Caries and Period Ontology

8/4/2019 Caries and Period Ontology

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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 masksthe 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 filmX-ray beam angle

Exposure factors



Radiographic Caries

I

M = Moderate

I = Incipient

A = Advanced

S = 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


http://slidepdf.com/reader/full/caries-and-period-ontology 8/88Incipient



Moderate

InterproximalCaries

M

More than half-way through

the enamel (up to DEJ)









0



Moderate



Advanced

InterproximalCaries AA

From DEJ to half-way throughthe dentin



Advanced



Advanced



Advanced



Advanced



Incipient

Moderate

Advanced



Severe

InterproximalCaries

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 reliablediagnostic aid for the detection

of occlusal caries.

Occlusal Caries



The apex of the triangle is

toward the outer surface of thetooth 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/LingualCaries



Buccal/lingual



Older patients with recession or periodontitis

Root Caries



Root caries



Root caries



Cervical burnout appears as aCervical burnout appears as a collar or wedge-shaped radiolucency on thecollar 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 regionsThe 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 theanterior 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 detectradiographically:

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 Band

Optical illusion giving appearance of increased radiolucency at junction of

differing tissue densities



Periodontal Disease

Periodontal ligament attachment and

alveolar bony support of the toothhave been lost.

Junctional epithelium migrates apical

to the CEJ.



Bitewings best for diagnosis. Some

feel that paralleling PA’s are best.

Higher kVp recommended (longscale, 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 softtissues not evident

Limitation of Radiographs



* Presence or absence of

periodontal pockets.* Early bone loss (<3mm) is notevident.

* Early furcation involvement is notevident.




* PA: X-ray beam alignment will

obliterate the presence of extent of furcation involvement.

* Facial and lingual aspects of

alveolar bone will be superimposedover the furcation.






Early radiographic changes:

1.Crestal irregularities.

1.Triangulation1.Interdental septal bone changes

Benefits



Involvement:

Localized

Generalized

Periodontitis





P i d titi



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 more

pointed 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 adjacentCEJ’s

Vertical (Angular) bone loss:More bone destruction on

interproximal aspect of one tooth

than on the adjacent tooth

Gi i iti



Gingivitis

No bone loss

No radiographic signs

Mild Adult Periodontitis



Mild Adult Periodontitis

Loss of cortical density

Rounding off of junction

between alveolar crest andlamina dura

Blunting of crest anteriorly



Mild adult periodontitis

Moderate Adult Periodontitis



Horizontal bone loss or verticalosseous defects

Total extent of bone loss notevident

May have slight mobility

Moderate Adult Periodontitis



Moderate adult periodontitis

(red arrows point to calculus)



Moderate adult periodontitis

Severe 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

Restorative Materials



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

crown



crown

amalgam

silver pointsgutta percha

cast post











Red arrows point to bases

Green arrow indicates recurrent caries with

fractured restoration



Compositesold new







Caries and Period Ontology

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