Oral Radiology. Dental Caries and Periodontal Disease
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Transcript of Oral Radiology. Dental Caries and Periodontal Disease
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Introduction to Radiological Interpretation Abdul Rahim b Ab Hamid (0813913)
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Objectives of Radiograph Interpretation To identify the presence or absence of
disease To provide information on the nature
and extent of disease To enable formation of differential
diagnosis
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Suggested systematic sequence for viewing this OPG
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Guidelines for interpreting bitewing radiograph
Distal aspect of upper posterior
molar
Consider each upper tooth individually
Distal aspect of upper canine*
Distal aspect of lower canine*
Consider each lower tooth individually
Distal aspect of lower posterior
molar
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Suggested sequence of examining individual tooth
Trace the outline/shape of the pulp chamber (reactionary dentin,pulp stone)
Presence and state of existing restoration (recurrent caries)
Any alteration in dentin density (approximal caries, occlusal caries)
Any alteration in the interproximal enamel density (interproximal caries)
Any alteration in the outline shape eg.possible cavitation
Trace the outline of dentino-enamel junction
CROWN: Trace the outline of the edge of the enamel cap
Note any alteration in the density of root dentin (root caries)
Note any alteration in the outline (cavitation cause by root caries)
NECK/ROOT: trace the outline of the neck and cervical 1/3 of the root of the tooth
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Dental caries & periodontal diseasesAbdul Rahim b Ab Hamid (0813913)
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Dental Caries Common infectious diseases, strongly
influenced by diet and affecting 95% of population
Primarily caused by mutan streptococci including S.Mutans, S. Sobrinus and etc
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Common classification of dental caries Pit or fissure
-occlusal-buccal @lingual pit)
Smooth surface -approximal-buccal or lingual surfaces-root
Recurrent caries
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Methods of diagnosing caries at different sites Thorough, careful clinical
examination using -Direct vision of clean and dry teeth-Gentle probing-Transillumination
Radiographic examination using:-bitewings in adult and children-periapical radiograph
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Rationale and frequency for the use of intraoral radiograph It can reveal carious lesion that
otherwise might go undetected during thorough clinical examination
Frequency decided on the basis of a patients' needs, considering factors of oral hygiene, fluoride exposure, diet, caries history, restorative care and exposure
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Examination from radiograph
Posterior bitewings radiographs are the most useful x-ray projections for detecting caries in distal third of the canine and the interproximal and occlusal surfaces of premolars and molars
Periapical radiographs are useful primarily for detecting changes in the periapical and interradicular bone
Children’s caries radiographic examination should include bitewing films
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Diagrams illustrating the radiographic appearances and shapes of various lesions, EDJ*OPG is not recommended for diagnosis of caries, however they may demonstrate ooclusal caries, particularly in molar better than bitewings
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Radiographic appearance of dental cariesOcclusal caries
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Incipient occlusal caries
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Moderate occlusal caries
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Severe occlusal caries
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Incipient proximal enamel caries
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Moderate enamel proximal caries
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Advanced proximal caries
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Severe Proximal Caries
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Facial, Buccal, Lingual caries
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Root surface (cementum caries)
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Recurrent caries
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Rampant caries in children
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Radiation caries in post radiation patient
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Radiographic appearance of other important shadows Radiolucent cervical burn-out or
translucency The radiopaque zone beneath amalgam
restoration
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Cervical burn-out Artefactual phenomenon created by teeth
anatomy and variable penetration of X-ray beam
Can be explained by considering all the different parts of tooth and supporting tissues the x-ray has to penetrate
Crown-dense enamel cap and dentine Neck-only dentine Root- dentine and the buccal & lingual plates
of alveolar bone
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Cervical burn-out
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Cervical burn-out Diagnostic importance because of its similarity to
the radiolucent shadows of cervical and recurrent caries
Can be distinguished by, Located in the neck of teeth, demarcated above by
enamel cap or restoration and below by alveolar bone level
Triangular in shape, gradually become less appearance towards the centre of the tooth
Affected all teeth usually, especially smaller premolar Root & recurrent caries have no apparent upper
and lower demarcating borders
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Radiopaque zone beneath amalgam It is shown that, with time, tin and zinc
ions from amalgam are released into the underlying demineralized dentine producing a radiopaque zone within the dentine
This may make the normal dentine on either side appear to be more radiolucent by contrast that may simulate the radiolucent shadows of caries and lead to difficulties in diagnosis
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Limitations of radiographic diagnosis of caries Carious lesions are usually larger clinically
than they appear radiographically and very early lesions are not evident at all
Technique variations in film and X-ray beam positions can affect considerably the image of the carious lesion
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Limitations of radiographic diagnosis of caries Exposure factors can have a marked effect on the
overall radiographic contrast and thus affect the appearance or size of carious lesions on the radiograph
Superimposition and a two-dimensional image mean that the following features cannot always be determined
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Limitations of radiographic diagnosis of caries
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Radiographic assesment of restoration The type and radiodensity of the restorative material, e.g.
— amalgam— cast metal— tooth-coloured materials such as composite or
glass ionomer Overcontouring Overhanging ledges Undercontouring Negative or reverse ledges Presence of contact points Adaptation of the restorative material to the base of the cavity Marginal fit of cast restorations Presence of absence of a lining material Radiodensity of the lining material.
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Assessment of the underlying tooth Recurrent caries Residual caries Radiopaque shadow of released tin and
zinc ions Size of the pulp chamber Internal resorption Presence of root-filling material in the
pulp chamber Presence and position of pins or posts.
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Limitation of radiographic image Technique variations in X-ray tubeheadposition may cause recurrent carious lesions to be obscured
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Limitation of radiographic image Cervical burn-out shadows tend to be more obvious
when their upper borders are demarcated by dense white restorations because of the increased contrast differences
Superimposition and a two-dimensional image
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Periodontal disease Most common of this are gingivitis and
periodontitis Radiograph aid the clinician in identifying
the extent of alveolar bone destruction, local contributing factors, and features of periodontium that influence prognosis
It should be combined with clinical examination to ensure a complete diagnosis reached
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Radiographic assessment of periodontal condition Amount of bone present Condition of the alveolar crests Bone loss in the furcation areas Width of the periodontal ligament space Local initiating factors that cause or intensify periodontal disease Calculus Poorly contoured or overextended restorations Root length and morphology and the crown-to-root ratio Anatomic considerations Position of the maxillary sinus in relation to a periodontal deformity Missing, supernumerary, or impacted teeth Pathologic considerations Caries Periapical lesions Root resorptions
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Radiographic features of healthy periodontium
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Periodontitis Superficial inflammation in the gingiva
tissues extends into the underlying alveolar bone and there has been loss of attachment
Terms to use to describe various appearance of bone destruction include:
Horizontal bone loss Vertical bone loss Furcation involvement
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Diagrams illustrating various radiographic appearance of periodontitis
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Mild adult peridontitis
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Moderate adult periodontitis Increase in the radiolucency of the tooth
root near alveolar crest Overall pattern of bone loss may appear
as generalized horizontal erosion of bone in a region or as localized vertical defects involving just one or two teeth
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Horizontal bone loss Used to described loss of height of
alveolar bone around multiple teeth Extent of bone loss evident at single
examination does not indicate the current activity of disease.
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Vertical osseous defects
Types of bony lesions that are localized to one or two teeth
Can be divided into 2 primary types which are interproximal crater and infrabony defects
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Severe adult peridontitis Bone loss is so extensive that remaining
teeth show excessive mobility & drifting and are in jeopardy of being loss due to inadequate support
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Osseous deformities in the furcation of multirooted teeth Furcation defects involve maxillary
molars 3x more often than mandibular molar
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Dental condition associated with periodontal disease Occlusal trauma Tooth mobility Open contacts Local irritating factor
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Occlusal trauma
Due to occlusal pressures are greater than physiologic tolerances of tooth’s supporting tissues
Assc with clinical symptoms such as increased mobility, wear facets and etc
Radiographic evidence- widening of PDL space and lamina dura, bone loss and increase in the number and size of trabeculae
Sequale of trauma include hypercementosis and root fracture
Does not cause gingivitis or periodontitis, but affect the epithelial attachment, or lead to pocket formation
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Tooth mobility Widening of PDL space may suggest it It is due to resorption of both the root
and alveolar bone
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Open contacts Trapped food may damage soft tissues
and induce an inflammatory response leading to periodontal disease
Thus bone loss detected
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Local irritating factor Calculus deposits prevent effective cleansing
of a sulcus and lead to progression of periodontal disease
Defective restoration with overhanging or poorly contoured margin may lead to bacterial accumulation and periodontal disease
Trauma from tissues- surgical removal of impacted 3rd molar
Insufficient contour crown fail to protect gingiva
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Evaluation of periodontal therapy Clinical crown to tooth ratio is a useful criterion
not only for determining the nature of restorative treatment to be performed on a tooth but also for deciding a prognosis of an individual tooth
It is a measure of tooth’s bony support, relating to proportion of clinical crown to bony investment
Unfavorable ratio when the length of tooth out of bone exceeds the length of root supported by bone
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Effects of systemic disease on periodontal disease AIDS-characterized by a rapid progression that lead to bone sequestration and loss of several teeth Diabetes melitus -uncontrolled diabetes and periodontal disease patient show more severe and rapid alveolar bone resorption and more prone to develop periodontal abscess
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The end . Thank youQ&A sessions now.
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References Whaites, E. (2002). Essentials of dental
radiography and radiology. churchill livingstone.
White, S. C. (2000). Oral Radiology . Principles and Interpretation. Toronto, Canada: Mosby.