IOPA INTERPRETATION.ppt

IOPA INTERPRETATION BY DR. PRASHANT PATIL

1. INTRA-ORAL PERIAPICAL
RADIOGRAPH -
INTERPRETATION
Dr. PrashantPatil
Professor and Head
Oral Medicine Diagnosis & Radiology

2. HISTORICAL PERSPECTIVE

3. Early history of x-rays

4. Wilhelm Conrad Roentgen
•Received PhD in 1869 from University of
Zurich
•Working with Crookes-Hittorfvacuum tube
in his laboratory at the University of
Wurzburg, Germany
•November 8, 1895 (mark this date)

5. HITORICAL PERSPECTIVE
ThediscoveryofXraysin1895wasthe
beginningofarevolutionarychangeinour
understandingofthephysicalworld

6. Mrs. Roentgen's hand?

7. POST X-RAY DISCOVERY
•X-ray studios
immediately
opened in many
cities
•"Bone Portraits" of
healthy individuals

8. First Dental Radiographs!!
First person to take
Intraoral radiograph
in 1896.
Dr C. EDMUND
KELLS (USA)

9. WESTON A PRICE
[ 1870 –1948 ]
•INTRODUCED
BISECTING
ANGLE
TECHNIQUE

10. INTERPRETATION
“Unravelingoruncoveringalltheinformation
Containedwithintheblack,white&grey
Shadows”

11. Only 2 colors

12. What shadows we are and what
shadows we pursue !

13. If You Look Hard Enough You
Can Find IT on The
Radiograph.

14. Golden Tips in Interpretation
•The Viewing Environment
•Write Reports
•If in doubt (re) shoot !
•Co-relate Clinical Findings

15. Golden Tips (continued….
•Locate Landmarks
•Keep a check list
•Look for more………….
•Evolve a differential Diagnosis

16. QUALITY MATTERS

17. Choice of Radiograph

18. Basic principles
•Multiple views needed
•Clinical and radiological diagnosis may not
always match
•You cannot comment on certain Things

19. Limitations of radiography
•2 D representation of a 3D object
•30% -60%decalcification needed to show
appreciable changes
•Soft tissue cannot be seen
•Activity of the disease cannot be studied

20. Basic Principles _Conservative
and Endodontics
•Buccal caries , Occlusal caries , cannot be
identified easily
•Secondary decay may be equivocal
•Proximal caries is picked up better by
radiography ;esp. Bitewing
•Status of the pulp cannot be studied ;only
inferred

21. Basic Principles _Conservative
and Endodontics
•All roots and root canals may not be
seen in a single radiographs
•Some canals of Posterior teeth may not
be seen , they are not necessarily non-
negotiable
•Current activity of periapical disease
cannot be studied ; sometimes can be
inferred .

22. Basic Principles _Periodontics
•Gingival health, pocket depth and
current activity of the disease cannot be
studied .
•Bitewing radiographs are the best to
evaluate early changes
•Paralleling radiographs are more
predictable in assessing bone level

23. Basic Principles _Periodontics
•Bone level is always lesser than what is
seen
•Abscesses will not show up on
radiographs in the acute stage
•Angular bone loss is difficult to assess in
its entirety by radiographs

24. Basic Principles _Conservative
and Endodontics
•Can you distinguish buccal caries from
occlusal caries ?
•Can you distinguish an actively
progressing carious lesion from a lesion
which is a good for conservative pulp
therapy ?

25. Xray Findings are Rarely Final
•The Classical / Patho Gnomonic
•The Usual

26. Normal v/s Abnormal
•Check Opposite side
•Identify Landmarks
•Correlate Clinically ( Know Your Strength)

27. OBJECTIVES
Presence or absence of disease
Nature & extent of pathology
Percolating to a list of DD
Evaluation & follow up of Treatment

28. REQUIREMENTS FOR
RADIOGRAPHIC INTERPRETATION
Optimal Viewing Conditions
Understanding The Nature & Limitations Of
the Image
Normal Anatomical Structures & Variations
Radiographic Appearances Of Pathologies

29. REQUIREMENTS FOR
RADIOGRAPHIC INTERPRETATION
Systematic Viewing Of Entire Image
Description Of Lesion
Comparison With Previous Images
Drawing Conclusion

33. LIMITAIONS OF IOPA
30-60% rule
2D representation of a 3D object
Cervical Burnout
Mach Band effect
Not effective for occlusal caries
Secondary caries may be missed
Solution –2 views at right angles to one
another

34. •Superimposition
•Radiation Hazard
•Cannot differentiate blood ,pus ,fluid
•The Bother of films and chemical
processing
•Soft Tissue is not seen
•30 % decalcification needed to observe
change s
•Morphology not disease activity studied

35. PERCEPTION OF RADIOGRAHIC
IMAGE
Effect Of Partial Images
Effect Of Contrast
Effect Of Context

36. IDEAL RADIOGRAPH
Acceptable definition
Include entire area of interest
No proximal overlapping
Endodontic purpose –well exposed with
good contrast
Periodontal purpose –under exposed to
avoid burnout of thin Alv. crest

37. PERIAPICAL RADIOGRAPH
Bitewing Vs Paralleling Technique

38. SYSTEMATIC VIEWING
Assessment of crown
Assessment of root(s)
Apical Tissues
Periodontal Tissues

51. Localize the abnormality
Assess the periphery and shape
Assess the internal structure
Effects on surrounding structures

54. Periodontal diseases
UseahigherkVpsetting(90kVp),insteadof
thecustomary70kVp,andreducethemAs
–widergrayscale(allowssubtlechangesin
bonedensity,aswellassofttissueoutlines)

55. Normal Anatomy
•Healthy bone height is within 1-1.5 mm of
the CEJ
•Anterior -the alveolar crest is pointed
•Posterior-the lamina dura and the crestal
bone form a box, with sharp angles
•PDL space varies along the length of the
roots. Wider at the apex and alveolar
crest, and narrower in the mid root areas.

56. Normal Anatomy

57. Normal Anatomy

58. Local Factors contributing to
periodontal disease
Caries Overhanging Restorations Open contacts
Calculus

59. Periodontal disease activity
Bone loss seen on radiographs is an
indicator of past disease activity

60. early Periodontitis
•Loss of sharp angle between the LD &
Alv crest (rounded off) –posterior
•Loss of spiking in the anterior
•Slight loss of bone height (<1/3)
•Subtle changesin density of root
structure (more radiolucent) indicate bone
loss on buccal or lingual side

61. early Periodontitis
Early vertical bone loss