1. RADIOLOGY
IN
ENDODONTICs
Presented By
Jean Michael
1

2. History
• 1895 – Discovery of cathode rays by Roentgen
• 1895 – Dr. Otto Walkoff took the 1st dental X ray
(of his own teeth)
• 1899 – Dr. Edmund Kells used Radiographs to
determine the root length during RCT
• 1900 – Dr. Weston Price advocated the use of
radiographs to check the adequacy of
root canal fillings
2

3. How To Obtain A Good Radiograph
1. Proper placement of film in the patient’s
mouth
2. Correct Angulation of the cone in relation to
the film and oral structures
3. Correct exposure time
4. Proper developing technique
3

4. Relevant Findings For An Endodontist
• Presence of Caries that may involve or threaten
to involve the Pulp
• Number, course, shape and length of root
canals
• Calcification or obliteration of pulp cavity
• Internal and External Resorption
• Thickening of Periodontal Ligament
• Nature and extend of Periapical and Alveolar
Bone Destruction
4

5. • Diagnose abnormalities like Dilaceration and
Taurodontism
• Diagnose fracture of root
• To estimate and confirm the length of root
canals before instrumentation (working length
determination)
• To confirm the position and adaptation of
master cone
• Evaluation of outcome of root canal therapy
(post operative radiograph)
5

6. Types of Radiographs
• Intraoral Radiographs
– Intraoral Periapical (IOPA)
– Occlusal Radiographs
– Bitewing Radiographs
• Extraoral Radiographs
– Panoramic Radiographs
– Lateral Cephalograms
6

7. Intraoral Periapical Radiographs
7

8. Occlusal Radiographs
8

9. Bitewing Radiographs
9

10. Panoramic Radiograph
10

11. Lateral Cephalogram
11

12. Disadvantages of Radiographs
• Radiographs are 2D shadow of a 3D Object
• They are only suggestive and not the final
evidence in judging a clinical problem
• Bucco-lingual dimension cannot be assessed in
an IOPA
• The bacterial status of the hard and soft tissues
cannot be determined
• Chronic inflammatory tissues cannot be
differentiated from healed fibrous scar tissue
12

13. • Lesions of the medullary bone are undetected
in the radiographs till there is substantial bone
loss and the involvement of cortical bone
• For a hard tissue lesion to be evident on a
radiograph, there should be at least a mineral
loss of 6.6 %
• Even a single error in the procedure can render
a radiograph useless
• Over exposure to X rays are harmful to the body
and strict precautions are to be maintained for
the patient and the operator
13

14. Techniques Employed for IOPA
• Paralleling Technique
• Bisecting Angle Technique
14

15. ParallelingTechnique
• Film is placed parallel
to the long axis of
the tooth to be
radiographed
• The film is exposed
using X rays which
are perpendicular to
its surface
• Requires special film
holding devices
15

16. Film Holding Devices
16

17. Bisecting Angle Technique
• The X rays pass
perpendicular to the
angular bisector of the
angle formed by the
long axis of the tooth
and the X ray film
• No film holding devices
are required
17

18. Normal Anatomical Landmarks
18

19. Enamel, Dentin & Pulp
19

20. Cervical Burnout
20

21. Radical Pulp & Apical Foramen
21

22. Radical Pulp
22

23. Lamina Dura
23

24. Lamina Dura (extracted tooth)
24

25. Double Periodontal Ligament and Lamina Dura
25

26. Periodontal Ligament Space
26

27. Periodontal Ligament Space
27

28. Intermaxillary Suture
28

29. Incisive Foramen
29

30. Soft Tissue Shadow of the Nose
30

31. Nasolacrimal Duct
31

32. Inferior Border of Maxillary Sinus
32

33. Neurovascular Canals in the Walls of Maxillary Sinus
33

34. Zygomtic Process of Maxilla
34

35. Shadow of Nasolabial Fold
35

36. Genial Tubercles
36

37. Lingual Foramen
37

38. Mental Foramen
38

39. Mental Foramen
39

40. Mandibular Canal
40

41. Mandibular Canal
41

42. Nutrient Canals
42

43. Nutrient Canals
43

44. Mylohyoid Ridge
44

45. Mylohyoid Ridge
45

46. Coronoid Process of Mandible
46

47. IOPA Radiographs in Endodontic Therapy
• Diagnostic Radiographs
• Working Radiographs
• Post operative Radiographs
• Follow up Radiographs
47

48. Diagnostic Radiographs
• Ideally, these radiographs should be taken
using paralleling angle technique
• They should be of high quality without any
foreshortening or elongination
• They help for proper diagnosis of the case
• These radiographs helps in determining the
prognosis by comparison with post operative
and follow up radiographs
48

49. 49

50. Comparison between Diagnostic and
Follow up Radiographs
Periapical Cyst Before RCT Complete Bony repair after RCT
50

51. Working Radiographs
• These radiographs are used for determining
the position of instruments – files etc during
the procedure
• These radiographs are to be taken without
removing the rubber dam as it can cause
contamination of the operating field
• Bisecting angle technique can be used
• A better alternative is the use of a hemostat as
a film holding device
51

52. Radiograph showing Endodontic
Instruments & Rubber Dam Clamp
52

53. Working Radiograph with Master Cone
53

54. Working Radiographs of same tooth
using Different Angulations
54

55. Advantages of using a Hemostat
• Film placement is easier when the opening is
restricted by the Rubber dam and frame
• In the mandibular posterior area, the closing
of mouth relaxes the mylohyoid muscle
permitting the film to be placed farther
apically
55

56. • The handle of the hemostat is a guide to align
the cone in a proper vertical and horizontal
angulation
• There is less risk of distortion caused by finger
pressure and film displacement as in bisecting
angle technique
• Any movement can be detected by the shift of
the handle and corrected before the exposure
56

57. Using a Hemostat as a Film Holder
57

58. Film is Perpendicular to X Ray Beam
58

59. View From Above
59

60. Mesial Angulation of X ray Beam
60

61. Distal Angulation of X ray Beam
61

62. Rubber Dam – Is It Necessary ?
62

63. Postoperative Radiographs
• They are used to evaluate the endodontic
treatment
• They are taken after removing the rubber dam
• Ideally paralleling angle technique should be
used
• They can be compared with the diagnostic
radiograph
63

64. Post Operative Radiograph
64

65. 65

66. Overdenture Abutment
66

67. Overextension into Inferior Alveolar Canal
leading to Permanent Paresthesia
67

68. Follow-up Radiographs
• These radiographs are taken to evaluate the
prognosis of the endodontically treated tooth
• After obturation, the tooth may have to
undergo procedures like core build up, crown
fabrication etc
• The follow up radiograph gives the health of
the periodontium and the tooth by evaluating
the presence of root resorption, other
treatment failures etc
68

69. 69

70. External Root Resorption
Before Bleaching 2 Years After Bleaching
70

71. Follow up Radiographs After RCT
71

72. Recovery from Furcal Bone Loss after RCT
72

73. Endo – Perio Lesion
73

74. Vertical Angulation
• Elongation – Corrected by increasing the
vertical angle of the central ray
• Foreshortening – Corrected by decreasing the
vertical angle of the central ray
74

75. Horizontal Angulation
Clarke’s Rule (S.L.O.B Rule)
• The object that moves in the SAME direction
as the cone is located toward the LINGUAL
• The object that moves in the OPPOSITE
direction as the cone is located toward the
BUCCAL
75

76. 76

77. Central Ray Perpendicular to the Film
77

78. Central Ray directed 20˚ Mesial to film
78

79. Working Radiographs with Instruments
inside the Root Canals
Superimposition of Files 4 separate Files in root canals
79

80. X-ray Beam passing through Two
Thicknesses of Root Structure
80

81. X-ray Beam aimed 20˚ Mesially through
Single Thicknesses of Hourglass Root
81

82. Radiographic Diagnosis Of
Pathologic Conditions
82

83. Caries Involving the Pulp
83

84. Pulp Calcification following Avulsion
84

85. Internal Resorption following Trauma
85

86. Internal Resorption
86

87. Internal Resorption following Trauma
87

88. Extensive Internal Resorption
88

89. External Resorption following Trauma
89

90. Fracture of Crown Exposing the Pulp
Crown Fracture After 3 Years
90

91. Fracture of Crown involving Pulp
91

92. Root Fracture at Multiple Sites
92

93. Fracture Healed by Interproximal Bone
93

94. Extensive Wear of Mandibular Incisors
94

95. Luxation
95

96. Apical Condensing Osteitis
96

97. Apical Condensing Osteitis associated
with Chronic Pulpitis
Just after RCT 1 Year after Treatment
97

98. Enostosis (Sclerotic Bone)
98

99. Tooth Intruded due to Trauma
99

100. Circumferential Dentigerous Cyst
100

101. Periradicular Cemental Dysplasia
101

102. Radicular Lingual Groove
102

103. Dens Invaginatus with Radicular Lesion
103

104. Hereditary Hypophosphatemia
104

105. Digital Radiography
105

106. • The digital systems relies on an electronic
detection of an X ray generated image that is
electronically processed and reproduced on a
computer screen
106

107. Advantages
• Reduced exposure to radiation
• Increased speed of obtaining the image
• Possibility for digital enhancement
• Storage as digital data in computers
• Ease of transmissibility
• Elimination of manual processing steps
107

108. Intraoral X ray Sensors
108

109. Digital Image Enhancement
109

110. Inversion
110

111. Contrast
111

112. Measurement of Angle of Root Curvature
112

113. Flash Light
113

114. Magnification
114

115. Pseudocolour
115

116. Linear Measurement
116

117. Conclusion
• Radiograph is a very powerful tool for a
dentist, especially an Endodontist with which
he are able to examine the status of hard
tissue which are beyond the field of his naked
eyes
• Application of radiology gives new standards
for the diagnosis, treatment and prognosis of
a dental problem
117

118. REFERENCE
• Grossman’s Endodontic Practice 12th edition
• Endodontics 6th edition – Ingle
• Oral Radiology 6th edition – White & Pharoah
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