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8/4/2019 Caries and Period Ontology
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Radiographic Diagnosis
of Dental Caries
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Caries
Bitewing Film primarily
Periapical film also used
Low kVp, high contrast
(short scale)
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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
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Factors affecting caries diagnosis:
Buccolingual thickness of tooth
Two-dimensional filmX-ray beam angle
Exposure factors
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Radiographic Caries
I
M = Moderate
I = Incipient
A = Advanced
S = Severe
S
AMA
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IncipientInterproximalCaries I
Up to half the thickness of
enamel
Cone-shaped radiolucent area
Treat or no treat ?
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Usually not restored:* Unless patient has high caries activity
IncipientInterproximalCaries I
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Moderate
InterproximalCaries
M
More than half-way through
the enamel (up to DEJ)
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0
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Moderate
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Advanced
InterproximalCaries AA
From DEJ to half-way throughthe dentin
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Advanced
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Advanced
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Advanced
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Advanced
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Incipient
Moderate
Advanced
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Severe
InterproximalCaries
More than halfway through
the dentin
S
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Severe
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Anterior interproximal caries
can usually be diagnosed by
directing bright light through
the contact areas.
Transillumination
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Must have penetrated into dentin
Diagnosed from clinical exam
Radiographs are not a reliablediagnostic aid for the detection
of occlusal caries.
Occlusal Caries
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The apex of the triangle is
toward the outer surface of thetooth and the base is at the
dentino-enamel juncition.
Occlusal Caries
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Occlusal
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Occlusal
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Use clinical exam
Can’t determine depth
Appears as round dots
Buccal/LingualCaries
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Buccal/lingual
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Older patients with recession or periodontitis
Root Caries
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Root caries
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Root caries
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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
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Radiolucency seen above left (arrow) disappears
on periapical film of same tooth (above right).
Cervical burnout
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Anterior Cervical Burnout
bone level
cervical burnout area
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Cervical burnout in theanterior region due to
gap between enamel (red
arrows) and alveolar
bone over root.
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May be due to high caries rate,poor oral hygiene, failure to
remove all the caries, defective
restoration or a combination.
Recurrent Caries
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Is not always easy to detectradiographically:
1.Location of caries lesion
relative to restoration.
2.Angulation of X-ray beam.
Recurrent Caries
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Recurrent caries
(red arrows)
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Recurrent caries
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Recurrent caries
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Rampant Caries
* Usually found in children and teens
with poor diet and inadequate oral
hygiene.* Patients with xerostomia
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Found in head/neck radiation
therapy patients with xerostomia
Fluoride used for control
Radiation Caries
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Before radiation
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1 year after radiation
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Mach Band
Optical illusion giving appearance of increased radiolucency at junction of
differing tissue densities
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Periodontal Disease
Periodontal ligament attachment and
alveolar bony support of the toothhave been lost.
Junctional epithelium migrates apical
to the CEJ.
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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
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• 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
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* Presence or absence of
periodontal pockets.* Early bone loss (<3mm) is notevident.
* Early furcation involvement is notevident.
Limitation of Radiographs
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* 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.
Limitation of Radiographs
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Early radiographic changes:
1.Crestal irregularities.
1.Triangulation1.Interdental septal bone changes
Benefits
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Involvement:
Localized
Generalized
Periodontitis
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P i d titi
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Periodontitis
Normal Anatomy:
Alveolar crest corticated
1-1.5 mm from crest to CEJ
Parallel to line between CEJ’s
Crest is pointed anteriorly
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Corticated alveolar crests
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1-1.5 mm
CEJ
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Alveolar crests more
pointed anteriorly
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Contributing Factors
• Occlusal trauma• Open contacts
• Overhangs, poor contours
• Calculus
• Post-extraction defects
• Systemic involvement (diabetes,blood disorders, hormonal
changes, stress, AIDS)
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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
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Gingivitis
No bone loss
No radiographic signs
Mild Adult Periodontitis
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Mild Adult Periodontitis
Loss of cortical density
Rounding off of junction
between alveolar crest andlamina dura
Blunting of crest anteriorly
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Mild adult periodontitis
Moderate Adult Periodontitis
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Horizontal bone loss or verticalosseous defects
Total extent of bone loss notevident
May have slight mobility
Moderate Adult Periodontitis
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Moderate adult periodontitis
(red arrows point to calculus)
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Moderate adult periodontitis
Severe Adult Periodontitis
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Severe Adult Periodontitis
Tooth mobility
Extensive horizontal bone
loss or vertical osseousdefects
Furcation involvement
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Severe adult periodontitis
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Severe adult
periodontitis
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Severe adult periodontitis
Restorative Materials
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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
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Gold crowns, amalgams
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Retention pins
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porcelain
crowns
Ceramic Crowns
crown
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crown
amalgam
silver pointsgutta percha
cast post
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Red arrows point to bases
Green arrow indicates recurrent caries with
fractured restoration
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Compositesold new
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