Radiographic Interpretation of Dental Caries

7/27/2019 Radiographic Interpretation of Dental Caries

http://slidepdf.com/reader/full/radiographic-interpretation-of-dental-caries 1/18

1

RADIOGRAPHIC

INTERPRETATION OF DENTAL

CARIES

Chandrika Dubey

Final year



2

CONTENTS

1. INTRODUCTION

2. METHODS – Clinical Examination

– Radiographic Examination

3. RADIOGRAPHIC EXAMINATION TO DETECT DENTAL CARIES

4. RADIOGRAPHIC APPEARANCE OF DENTAL CARIES

5. RADIOGRAPHIC DETECTION OF LESION – Proximal Surface

– Occlusal Surface

– Buccal and Lingual Surface

– Root Surface

– Associated with Dental Restoration6. DIFFERENTIAL DIAGNOSIS

7. ALTERNATIVE DIAGNOSTIC TOOLS

8. LIMITATION OF RADIOGRAPHIC DIAGNOSIS OF CARIES



3

INTRODUCTION

Dental Caries is an infectious microbial disease of the calcified tissue of

the teeth characterized by demineralization of inorganic portion and

destruction of organic substance of tooth.



4

METHODS

1. CLINICAL EXAMINATION – Direct vision of clean and dry mouth

– Gentle probing

– Transillumination

2. RADIOGRAPHIC EXAMINATION

– Bitewing radiography in adults and children

– Periapical Paralleling Technique in adults

RADIOLOGIC EXAMINATION TO DETECT CARIES

Caries process cause due to demineralization of enamel and dentin.Lesion is seen as radiolucent (darker) zone because

demineralization area of tooth does not absorb as many X-Ray

photon as compared to unaffected portion.



5

VARIOUS RADIOGRAPHIC TECHNIQUE FOR CARIES

DETECTION

1. BITEWING RADIOGRAPHIC TECHNIQUE

– Aids in detecting proximal caries

– Distal ends of premolar and molar

– Caries at CEJ

2. PERIAPICAL RADIOGRAPHIC TECHNIQUE – Gross carious lesion

– Changes in apical and interradicular bone

3. OPG

– Multiple carious teeth

– Rampant caries



6

RADIOGRAPHIC APPEARANCE OF CARIES

• ACCORDING TO LOCATION OF CARIES ON TOOTH :-

1. Pit and fissure Caries

• Occlusal

• Buccal and lingual

2. Smooth Surface Caries

• Proximal

• Buccal and lingual

• Root surface caries



7

PROXIMAL SURFACE

• TYPICAL RADIOGRAPHIC APPEARANCE

– Shape of lesion is triangular with broad base at tooth surface spreading along enamelrods.

– They are most commonly found in area between contact point and free gingival margin.

• FALSE INTERPRETATION – Failure to recognize caries of proximal surface because of false-positive outcome

– Cervical burnout, enamel hypoplasia, wear

– When demineralization is not radiographically visible, its c/as false negative outcome

– Overlapping contact points.• TREATMENT CONSIDERATION

– If lesion is present, then no operative t/t. arrest lesion progression by conservativeintervention.

– For cavitated lesion, operative t/t

– Dentinal lesion, either monitor the lesion or operative t/t



8

OCCLUSAL SURFACE

• TYPICAL RADIOGRAPH APPEARANCE

– Occurs often on occlusal surface of posterior teeth.

– Demineralization process occurs on enamel pits and fissures where plaque

accumulates.

– Broad based radiolucent zone, often beneath the fissure.

– Little or no apparent change in enamel.

• FALSE INERPRETATION

– Superimposition of enamel over fissured areas

– Failure to observe thin radiolucency

– Failure to distinguish between occlusal and buccal caries.

– Mach band- when there is sharply defined density difference, such as enamel

and dentin, there may appear more radiolucent region adjacent to enamel.This is

an optical illusion referred to as “mach band” • TREATMENT COSIDERATION

– An occlusal lesion spreads through dentin, it undermines enamel and eventually

masticatory forces cause cavitation.

– Operative treatment is required when cavitation is visible.



9

BUCCAL AND LINGUAL SURFACE

• They often occur in enamel pits and fissures• When small, these lesion are round

• As they enlarge, they become semilunar.

• they demonstrate sharp and well defined border.

• It is difficult to differentiate between buccal and lingual lesion

through a radiograph.

• The clinician should look for a uniform non-carious region of enamel

surrounding the radiolucency. This area represents parallel non-

carious enamel rods surrounding lesion.



10

ROOT SURFACE

• Involves both cementum and dentin and are associated with gingival

recession.

• Exposed cementum is relatively soft and so it rapidly damage

degrades by attrition, abrasion, erosion.

• Root surface caries should be detected clinically.• True carious lesions radiographically will have:-

– Absence of an image of root edge

– Appearance of diffused, rounded inner border where tooth substance

has been lost.



PULPAL CARIES

• The extent of caries to the pulp chamber can be evaluated with a

limited degree of reliability from radiograph.

• If on radiograph, a carious lesion appears to have progressed right

to the edge of pulp chamber, and not in pulp, a dentist should be

forewarned of a possible pulp exposure

11



ARRESTED CARIES

• Incipient or advanced carious lesion may become arrested if there’s

a shift in oral environment.

• TYPICAL RADIOGRAPHIC APPEARANCE

- May appear as small radiolucent area- Appearance of arrested occlusal caries is an open cavity

revealing yellow, brown or black exposed lesion that has

polished surface.

12



13

ASSOCIATED WITH DENTAL RESTORATION

• Carious lesion developing at the margin of an existing restoration

may be termed as SECONDARY OR RECURRENT CARIES.

• Lesion next to restoration can be obscured by radioopaque image.

• Two radioopaque views are made at different horizontal or vertical

angulation in case of multiple restoration.• Restorative material vary in their radiographic appearance

depending upon the thickness, density etc.



14

DIFFERENTIAL DIAGNOSIS

• EROSION CAVITY

– Saucer shaped and have sloping margins.

• NON OPAQUE FILLINGS

– Distinguished by sharpness and uniformity of the margins

• CARVICAL BURNOUT

– Located at the neck of teeth demarcated above by enamel cap andbelow by alveolar bone level.

• INTERNAL RESORPTION

– Margins are well defined and normal margins of pulp chamber areeffaced.

• EXTERNAL RESORPTION – Line of demarcation between adjacent tooth and defective area is sharp.

• HYPOPLASIA

– Several small dark spots are seen.



CERVICAL BURNOUT

• Constricted cervical neck of the tooth, the area between the crown

and root absorbs less x-ray energy than the areas above and below

it.

• This is because of the presence of enamel above the cervical neck

and alveolar bone covering root of this tooth below cervical neck.

• Radiolucent band running across cervical neck of teeth (anterior)

and triangular wedge shaped radiolucency at interproximal cervical

neck of posterior teeth

15



16

ALTERNATIVE DIAGNOSTIC TOOLS

• LIGHT FLUROSCENCE

– Helps to quantify mineral loss on smooth surface

• DIAGODENT LASER

– Helps to quantify mineral loss on occlusal surface

• FIBEROPTIC TRANSILLUMINATION – Helps to quantify mineral loss on proximal surface, but cannot detect

small lesion.

• ULTRASOUND

• DIGITAL FOTI

– Combines fiberoptic transillumination with digital camera

• FLUOROSCENCE



17

LIMITATION

• Carious lesion are larger clinically than they appear radiographically,

• Technique variation in film and X-ray beam position can effect the

image.

• Exposure factors can have a marked effect on overall radiographic

contrast, i.e size or appearance of caries.• Exact site of carious lesion – buccal or lingual cannot be

determined.

• Distance between pulp horn and carious lesion can not be

determined.

• Recurrent carious lesion at the base of interproximal box cannot bedetermined.



REFERENCE

• White and Pharoah – Radiographic Interpretation of Dental Caries

• Eric Whaites – Radiographic Features Of Dental Caries

• Freny Karjodkar – Radiographic Diagnosis Of Pathology Affecting

Jaw

18

Radiographic Interpretation of Dental Caries

Documents

Transcript of Radiographic Interpretation of Dental Caries