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Radiographic Examination
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2 major considerations:
1. The clinical decision to orderradiographic studies
2. The selection of appropriate numberand type of views necessary toconduct the examination
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oal:
! to maximi"e the yield# minimi"e the ris$!
• %ll radiographs should be obtained with thecurrent standard of care.
• The type of radiographs# the number of &lmsta$en# the date on which they are ta$en andthe diagnostic data obtained should bedocumented in the progress notes.
• Radiographs should be retained as part ofthe patient's dental record.
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• (efore any radiographic procedures#the clinician is further responsible forobtaining the patient's )*+,E+T.
• -mplied consent for procedures withfew $nown ris$.
• /ritten 0 for patients with potentislris$ pregnant and child patients
•
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The new patient
• )hild with primary dentition – osterior bitewings
• )hild with ixed dentition – osterior bws
– ,elected %s 0 evidence of periapical orperiodontal pathosis
–
% with *cclusal – anoramic with posterior (/s
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• %dolescent with permanent dentitionprior to the eruption of 3rd molars – ,hift from proximal caries to pits and
&ssures
– osterior (/s and selected as
– anoramic 0 for evaluation of the third
molars
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• %dult dentate patients – osterior (/s and selected as
– Routine full mouths not indicated unless
the patient presents with clinicalevidence of generali"ed dental diseaseor past extensive dental care
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• %dult edentulous – 4nless indicated5
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RADIOGRAPHIC EXAM OF THE RECALL PATIENT
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+o clinical caries and no evidence ofhigh ris$ factors for caries
• )hild with primary dentition
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CLINICAL CARIES ANDEVIDENCE OF HIGH-RISK
FACTORS FOR CARIES
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... rowth and 6evelopment
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... rowth and 6evelopment
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... rowth and 6evelopment
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Review of R%6-*R%7-)
-+TERRET%T-*+
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,ystematic viewing of the entire radiograph:8suggested systematic approach9
1. eneral overview of the entire
radiograph2. The teeth
3. The apical tissues
. The periodontal tissues;. The body and ramus of the
mandible
<. *ther structures/haites et al
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White and Pharaoh
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• -n no instance should a clinicianarrive at a de&nitive diagnosis on thebasis of radiographic &ndings alone.
• The radiographic diagnosis mustcorrelate with the historical pro&le#physical examination# and when
indicated# with the clinical laboratorydata and microscopic analysis.
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• Radiolucent lesions – ,ome measure of bone destruction
• Radiopa=ue – >re= with slowgrowing lesions? gen non
destructive? E@)ET if associated with aradiolucent area
• ixed – ostly with &broosseous lesions0 which
resorb and produce bone
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• 4nilocular vs multilocular
– ultilocular suggests slow growing neoplasm
– ,oapbubble appearance fre= ameloblastoma or myxoma
• eripheral outline
– 6istinct? rough irregular or indistinct
– /ith lamina dura or radiopa=ue sclerotic border slowgrowing ? sugg of most cystic lesions
– 6e&nite# relatively smooth# easily de&nable margin solidgranulation tissue develops in bone
– Rough # irregular or indistinct margins tissue growth orspread of infection? or malignancy
– Radiolucent around radiopa=ue line tissue capsule odontomas
– Easily observed diAerentiation 8radiopa=ue9between massand surrounding bone enostosis or a sclerotic bonelesions
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• Trabecular pattern – round glass &brous dysplasia?
paget's disease? hyperparathyroidism
– )ottonwool
• 6imensional changes – Expansion? resorption? displacement
– Expansive lesions cause a characteristicresponses in the periosteum of overlyingbone• *nions$in? sunburst? of )odman's triangles
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RADIOGRAPHICMANIFESTATIONS OF
COMMON CONDITIONS
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• References: – Terezhalmy . hys evaluation in dental
practice.
– White and Pharaoh – Whaites