Radiographic Diagnosis of
Dental Caries
Caries
Bitewing Film primarily
Periapical film also used
Low kVp, high contrast
(short scale)
Approximately 50 % demineralization is required for radiographic detection of a lesion.
The thickness of the tooth buccolingually masks the carious lesion when it is small.
The actual depth of penetration of a carious lesion is deeper clinically than radiographically.
Proximal caries susceptible zone
caries
Factors affecting caries diagnosis:
Buccolingual thickness of tooth
Two-dimensional film
X-ray beam angle
Exposure factors
Radiographic Caries
I
M = Moderate I = Incipient
A = AdvancedS = Severe
S
AMA
IncipientInterproximalCaries I
Up to half the thickness of enamel
Cone-shaped radiolucent area
Treat or no treat ?
Usually not restored:* Unless patient has high caries activity
IncipientInterproximalCaries
I
Incipient
ModerateInterproximalCaries M
More than half-way through the enamel (up to DEJ)
Moderate
AdvancedInterproximalCaries AA
From DEJ to half-way through the dentin
Advanced
Advanced
Advanced
Advanced
IncipientModerateAdvanced
SevereInterproximalCaries
More than halfway through the dentin
S
Severe
Anterior interproximal caries can usually be diagnosed by directing bright light through the contact areas.
Transillumination
Must have penetrated into dentin
Diagnosed from clinical exam
Radiographs are not a reliable diagnostic aid for the detection of occlusal caries.
Occlusal Caries
The apex of the triangle is toward the outer surface of the tooth and the base is at the dentino-enamel juncition.
Occlusal Caries
Occlusal
Occlusal
Use clinical exam
Can’t determine depth
Appears as round dots
Buccal/Lingual Caries
Buccal/lingual
Older patients with recession or periodontitis
Root Caries
Root caries
Root caries
Cervical burnout appears as a Cervical burnout appears as a collar or wedge-shaped radiolucency on the collar or wedge-shaped radiolucency on the mesial and distal root surfaces near the CEJ of a toothmesial and distal root surfaces near the CEJ of a tooth. . The tissue density at the cervical region of the tooth is less than the regions The tissue density at the cervical region of the tooth is less than the regions above and below it. (variable penetration of X-ray)above and below it. (variable penetration of X-ray)
Burn-Out:Burn-Out:*Mainly located at the neck of the tooth (Demarcated above *Mainly located at the neck of the tooth (Demarcated above by enamel cap or restoration and below by the alveolar by enamel cap or restoration and below by the alveolar bone)bone)**Usually all teeth are affected esp. smaller premolars.**Usually all teeth are affected esp. smaller premolars.***it is more obvious when the exposure factors are ***it is more obvious when the exposure factors are increased!increased!
Root caries may be confused with cervical burnout
Radiolucency seen above left (arrow) disappears on periapical film of same tooth (above right).
Cervical burnout
Anterior Cervical Burnout
bone level
cervical burnout area
Cervical burnout in the anterior region due to gap between enamel (red arrows) and alveolar bone over root.
May be due to high caries rate, poor oral hygiene, failure to remove all the caries, defective restoration or a combination.
Recurrent Caries
Is not always easy to detect radiographically:
1.Location of caries lesion relative to restoration.
2.Angulation of X-ray beam.
Recurrent Caries
Recurrent caries(red arrows)
Recurrent caries
Recurrent caries
Rampant Caries
* Usually found in children and teens with poor diet and inadequate oral hygiene.* Patients with xerostomia
Found in head/neck radiation therapy patients with xerostomia
Fluoride used for control
Radiation Caries
Before radiation
1 year after radiation
Mach BandOptical illusion giving appearance of increased radiolucency at junction of differing tissue densities
Periodontal Disease
Periodontal ligament attachment and alveolar bony support of the tooth have been lost.
Junctional epithelium migrates apical to the CEJ.
Bitewings best for diagnosis. Some feel that paralleling PA’s are best.
Higher kVp recommended (long scale, low contrast).
Compare images from differentvisits (using same technique).
Periodontal Disease
• Two-dimensional representation of a 3-D anatomic structure.
• Superimposition of the bone and tooth structures
* Relationship of hard to soft tissues not evident
Limitation of Radiographs
* Presence or absence of periodontal pockets.
* Early bone loss (<3mm) is not evident.
* Early furcation involvement is not evident.
Limitation of Radiographs
* PA: X-ray beam alignment will obliterate the presence of extent of furcation involvement.
* Facial and lingual aspects of alveolar bone will be superimposed over the furcation.
Limitation of Radiographs
Early radiographic changes:
1.Crestal irregularities.2.Triangulation3.Interdental septal bone changes
Benefits
Involvement:
LocalizedGeneralized
Periodontitis
Periodontitis
Normal Anatomy:
Alveolar crest corticated
1-1.5 mm from crest to CEJ
Parallel to line between CEJ’s
Crest is pointed anteriorly
Corticated alveolar crests
1-1.5 mm
CEJ
Alveolar crests morepointed anteriorly
Contributing Factors• Occlusal trauma• Open contacts• Overhangs, poor contours• Calculus• Post-extraction defects• Systemic involvement (diabetes, blood disorders, hormonal changes, stress, AIDS)
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
Gingivitis
No bone loss
No radiographic signs
Mild Adult Periodontitis
Loss of cortical density
Rounding off of junction between alveolar crest and lamina dura
Blunting of crest anteriorly
Mild adult periodontitis
Horizontal bone loss or vertical osseous defects
Total extent of bone loss not evident
May have slight mobility
Moderate Adult Periodontitis
Moderate adult periodontitis(red arrows point to calculus)
Moderate adult periodontitis
Severe Adult Periodontitis
Tooth mobility
Extensive horizontal bone loss or vertical osseousdefects
Furcation involvement
Severe adult periodontitis
Severe adult periodontitis
Severe adult periodontitis
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.
Restorative Materials
Gold crowns, amalgams
Retention pins
porcelain crowns
Ceramic Crowns
crownamalgam
crown
silver pointsgutta percha
cast post
Red arrows point to basesGreen arrow indicates recurrent caries with fractured restoration
Compositesold new
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