Radiographic interpretation

dental radiographic interpretation

1. Radiographic Interpretation ( P eri -apical and OPG) Presented by: Syed M oiz Rafiq

2. Objectives: The students should know the normal anatomy of the tooth under dental radiograph. The students should interpret the pathology of the tooth under dental radiograph.

3. What is dental radiograph ? Dental radiography : It is the art of producing an image or picture for intra-oral or extra-oral structures on a dental film using X-rays.

4. Dental radiographic views I ntra oral : - Peri - apical -Bitewing - Occlusal Extra oral : -OPG - C ephalometry - S ialography

5. P eriapical radiograph

6. Periapical radiograph: It is the most frequently used intra-oral view radiograph, which shows the entire tooth and surrounding structures on the film.

7. Need for prescribing peri -apical dental radiograph Extent of carious involvement in the tooth Interproximal decay under the contact point Periapical pathological changes Traumatic injuries to dento -alveolar process Periodontal diseases

8. Dental anomalies Occult diseases Prognostic assessment during treatment planning Post obturation assessment of endodontic therapy Working length measurement during root canal therapy I mplants

9. N ormal R adiographic A natomy ( Peri -apical )

10. Normal radiographic anatomy

11. ENAMEL Most radiopaque structure DENTINE Slightly lighter than enamel PULP CAVITY Radiolucent lines within the tooth

12. ALVEOLAR CREST Gingival margin of the alveolar process appear as a radiopaque line PDL SPACE Narrow radiolucent line around tooth surface LAMINA DURA Radiopaque line representing tooth socket

13. Radiographic interpretation:

14. Interpretation : Step by step analytical process that provides an exact idea of the clinical problem and helps to achieve the final diagnosis of any particular lesion.

15. The importance of interpretation: Radiographic interpretation is an essential part of the diagnostic process. The ability to evaluate & recognize what is revealed by a radiograph enable us to detect diseases, lesions & conditions which can’t be identified clinically.

16. Steps of interpretation L ocalization. O bservation. G eneral consideration. I nterpretation. C orrelation.

17. L ocalization: Localized or generalized Position in the jaw Single or multiple Size

18. O bservation: All shadows, other than the localized shadows of the normal landmarks must be observed. For example: shadows in crowns, cervical area, roots, restorations, size of root canals, periodontal membrane space, periapical area, alveolar crest, foreign bodies, integrity of bone

19. G eneral consideration : A radiograph shows only 2 dimensions of a 3 dimensional object (width and height but not the depth) Cervical burnout: usually appears as cervical Radiolucency and misinterpreted by caries; this occurs due to less density and more penetration of rays. Pulp exposure: never to be determined from radiograph but only the proximity to the pulp.

20. I nterpretation: Studying the features of teeth and bone: T eeth Study the whole tooth,(crown, root, enamel, pulp), number of teeth and finally supporting structures, (Periodontal membrane space, lamina dura , alveolar crest)

21. B one: Changes in bone may include: 1- Changes in density. 2- Changes in the margin 3- Changes inside the lesion. 4- Effect on surrounding tissues. 5- Changes in structure

22. C orrelation: The final step is to correlate all of the radiographic features to reach a radiographic differential diagnosis. Then to draw a final diagnosis, we have to correlate other data as case history, clinical examination, and other diagnostic aids with the radiographic differential diagnosis

23. Dentine Pulp chamber Root canal enamel Metallic restoration P/d ligament Lamina dura alveolar bone

24. P eriapical radiograph interpretation:

25. E namel Caries of the enamel : appears as radiolucent area

26. Enamel hypoplasia: appears as radiolucent area surrounded with radiopaque margins

27. Amelogenesis imperfecta : all the enamel appear as radiolucent area

28. D entin: Caries of the dentin : appears as radiolucent area

29. Dentinogenesis imperfecta : dentin appear as radiolucent area surrounded by faint radiopaque margins

30. Dense in dente: appears as radiopaque structure within the tooth surrounded by radiolucent margin

31. Internal resorption : radiolucent lines on the apex or lateral side of the root dentin

32. P ulp: Calcification of the pulp: appears as a localized area of radiopacity , if the calcification is generalized it appears as a generalized area of radiopacity

33. Shell tooth: appear as wide pulp chamber

34. C ementum : Hypercementosis : appear as radiopaque area covers the cementum line

35. Cementoma : appears at the apex of the tooth as a radiolucent area in its early stages and converted into radiopaque at the terminal stages

36. P DL space: Normally appear as radiolucent line surround the root surface Widening of the space as a result of osteolytic process e.g , osteolytic osteoma Narrowing of the space as a result of osteoblastic process e.g , scleroderma

37. Pdl space Widened pdl space Narrow PDL space

38. L amina dura : Normally appear as radiopaque clear continuous band covers the alveolar bone i.e , lining the socket and covers the crest of the alveolar bone Discontinuity of the lamina dura indicate pathological changes

39. Lamina dura pathology Normal lamina dura Loss of lamina dura

40. A lveolar bone: Bone resorption either horizontal or vertical Bone loss: Alveolar bone height Alveolar bone health Generalized v/s localized alveolar bone loss

41. Horizontal bone loss Vertical bone loss

42. Metallic restoration : Restoration done on tooth showing radio-opacity.

43. Status of root filling (RCT) : Radio-opacity on the whole pulp chamber can be seen.

44. Dental Implant : Dental implant shows obvious shape and radio-opacity on radiographs

45. Follow up:

46. O PG radiographs :

47. OPG radiographs : An Extra-oral technique which produces a radiograph with wide view of the maxilla and mandible. I t's also known “ pantomography ” “Rotational panoramic radiography”

48. Indications for OPG radiographs: Gross caries Pain related to a whole quadrant Orthodontic assessment Pre-operative assessment Mandibular fractures

49. Cysts, tumors , developmental anomalies Assessment of TMJ Periodontal disease Impacted tooth Implants

50. N ormal Radiographic Anatomy (OPG)

51. O PG Radiographic interpretation :

52. Describing the Lesion 1 . Size 2. Shape 3. Location 4. Density 5. Borders 6. Internal Architecture 7. Effect on adjacent structures

53. Nolla stages ( dentitional status) : Panoramic radiographs shows unerupted tooth and help to diagnose nolla stage and dentitional status.

54. Impacted tooth : Impacted tooth are identified on OPG radiographs easily as the teeth are displacement and tilted.

55. Fractures : Bone displacement, broken mandible gives the diagnosis of fracture.

56. Tumors/lesions: Ill-defined borders with sclerosis and ground glass appearance gives the diagnosis of lesion.

57. Cyst: Presence of radiolucency , corticated borders , locularity and displacement of tooth shows the diagnosis of a cyst.

58. Restoration material : Restoration can be diagnosed by r adiopacity on tooth structures.

59. Thank you!