anastomosis between canals.

7. -Periapical tissue There are three important features observed in this region:- The radiolucent line representing the periodontal ligament space. It forms a thin continuous black line around the root outline. In the early stage of acute pulpitis, no changes are visibly evident until after several days to a week later when the infection spreads apically. When this happens, the radiolucent line would become wider and more noticeable. In severe chronic state, the radiolucent area may appear better defined, often surrounded by dense sclerotic bone .But these changes should ideally be supported by clinical findings, as the appearance of the radiolucent line may also be physiological, for example, in people with heavy occlusion.

8. The radiopaque line that represents the lamina dura: loss of continuity is often associated with acute periapical infection that may lead to abscess formation. The trabecular pattern and density of the surrounding bone: mandible and maxilla have different trabecular pattern with the former being relatively thicker and closely arranged together. Area of periapical radiolucency involving bony trabeculae usually indicates active inflammatory process .

9. As a dentists we should keep in our mind that periapical area is subjected to anatomical shadows superimposition. Radiolucent shadows –superimposition of the maxillary sinus, the nasopalatine foramen and the mental foramina. These intrabony cavities reduce total bone density and amplify the radiolucent effect.

10. .Such appearance could also be found at the lateral fossa between upper lateral incisor and canine. The region shows a diffuse radiolucency, which is formed by a depression in the maxilla. Radiopaque shadows– examples include superimposition of the mylohyoid ridge, the body of the zygoma and areas of sclerotic bone such as dense bone islands.

11. Treatment Working length estimation radiograph The objective of determining the working length is to enable the root canal to be prepared as close to the cemento-dentinal junction as possible. There are many radiographic methods of working length estimation. INGLES METHODE 1. Measure the tooth on the preoperative radiograph. 2. Subtract at least 1.omm " safety allowance“ for possible image distortion.

12. 3. Set the endodontic ruler at this tentative working length and adjust the stop on instrument at that level. 4. Place the instrument in the canal until the stop is at the plane of reference 5. On the radiograph, measure the difference between the end of the instrument and the end of the root and add this amount to the original measured length the instrument extended into the tooth. 6. From this adjusted length of tooth, subtract a 1.0 mm "Safely factor" to conform with apical termination of the root canal at the apical constriction. 7. Set the endodontic ruler at this new corrected length And readjust the stop on the exploring instrument .

13. Post Treatment Finished case radiograph post obturation (root canal filling) to ensure the fitness of gutta-percha to the radiographic apical foramen (not over or under extended). if there is any error it is yet simple to do retreatment. over under

14. Follow up radiograph serial radiographs (after 6 months,1year,2years,5years for example) to monitor the periapical area of endodontically treated tooth &make sure of the endodontic treatment success. There are studies documented that endodontically treated teeth present a high proportion signs of healing (89%) at one year after treatment post treatment after 1 year

15. Types and techniques of dental radiographs Radiology is an essential tool in the clinical practice of endodontics because most diseased structures are not visible to the naked eye.

16. Types of radiographs according to placement of film 1-INTRAORAL FILM PLACEMENT Film placed inside the oral cavity and exposed to cathode rays

17. Types of radiographs according to placement of film 1-INTRAORAL FILM PLACEMENT hemostat is used for grasping the film and as a cone positioning and orientation device. The Universal Rinn Endo Ray plastic film holder

18. Types of radiographs according to placement of film 2- EXTRAORAL FILM PLACEMENT This is useful for patients who cannot accommodate or tolerate intraoral film placement, usually because of gagging or trismus .

19. Types of radiographs according to the system used 1- CONVENTIONAL RADIOTHERAPY.

20. Types of radiographs according to the system used 2- DIGITAL RADIOGRAPHY

21. COST DIFFICULTE TO PLACING SENSOR UNCOMFORTABLE TO THE PATIENT ENHANCEMENT OF IMAGE SPEED OBTAIN OF IMAGE AND COMPUTER SATORAGE REDUCED RADIATION ADVANTAGES DISADVANTAGES

22. Techniques of intraoral radiograph 1. Paralleling technique : USED MAINLY FOR MANDIBULAR TEETH 2. Bisecting angle technique: USED MAINLY FOR MAXILLARY TEETH

23. R a diographs have limitation, they are two dimensional shadows on a single film. the buccolingual dimension is absent techniques are available to define the third dimension.

24. CONE POSITIONING exposures taken from varied horizontal or vertical projections give visualization of the third dimension

25. VERTICAL ANGULATION 1-If you have too little vertical angulation <90° Elongation will increase 2- If u have too much vertical angulation >90°Foreshortening will increase 3-In short roots superimposition of the clamp can interfere with the image of the roots. In these cases, an angulated radiograph is recommended. A more negative vertical angulation will elongate the radiographic appearance 4- impinging palatal vault prevents parallel alignment of the film and the teeth. However, if the film angle is no greater than 20°in relation to the long axis of the teeth, and the beam is directed at a right angle to the film, no distortion occurs, The resulting radiograph is still adequate.

26. HORIZONTAL ANGULATION

27. Clark’s rule (SLOB) : the most distant object from the cone (lingual) moves toward the direction of the cone.’’ SLOB rule (Same Lingual, Opposite Buccal)

28. CBCT in endodontic treatment BY:.Mohamed Raad Ghani.

29. MEMBER NAME Work Experience 2013 ~ 2014 Text here Example Text : Get a modern PowerPoint Presentation that is beautifully designed. 2014 ~ 2016Text here Example Text : Get a modern PowerPoint Presentation that is beautifully designed No information about depth Limitation of periapical x-ray

30. MEMBER NAME Superimposed structures 2013 ~ 2014 Text here Example Text : Get a modern PowerPoint Presentation that is beautifully designed. 2014 ~ 2016Text here Example Text : Get a modern PowerPoint Presentation that is beautifully designed 2016 ~ 2019 Text here Example Text : Get a modern PowerPoint Presentation that is beautifully designed. ALLPPT Layout Clean Text Slide for your Presentation 201 ~ 2014 Text here Example Text : Get a modern PowerPoint Presentation that is beautifully designed. Limitation of periapical x-ray

31. Limitation of periapical x-ray Non uniform magnification and distortion 2016 ~ 2019 Text here Example Text : Get a modern PowerPoint Presentation that is beautifully designed. ALLPPT Layout Clean Text Slide for your Presentation

32. What we need?

33. Used for 3D Imaging of teeth and there surrounding structures. the first CBCT unit for dental use in USA was in 2000 . It provide valuable information. CBCT C one B eam C omputed T omography

34. How to take CBCT scan

35. Axial view . Buccal view . Saggital view. When to treat?

36. Axial view . Buccal view . Saggital view. When to treat? When to treat? When not to treat? How to treat?

37. Advantages of CBCT 3D imaging Eliminate superimposition Uniform magnification

38. Fields of view (FOV) It refers to area of anatomy that is captured by the scan 2013 ~ 2014 Text here Example Text : Get a modern PowerPoint Presentation that is beautifully designed. 11 cm X 8cm :full maxilla and mandible 8cm X 8cm : only for mandible or maxilla 6cm X 6cm : part of mandible 4cm X 4cm : for one or two teeth . ALLPPT Layout Clean Text Slide for your Presentation

39. Reduce the effective radiation Reduce scatter Improve the quality Only small FOV CBCT scans are recommended for the diagnosis and management of endodontic problems.

40. How safe is CBCT and how to explain it to patient? AAE/ AAOMR position statements on use of CBCT in endodontic, CBCT should not be used routinely for endodontic diagnosis. Clinicians should use CBCT only when the need for imaging can not be meet by periapical radiographs. CBCT should not be used for screening purpose in absence of clinical sings and symptoms.

41. When to use CBCT? Text Here Text Here Text Here Text Here A B C D Assessment of complex root canal anatomy Atypical anatomy Types of canals Degree of calcification

42. When to use CBCT? Text Here Text Here Text Here Text Here A B C D Assessment of complex root canal anatomy Atypical anatomy Types of canals Degree of calcification

43. When to use CBCT? Text Here Text Here Text Here Text Here A B C D Assessment of complex root canal anatomy Atypical anatomy Types of canals Degree of calcification

44. When to use CBCT? Text Here Text Here Text Here Text Here A B C D Assessment of complex root canal anatomy Atypical anatomy Types of canals Degree of calcification

45. When to use CBCT? Text Here Text Here Text Here Text Here A B C D Assessment of complex root canal anatomy Atypical anatomy Types of canals Degree of calcification

46. When to use CBCT? Text Here Text Here Text Here Text Here A B C D Assessment of complex root canal anatomy Atypical anatomy Types of canals Degree of calcification

47. When to use CBCT? Text Here Text Here Text Here Text Here A B C D Assessment of complex root canal anatomy Atypical anatomy Types of canals Degree of calcification

48. CBCT limitations Presence of metallic restoration Presence of gutta percha

49. References :

50. THANK YOU Insert the Sub Title of Your Presentation