Caries and periodontology

1. Radiographic Diagnosis
of
Dental Caries

2. Caries
Bitewing Film primarily
Periapical film also used
Low kVp, high contrast
(short scale)

3. Approximately 50 % demineralization is required
for radiographic detection of a lesion.
The thickness of the tooth buccolingually masks
the 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

4. Factors affecting caries diagnosis:
Buccolingual thickness of tooth
Two-dimensional film
X-ray beam angle
Exposure factors

5. Radiographic Caries
I
M = Moderate
I = Incipient
A = Advanced
S = Severe
S
AM
A

6. Incipient
Interproximal
Caries I
Up to half the thickness of
enamel
Cone-shaped radiolucent area
Treat or no treat ?

7. Usually not restored:
* Unless patient has high caries activity
Incipient
Interproximal
Caries I

8. Incipient

9. Moderate
Interproximal
Caries
M
More than half-way through
the enamel (up to DEJ)

14. Moderate

15. Advanced
Interproximal
Caries AA
From DEJ to half-way through
the dentin

16. Advanced

17. Advanced

18. Advanced

19. Advanced

20. Incipient
Moderate
Advanced

21. Severe
Interproximal
Caries
More than halfway through
the dentin
S

22. Severe

23. Anterior interproximal caries
can usually be diagnosed by
directing bright light through
the contact areas.
Transillumination

24. Must have penetrated into dentin
Diagnosed from clinical exam
Radiographs are not a reliable
diagnostic aid for the detection
of occlusal caries.
Occlusal Caries

25. The apex of the triangle is
toward the outer surface of the
tooth and the base is at the
dentino-enamel juncition.
Occlusal Caries

26. Occlusal

27. Occlusal

28. Use clinical exam
Can’t determine depth
Appears as round dots
Buccal/Lingual
Caries

29. Buccal/lingual

30. Older patients with recession or
periodontitis
Root Caries

31. Root caries

32. Root caries

33. 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 alveolarby 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

34. Radiolucency seen above left (arrow) disappears
on periapical film of same tooth (above right).
Cervical burnout

35. Anterior Cervical Burnout
bone level
cervical burnout area

36. Cervical burnout in the
anterior region due to
gap between enamel
(red arrows) and
alveolar bone over root.

37. May be due to high caries rate,
poor oral hygiene, failure to
remove all the caries, defective
restoration or a combination.
Recurrent Caries

38. Is not always easy to detect
radiographically:
1.Location of caries lesion
relative to restoration.
2.Angulation of X-ray beam.
Recurrent Caries

39. Recurrent caries
(red arrows)

40. Recurrent caries

41. Recurrent caries

42. Rampant Caries
* Usually found in children and teens
with poor diet and inadequate oral
hygiene.
* Patients with xerostomia

44. Found in head/neck radiation
therapy patients with xerostomia
Fluoride used for control
Radiation Caries

46. Before radiation

47. 1 year after radiation

48. Mach Band
Optical illusion giving appearance of
increased radiolucency at junction of
differing tissue densities

49. Periodontal Disease
Periodontal ligament attachment and
alveolar bony support of the tooth
have been lost.
Junctional epithelium migrates apical
to the CEJ.

50. Bitewings best for diagnosis. Some
feel that paralleling PA’s are best.
Higher kVp recommended (long
scale, low contrast).
Compare images from different
visits (using same technique).
Periodontal Disease

51. • Two-dimensional representation
of a 3-D anatomic structure.
• Superimposition of the bone and
tooth structures
* Relationship of hard to soft
tissues not evident
Limitation of Radiographs

52. * Presence or absence of
periodontal pockets.
* Early bone loss (<3mm) is not
evident.
* Early furcation involvement is not
evident.
Limitation of Radiographs

53. * PA: X-ray beam alignment will
obliterate the presence of extent of
furcation involvement.
* Facial and lingual aspects of
alveolar bone will be
superimposed over the furcation.
Limitation of Radiographs

55. Early radiographic changes:
1.Crestal irregularities.
2.Triangulation
3.Interdental septal bone changes
Benefits

56. Involvement:
Localized
Generalized
Periodontitis

59. Periodontitis
Normal Anatomy:
Alveolar crest corticated
1-1.5 mm from crest to CEJ
Parallel to line between CEJ’s
Crest is pointed anteriorly

60. Corticated alveolar crests

61. 1-1.5 mm
CEJ

62. Alveolar crests more
pointed anteriorly

63. Contributing Factors
• Occlusal trauma
• Open contacts
• Overhangs, poor contours
• Calculus
• Post-extraction defects
• Systemic involvement (diabetes,
blood disorders, hormonal
changes, stress, AIDS)

64. Horizontal bone loss: Parallel to
line drawn between adjacent
CEJ’s
Vertical (Angular) bone loss:
More bone destruction on
interproximal aspect of one tooth
than on the adjacent tooth

65. Gingivitis
No bone loss
No radiographic signs

66. Mild Adult Periodontitis
Loss of cortical density
Rounding off of junction
between alveolar crest and
lamina dura
Blunting of crest anteriorly

67. Mild adult periodontitis

68. Horizontal bone loss or vertical
osseous defects
Total extent of bone loss not
evident
May have slight mobility
Moderate Adult Periodontitis

69. Moderate adult periodontitis
(red arrows point to calculus)

70. Moderate adult periodontitis

71. Severe Adult Periodontitis
Tooth mobility
Extensive horizontal bone
loss or vertical osseous
defects
Furcation involvement

72. Severe adult periodontitis

73. Severe adult
periodontitis

74. Severe adult periodontitis

75. 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

76. Gold crowns, amalgams

77. Retention pins

78. porcelain
crowns
Ceramic Crowns

79. crown
amalgam
crown
silver points
gutta percha
cast post

84. Red arrows point to bases
Green arrow indicates recurrent caries with
fractured restoration

85. Compositesold new