g5 - radio graphic examination
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Radiographic Examination
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Outline
Introduction Interpretation of Normal Radiographs
Normal Landmarks Periapical
Radiographs Complete Mouth Radiographs
Posterior Bitewing Radiographs
Supplemental Radiographs Radiographs for Children
Dangers from Radiation
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Introduction
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Introduction
Radiographic Examination - most commonly omitted
- (initial examination) completemouth radiograph, posterior bitewingradiographs
- separate fee is charged
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Interpretation of NormalRadiographs
- normal should always beunderstood
- it is the architecture of the hard
tissues - radiopacity or radiolucency may beseen
- two-dimensional shadow of
structures - superimposition may occur
Radiopaque areas appear lighter,shadow of dense structures
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Normal Landmarks PeriapicalRadiographs
The Maxilla.1 Incisive
Foramen
Oval shaped radiolucent area between the roots of themaxillary incisor teeth
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Normal Landmarks PeriapicalRadiographs
The Maxilla.2 Nasal Septum
Vertical Radiopaque band above the apices ofthe central incisors
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Normal Landmarks PeriapicalRadiographs
The Maxilla. /3 Incisive Fossa Lateral
Fossa
Radiolucent area between the roots of the cuspid andcentral incisor and over the apex of the lateral
incisor
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Normal Landmarks PeriapicalRadiographs
The Maxilla.4 Maxillary Sinus
Radiolucent area extending from the Premolar Areaposteriorly to the second molar region
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Normal Landmarks PeriapicalRadiographs
The Maxilla.4a Sinus Septa
Radiopaque lines running throughthe maxillary sinus
.4b Antral Y
Radiopaque line marks theseparation of the anterior portion
of the maxillary sinus from the
nasal cavity
l d k i i l
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Normal Landmarks PeriapicalRadiographs
The Maxilla.5 Malar Bone
-U shaped radiopaque band at the maxillary first molar;area frequently superimposed on the roots of it
N l L d k P i i l
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Normal Landmarks PeriapicalRadiographs
The Maxilla.6 Coronoid Process
Fingerlike projection seen when the second molarregion is radiographed
N l L d k P i i l
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Normal Landmarks PeriapicalRadiographs
The Maxilla.7 Hamulus
Small projection of bone posterior to the maxillarytuberosity on radiographs of the second molar region
N l L d k P i i l
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Normal Landmarks PeriapicalRadiographs
The Maxilla.8 Confusing Areas
Maxillary sinusmistaken for cystic area
Incisive Fossamistaken for a
rarefied area aboutthe lateral incisor
root apex
Incisive foramen( )if large suggest
the presence ofincisive canal cyst
or bone refraction if
superimposed on the
apex of the incisor
N l L d k P i i l
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Normal Landmarks PeriapicalRadiographs
The Mandible.1 Lingual Foramen
A small dot inferior to the apices of the central; .incisors 0 5 mm radiolucent center lined with
radiopaque border
N l L d k P i i l
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Normal Landmarks PeriapicalRadiographs
The Mandible.2 Genial Tubercles
Sharp radiopaque projections from the lingual corticalplate of bone
Normal Landmarks Periapical
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Normal Landmarks PeriapicalRadiographs
The Mandible.3 Mental Foramen
Radiolucent area licated near the apices of the;mandibular bicuspids multiple foramina may also occur
Normal Landmarks Periapical
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Normal Landmarks PeriapicalRadiographs
The Mandible.4 Mental Ridge
-Definite linear structures that appears an inverted Vshaped radiopacity and may be superimposed on incisor
roots
Normal Landmarks Periapical
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Normal Landmarks PeriapicalRadiographs
The Mandible.5 Submaxillary Fossa
;Radiolucent area beneath the mandibular molar rootsoccupied by the submaxillary salivary gland
Normal Landmarks Periapical
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Normal Landmarks PeriapicalRadiographs
The Mandible.6 Mandubular Canal
Horizontal linear radiolucent band bordered by two,radiopaque lines beneath the first second and third
molar roots
Normal Landmarks Periapical
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Normal Landmarks PeriapicalRadiographs
The Mandible.7 External Oblique Ridge
Radiopaque linear structure immediately superior tothe mandibular canal
Normal Landmarks Periapical
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Normal Landmarks PeriapicalRadiographs
The Mandible.8 Confusing Areas
Mental Foramen mistakenfor a cyst when it is
superimposed over the apexof one of the bicuspids
Submaxillary Gland Fossamistaken for a bone
rarefaction
Normal Landmarks Periapical
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Normal Landmarks PeriapicalRadiographs
General Landmarks.1 Alveolar process
Trabecular bone that surrounds the roots of the teeth
Normal Landmarks Periapical
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Normal Landmarks PeriapicalRadiographs
General Landmarks.2 Alveolar Bone and Crest
( )Alveolar Bone Lamina Dura cortical bone that
immediately surrounds the;teeth radiopaque line of
uniform thickness
Alveolar Crest mostcoronal portion of thealveolar process that
occupies the space between;adjacent teeth normally.within 1 or 1 5 mm above
the CEJ
Normal Landmarks Periapical
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Normal Landmarks PeriapicalRadiographs
General Landmarks.3 Periodontal Space
Radiolucent line between the root of the tooth and the
;alveolar bone represents the space occupied by the
periodontal ligament
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Complete Mouth
Radiographs
Complete Mouth Radiographs
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Complete Mouth Radiographs
La m in a D u ra co n tin u ity a n dth ickn e ss
C o n tin u o u s lin e a ro u n d th e ro o ts o f th e te e th a n d o v e r th ea lve o la r cre st
B e st se e n in p e ria p ica lfilm sPathologie:s
. 1 Lack of continuity ActivePeriodontal Disease
.2 Break in the continuity at theapical area inflammatory
reaction of the periapicaltissue of a nonvital pulp
.3 Interruption at the lateralaspect of the root of a tooth
extension of periodontal disease
. 4 Resorption Acute periodontaldisease
.5 Disappearance with noperiodontal pocket or abscess
formation on the lateral rootsurface ,trauma lateral root
cyst formation or neoplasm
1
2
3
4 5
C l h di h
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Complete Mouth Radiographs
Pe rio d o n ta l sp a ce s v a ria tio n sin w id th
. .S p a ce a v e ra g e s fro m 0 1 8 0 2 5 m m( )Kronfeld
Pathologie:s
.1 Widening of the cresttraumatized tooth fromocclusion
.2 Excessive widening at the-apical region
periapical reactions ofnon vital pulps
.3 Widening in the bifurcation
and trifurcation of molars advance periodontaldisease
2
3
C l M h R d i h
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Level of alveolar crest in relation to thecementoenamel junction
normal level of the alveolar creast is 1 to 1.5mmapical to the cementoenamel junction.
The level of the alveolar crest is a very importantconsideration in the selection of teeth to be retained
in periodontal treatment and in the selection ofabutment teeth for prosthetic appliances.
The terms horizontal and vertical have been
applied loosely to the two patterns of bone loss in thereduction of the alveolar crest.
C o m p le te M o u th R a d io g ra p h s
C l M h R d i h
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Periapical Radiolucency
A periapical radiolucency usually indicates a nonvital tooth.
Periapical radiolucencies may be the result of a chronicperiapical granuloma, radicular cyst, periapical abscess,or neoplasm.
C o m p le te M o u th R a d io g ra p h s
C l t M th R d i h
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Pathologic conditions of theteeth.
C o m p le te M o u th R a d io g ra p h s
P th l i C d iti f T th
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Calcification of the Pulp
occurs for the most part in the incisor and cuspid teeth.
In most cases, trauma is involved.
Pa th o lo g ic C o n d itio n s o f Te e th
P th l i C d iti f T th
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Pulp Stones
Pulp stones are frequently seen in various places in thepulp.
Pulp stones, as well as the amount of secondary dentin thatcan be seen radiographically in the pulp canals, are of
importance when a tooth is being evaluated for rootcanal therapy.
Pa th o lo g ic C o n d itio n s o f Te e th
Pa th o lo g ic C o n d itio n s o f Te e th
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Caries
most common pathologic change seen radiographically inthe teeth.
Pa th o lo g ic C o n d itio n s o f Te e th
P th l g i C n d iti n f T th
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Attrition
Occlusal attrition may be confusedwith extensive caries in theradiograph.
Pa th o lo g ic C o n d itio n s o f Te e th
Pa th o lo g ic C o n d itio n s o f Te e th
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Calculus projections near the proximocervical aspect of the tooth
or as a linear radiopaque line running from themesial to the distal aspect of the tooth andrepresenting the buccal or lingual aspect,
Calculus that has been altered in contour with a scaler
but incompletely removed loses its angularapprearance radiographically ang appreas as asomewhat rounded elevation along the root surfaceof the tooth.
Pa th o lo g ic C o n d itio n s o f Te e th
Pa th o lo g ic C o n d itio n s o f Te e th
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Conditions caused by overhangingrestorations.
Easy to detect in the radiograph when the filling material isradiopaque.
Buccal/lingual overhanging are difficult to detectradiographically .
Pa th o lo g ic C o n d itio n s o f Te e th
Pa th o lo g ic C o n d itio n s o f Te e th
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Resorption
Internal/external When resorption has occurred to a
somewhat advanced degree atthe apex, it may give theimpression that the apical portionof the tootht has been cut off.
Root resorption that occurs in anarea where the periodontalmembrane is intact is almostalways caused by trauma of sometype from occlusion, othodontic
treatment, or prosthetic abutmentoverload.
Pa th o lo g ic C o n d itio n s o f Te e th
Pa th o lo g ic C o n d itio n s o f Te e th
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Internal Resorption
Internal resorption less frequent that external resorption.
Always occurs somewhere along the pulp canal or adjacentto the pulp chamber.
radiolucency and maybe confused with dental caries if thethe coronal pulp is involved.
Pa th o lo g ic C o n d itio n s o f Te e th
Pa th o lo g ic C o n d itio n s o f Te e th
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Hypercementosis
Excessive cementum deposition on the roots of the teeth.
Easily detected radiographically
Pa th o lo g ic C o n d itio n s o f Te e th
Pa th o lo g ic C o n d itio n s o f Te e th
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Dilaceration
Angular curvature of the roots
Readily detected on periapical radiographs.
Common area: apical third of the maxillary lateral incisors.
Important consideration in the diagnosis of teeth that
require endodontic treatment or extraction.
Pa th o lo g ic C o n d itio n s o f Te e th
Pa th o lo g ic C o n d itio n s o f Te e th
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Abnormalities of Root Form
Important considerations in the Selection ofthe abutment teeth for dental prosthesis.
Root form and length Number of roots on teeth Portion of the root supported by bone
-- discernible by on properly taken periapical
radiographs
Important considerations in EndodonticTreatment
The degree of calcification of the radicularportion of the pulp canal.
The degree of curvature of the pulp canal. The number of pulp canals present
Pa th o lo g ic C o n d itio n s o f Te e th
C o m p le te M o u th R a d io g ra p h s
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Pathologic Condition
of the Jaws
O
Pa th o lo g ic C o n d itio n s o f Ja w s
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Osseousradiolucencies
The ff. should consider:
1. Location and extent of the radiolucency in reference of the teeth,normallandmarks,and anatomic region -it is important to note wether a radiolucent zone is associated
with an area from which teeth has been extracted or are congenitallyabsent. Certain pathologic conditions of the jaws have tendency tooccur in in a certain area of either jaw or one jaw in particular.
-extremely important in considering the type of treatment andthe prognosis
2. Relative degree of radioluscency -depends upon the nature of the pathologic process3. Presence or absence of radiopaque areas or lines in the
substance of the lesion
- ossification center or sequestra.4 The nature of the borders of a lesion -radiolucency relates in some degree of the growth
characteristics of certain lesions of the jaws.
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4 The nature of the borders of a lesion
-radiolucency relates in some degree of the growth characteristics ofcertain lesions of the jaws.
5. Apparent effect of the process that is producing radioluscency on the teethand the anatomic landmarks.
-that cause root resorptionof the teeth adjacent to,or involved in the
process. Effects on landmarks such asobliteration of normal detail or expansionof normal boundaries of the jaws must also considered as evidence ofpathologic proce of an extensive and serious nature
6. Possible origin of the lesion - determine from its location and general characteristics.
A Osteolystic
Complete Mouth Radiographs
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A.OsteolysticlesionI. CYST - are ostoelystic lesion that they destroy bone by expansion
vary in sized.
- very radiolucent,limited buccolingual spaces in the jaws usually little orno normal trabecular pattern superimposed of the cyst.the central portion may showssigns of septal separation of locules or compartments.
-Cyst other than radicular arise from residual epithelium lines of fusion of thejaws and are known as fissural cyst.
Nasopalatine cyst Residual cyst
Complete Mouth Radiographs
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II. Neoplasm a. Benign 1. Odontogenic neoplasm- those do not have the ability to form calcified
tissue Ameloblastoma-usually arise in the mandibular third molar
2. Non-odontogenicneoplasm- their general characteristic may be similar tothose attributed to a multilocular cystic lesion or a soft odontogenic tumor.
A.Osteolysticlesion
Complete Mouth Radiographs
l i
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b. Malignant
1. primary malignant neoplasm - rapid growth and their abilty to
invade surrounding tissue andbecome wide spread. Arise fromconnective tissue.
- the primary radiolucent leionare usually fibrosarcoma and multiplemyeloma
Fibrosarcoma- widespread or diffuseinvolvement. Often punched-out
2. Secondary - involve by local invasion or by
metastasis, epithelial origin 3. Endocrinopathic bone dysplasia - seen in endocrine dysfunction
result of Hyperparathyroidism.
Histologic findings must be supported
A.Osteolysticlesion
Complete Mouth Radiographs
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B. Systemic disease
-produceradiolucency includeeosinophilic granuloma andHand-Cristian disease.
-the radiolucencentzone is not trabeculated and
show some angularity of theoutline. Often teeth areinvolve and radiographicallylost of bony support.
-Hand-Schller-
Christian diease involvedeveloping teeth, resultingand destruction malformationof the follicle
Complete Mouth Radiographs
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D. Residual postoperative osseous defect -seen after extraction of mandibular third
molars. - incomplete repair of osseous defect in the
maxilla result round radiolucent area that is well
defined and surrounded by normal bone.
C. Osteomyelitis-suppurative inflammatoryprocess,accompanied bychanges in radiolucencyin its earlier stages whiledestroyed.- bone appears to be
mothened, and zones ofradiolucency surround islandsof necrotic bone or sequestra.
-later stages show newbone formation with areasof destruction.
Complete Mouth Radiographs
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II. Osseous Radiopacities ff. should be consider in evaluating radiopacities
1. Location and extent
2. relative degree of radiopacity3. Variations in radiopacity within the lesion
4. Nature of the area immediately surrounding the radiopacity and
5. Possible origin of the lesion A. Tumors 1. Odontogenic -hard odontomas.itis produce by a calcified mass made
up of enamel,dentin,and cementum. -relative degree is variable throughout the mass. The
enamel in the mass is more radiopaquethan the dentin orcementum
- degree of involvement varies from 1cm.
Complete Mouth Radiographs
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Enamel pearl-misplaced spherical masses of enamel thatappear at the cervical areas of teeth especially in thetrifurcation and bifurcation areas of molars. pearls are samedegree of radiopacity and relatively greater opacity to dentinand cementum.
Cementoma- irregular radiopaque mass involving the apex ofone or more teeth.
C o m p le te M o u th R a d io g ra p h s
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2. Non-odontogenic 1.Bone whorls-islands of
compact bone reffered to cleroticbone or bonescars. Irregularoutline and clear cut margins.
2.Enostoses- inwardgrowth, similar to bone whorls
Exostoses- outwardsovergrowths of bone include toriinthe mandible andmaxilla. Appears increasedradiopacitysuperimposed on theroots of the mandibularpre-molars.
C o m p le te M o u th R a d io g ra p h s
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B. Foreign bodies1. Root tips-root tips usually
associated with edentulouarea. May or may notsuroundedby thin radiolucentline comparable to theperiodontal sp ace.
2. Metallic objects- as result of
frequent accidentaldeposition of amalgamin a extraction socket.
3. Silver amalgam fragments-appear a small granularradiopaque deposits or large
angular pieces.
C o m p le te M o u th R a d io g ra p h s
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C. Bone dyplasia Include Leontiasis osea and osteopetrosis Generalized radiopacity of the jaws- generalized obliteration of the
marrow spaces by osteosclerosisshould suggest to the examiner a
generalized bone dysplasia such as leonista osea and osteopetrosis.
III. Combination Osseous radiolucency and radiopacity1. Location and extent
2. relative degree of radiolucency3. relative degree of radiopaque4. variations in the radiopacity within the radiopaque part of the area in
question5. nature of the borders of the areas in question6. apparent effect of the lesion on the teeth and anatomic landmarks
7. possible origin of the lesion
C o m p le te M o u th R a d io g ra p h s
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A. Neoplasm 1. Benign a.Odontogenic b.Non-odontogenic
2. Malignant- primary B. Bone dysplasia -that cause a combination of RO & RL are generalized process Pagets diease or oteites deformansgeneralized process that may affect
the jaw in its involvementof the bones of the head . Usually descrbed as cotton wool
Bone enlargement, hypercementosis and resorptiom of teeth mayseen if jaw is involve
C o m p le te M o u th R a d io g ra p h s
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Fibrous dysplasia- characterizedradiographically only by achange In trabecular pattern
C. Osteomyelitis D. Foreign bodiesIV. Other dental findings impacted
teeth, supernumerary teeth, root
canal fillings
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POSTERIOR BITE-WINGRADIOGRAPHS
Po ste rio r B ite w in g
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are used to:1. determine the continuity of the lamina dura at the
alveolar crest- it is less difficult in posterior bitewing radiographs than
periapical radiographs- recognition of early periodontal disease is aided by
careful inspection of the lamina dura
2. estimate the alveolar crest level in relation to CEJ
Po ste rio r B ite w in g
R a d io g ra p h s
Po ste rio r B ite w in g R a d io g ra p h s
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3. evaluate tooth crown shape and formative defects
of the crown- the level and the vertical lenght of the contact or the lack
of a contact between two adjacent posterior teeth are
detemined through bitewing radiograph- local formative defects such as hypoplastic pits andalteration of crown form can be seen readily
Po ste rio r B ite w in g R a d io g ra p h s
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4. determine pulp size and degree of calcification
-pulp size determines thetype of restoration that can
be placed in a tooth- degree of pulpal calcificattion representsd the
response of the pulp to occlusal functions,restorations, and dental caries
Po ste rio r B ite w in g R a d io g ra p h s
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5. evaluate existing restorations
-marginal fit, recurrence of dental caries,adequacy of contact points, and depthinvolvement are important factors in
examining restorations.
Po ste rio r B ite w in g R a d io g ra p h s
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6. locate calculus
- interproximal subgingival calculus appears asspurlike projection on the proximal surface of a
tooth- buccal or lingual surface calculus has linearappearance- but not all calculus can be seen radigraphically,
bitewing is just supplemental
Po ste rio r B ite w in g R a d io g ra p h s
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7. locate carious lesions
- interproximal carious lesions that have progressedthrough the enamel to involve the DEJ are best viewed
through bitewing radiograph- recurrent caries are may be detected more readily- should be inspected in a routine manner, the maxillaryteeth should be thoroughly inspected in sequence,followed by mandibular teeth
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SUPPLEMENTAL RADIOGRAPHS
S u p p le m e n tal R ad iog rap h s
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Indications:
- suspected bone fracture- salivary calculus is suspected- extent of radiographic lesioncannot bedetermined by means periapical radiographs- the exact location of a radiographic lesion, foreign
body, or tooth cannot be determined from
periapical radiographs- the patient is unable to tolerate intraoral films- suspicion of TMJ changes
S u p p le m e n tal R ad iog rap h s
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Types:1. Occlusal films
a. Max. and Man. topographic occlusal viewsb. Max. and Man. anterior occlusal viewsc. Max. posterior occlusal views
2. Lateral films of the body of the mandible
3. Lateral film of the condyle4. Temporomandibular joint films5. Panographic films
S u p p le m e n tal R ad iog rap h s
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S u p p le m e n tal R ad iog rap h s
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The basic requirement for children is posteriorbitewing radiograph, supplemented by lateral films of
the jaw and anterior radiographs.
Interpratation of radiographs require additionalconcern that the permanent tooth buds are present.
R a d io g ra p h s fo r C h ild re n
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Hazards to the patient.
It is well established that the routine
dental radiographs taken from diagnosticpurposes do not endanger the patient, when aproperly filtered x-ray machine, a diaphragm tolimit the size of the x-ray beam and fast x-ray
film are used.
D a n g e rs Fro m R a d ia tio n
D a n g e rs fro m R a d ia tio n
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Hazards to the dentist.
Dentists are subject to exposure in varying quantities
of radiation.
Adequate protection from exposure is easily obtained
by proper shielding and properr use of x-ray machine.Whenever possible, a lead-lined shield should be installed in
the office, behind this the dentist is completely protected.
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