Radiographic Interpretation
Jan 15, 2016
Radiographic
Interpretation
Dental Radiography
• Questions• How does the radiographic
examination contribute to the detection of caries?
• What factors may influence caries interpretation?
• What is the radiographic appearance of: incipient, moderate, advanced and severe caries?
Detection of Caries
• Clinical examination and radiographs are necessary to detect dental caries• Radiographs enable the dental
professional to identify carious lesions that are not visible clinically
• It also allows the dental professional to evaluate the extent and severity of carious lesions
Clinical Examination
• Some carious lesions can be detected simply by looking in the mouth, and others cannot• The mirror can be used to reflect light,
allow for indirect vision, and retract the tongue
• The explorer can be used to detect changes in consistency in pits, grooves, and fissures of teeth
Clinical Examination
• Color changes may be observed• Occlusal surfaces may show dark
staining in fissures, pits, and grooves• Smooth surfaces may exhibit a chalky
white spot or opacity• An interproximal ridge may appear
discolored
Radiographic Examination
• A carious area appears radiolucent because decreased density allows for greater penetration in the carious area• The bite-wing radiograph provides the
dental professional with the greatest amount of diagnostic information
• A periapical radiograph taken with paralleling technique may also be used
Factors Influencing Caries Interpretation• Radiographs must be of diagnostic
quality• Examples may include
• Improper horizontal angulation on a bitewing film
• Errors in exposure with improper contrast and density
Interproximal Caries• Interproximal
• Between two adjacent surfaces• Typically seen on dental radiographs at
or just below the contact point• As caries progresses through the
enamel, it typically assumes a triangular configuration
• When it reaches the DEJ, it spreads laterally and progresses through dentin
• Classified as incipient, moderate, advanced, and severe
Incipient Interproximal Caries
• Extends less than halfway through the thickness of enamel• An incipient or Class I lesion is seen
only in enamel
Moderate Interproximal Caries
• Extends more than halfway through enamel but does not involve the DEJ• A moderate or Class II lesion is seen
only in enamel
Advanced Interproximal Caries
• Extends to or through the DEJ and into dentin, but does not extend into dentin more than half the distance toward the pulp• An advanced or Class III lesion affects
both enamel or dentin
Severe Interproximal Caries
• Extends through enamel and dentin more than half the distance toward the pulp• A severe or Class IV lesion involves
both enamel and dentin and may appear clinically as a cavitation in the tooth
Occlusal Caries
• Caries that involve the chewing surface of posterior teeth• “A thorough clinical exam is the
method of choice for the detection of occlusal caries”
• Early occlusal caries is difficult to see on a dental radiograph
Incipient Occlusal Caries
• Cannot be seen on a dental radiograph
• Must be detected with an explorer or DiagnoDent
Buccal and Lingual Caries
• These are difficult to detect on radiograph because they are superimposed on tooth structure• If seen on film, they appear as a
circular radiolucent area
Root Surface Caries
• Ivolves only the roots of teeth• On radiograph, it appears as a
cupped-out or crater-shaped radiolucency below the CEJ
• Early lesions may be difficult to detect on radiograph
Recurrent Caries
• Occurs adjacent to an existing restoration• It appears as a radiolucent area just
beneath a restoration• It is most often located beneath the
interproximal margins of a restoration
Rampant Caries
• Advanced and severe caries affecting a number of teeth• Associated with children with poor
diets and adults with decreased salivary flow