Radiographic Examination

7/18/2019 Radiographic Examination

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Radiographic Examination



2 major considerations:

1. The clinical decision to orderradiographic studies

2. The selection of appropriate numberand type of views necessary toconduct the examination



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.



• (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

•





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



• %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



• %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



• %dult edentulous – 4nless indicated5



RADIOGRAPHIC EXAM OF THE RECALL PATIENT



+o clinical caries and no evidence ofhigh ris$ factors for caries

• )hild with primary dentition









CLINICAL CARIES ANDEVIDENCE OF HIGH-RISK

FACTORS FOR CARIES













... rowth and 6evelopment









Review of R%6-*R%7-)

-+TERRET%T-*+



,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



White and Pharaoh



• -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.



• 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



• 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



• 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



RADIOGRAPHICMANIFESTATIONS OF

COMMON CONDITIONS





























































• References: – Terezhalmy . hys evaluation in dental

practice.

– White and Pharaoh – Whaites

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Radiographic Examination