Radiographic Examination

2 major considerations:
1. The clinical decision to order
radiographic studies
2. The selection of appropriate number
and type of views necessary to
conduct the examination

Goal:
to maximize the yield, minimize the risk
All radiographs should be obtained with the
current standard of care.
The type of radiographs, the number of films
taken, the date on which they are taken and
the diagnostic data obtained should be
documented in the progress notes.
Radiographs should be retained as part of
the patients dental record.

 Before any radiographic procedures,

the clinician is further responsible for
obtaining the patients CONSENT.
Implied consent- for procedures with
few known risk.
Written for patients with potentisl
risk pregnant and child patients

The new patient

Child with primary dentition
Posterior bitewings

Child with Mixed dentition

Posterior bws
Selected PAs evidence of periapical or
periodontal pathosis
PA with Occlusal
Panoramic with posterior BWs

 Adolescent with permanent dentition

prior to the eruption of 3rd molars
Shift from proximal caries to pits and
fissures
Posterior BWs and selected Pas
Panoramic for evaluation of the third
molars

 Adult dentate patients

Posterior BWs and selected Pas
Routine full mouths not indicated unless
the patient presents with clinical
evidence of generalized dental disease
or past extensive dental care

 Adult edentulous
Unless indicated*

RADIOGRAPHIC EXAM OF THE

RECALL PATIENT

No clinical caries and no evidence of

high risk factors for caries
Child with primary dentition

CLINICAL CARIES AND

EVIDENCE OF HIGH-RISK
FACTORS FOR CARIES

... Growth and Development

... Growth and Development

... Growth and Development

Review of
RADIOGRAPHIC
INTERPRETATION

Systematic viewing of the entire radiograph:

(suggested systematic approach)

1. General overview of the entire

radiograph
2. The teeth
3. The apical tissues
4. The periodontal tissues
5. The body and ramus of the
mandible
6. Other structures
Whaites et al

White and Pharaoh

 In no instance should a clinician

arrive at a definitive diagnosis on the
basis of radiographic findings alone.
The radiographic diagnosis must
correlate with the historical profile,
physical examination, and when
indicated, with the clinical laboratory
data and microscopic analysis.

 Radiolucent lesions
Some measure of bone destruction

Radiopaque
Freq with slow-growing lesions; gen nondestructive; EXCEPT if associated with a
radiolucent area

Mixed
Mostly with fibroosseous lesions which
resorb and produce bone

 Unilocular vs multilocular
Multilocular- suggests slow growing neoplasm
Soap-bubble appearance freq ameloblastoma or myxoma

Peripheral outline
Distinct; rough irregular or indistinct
With lamina dura or radiopaque sclerotic border slow
growing ; sugg of most cystic lesions
Definite, relatively smooth, easily definable margin solid
granulation tissue develops in bone
Rough , irregular or indistinct margins tissue growth or
spread of infection; or malignancy
Radiolucent around radiopaque line tissue capsule
odontomas
Easily observed differentiation (radiopaque)between mass
and surrounding bone enostosis or a sclerotic bone
lesions

 Trabecular pattern
Ground- glass fibrous dysplasia;
pagets disease; hyperparathyroidism
Cotton-wool

Dimensional changes
Expansion; resorption; displacement
Expansive lesions cause a characteristic
responses in the periosteum of overlying
bone
Onion-skin; sunburst; of Codmans triangles

RADIOGRAPHIC
MANIFESTATIONS OF
COMMON CONDITIONS

 References:
Terezhalmy. Phys evaluation in dental
practice.
White and Pharaoh
Whaites