principles of basic interpretation - canaray · · 2015-12-11principles of basic interpretation....
TRANSCRIPT
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Principles of Basic Interpretation
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Assessment Types
• General Assessment• The routine assessment of radiographic images
• Always conducted
• Specific Assessment• The in-depth assessment of abnormal (unusual)
radiographic shadows
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General Assessment
• Systematic
• Consistent
• Complete
• Concise
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The Report
• Patient Identification
• Name, Date of Birth, Address
• Referring Dentist
• Prescribing Dentist
• Date of Exam
• Date of Report (Dictation and Transcription)
• Reason for Examination
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The Report
• Type of Scan, Scan Protocol
• Findings• Comparison to other / previous studies
• Diagnosis or Differential Diagnosis
• Recommendations for further examination
• Conclusion
• Proof and Sign
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General Assessment
• Assessment 1 : Bone Patterns and Osseous and Soft Tissue Anatomy
• This is an overall assessment of radiographic anatomy excluding the detailed dental assessment that follows. This section would include interpretation of bone/soft tissue variations, cysts, neoplasms, developmental changes, etc.
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General Assessment
• Assessment 2: General Dental Assessment
• i) Missing / Supernumerary Teeth
• ii) Eruptive and Positional Variations
• iii) Regressive Changes to Teeth
• iv) Anomalies of Teeth
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General Assessment
• Eruptive and Positional Variations
• Unerupted Teeth:• Assess follicle, Surrounding Bone, Adjacent Teeth.
• Eruption Pattern• Symmetry, Delayed, Accelerated, Impaction
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General Assessment
• Eruptive and Positional Variations
• Impacted Teeth:• Assess follicle, Surrounding Bone, Adjacent Teeth.
• Type: Vertical, Horizontal, Mesioangular, Distoangular, Bucco-palatal, Bone, Soft Tissue
• Relation to: Canal, Sinus, Other Teeth
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General Assessment
• Eruptive and Positional Variations• Tipping
• Drifting
• Rotation
• Over-Eruption
• Crowding
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General Assessment
• Regressive Changes to Teeth• Attrition
• Abrasion / Abfraction
• Erosion
• Pulp Sclerosis
• Resorption• Internal
• External• Root
• Crown (Impaction)
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General Assessment
• Anomalies of Teeth• Crown
• Size, Shape, Enamel, Dentine, Pulp
• Root• Number, Size, Shape
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General Assessment
• Assessment 3: Periodontal Assessment
• i) Causative Factors
• ii) Bone Changes
• Lamina Dura and Periodontal Ligament Space
• Crown:Root Ratio
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General Assessment
• Causative Factors• Calculus
• Restorations• Overhanging Margins
• Deficient Margins
• Over Contoured Crowns
• Occlusion• Open Contacts
• Crowding
• Appliances
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General Assessment
• Bone Changes• Severity : Mild, Moderate, Severe
• Type : Horizontal• Craterform
• Inconsistent Plates
• Furcation Involvement
• Vertical
• Loss of Crestal Definition
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General Assessment
• Lamina Dura & Periodontal Ligament Space• Funnelling
• Secondary Traumatic Occlusion
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General Assessment
• Assessment 4: Periapical Assessment
• i) Lamina Dura and Periodontal Ligament Space
• ii) Periapical Bone
• iii) Root End Changes Associated with Periapical Abnormalities
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General Assessment
• Periapical Bone• Widened PDL / Loss of LD
• Early Inflammation
• Rarefying Osteitis
• Sclerosing Osteitis
• Incomplete Healing
• Apical Scar
• Idiopathic Osteosclerosis (DBI)
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General Assessment
• Root End Changes Associated with Periapical Abnormalities• Open Apex
• External Root Resorption
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General Assessment
• Assessment 5 : Caries Assessment
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General Assessment
• Assessment 6 : Previous Treatment
• Root Canal Fillings
• Pins and Posts
• Implants
• Restorations
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An Approach to the Radiographic Interpretation
of a Lesion
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General Considerations
• History
• Clinical Findings
• Imaging• 2D Images
• Comparison to previous images
• Comparison to contralateral side useful?
• 3D CBCT Imaging
• Other Imaging Modalities
• Biopsy
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Radiographic Description
• Intrinsic Features:
• Inherent features (appearance) of the lesion.
• Extrinsic Features:
• Effect of lesion on surrounding structures.
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Radiographic Description
• Intrinsic Features:
• Number
• Location
• Size
• Shape
• Periphery
• Internal Structure
• Soft Tissue
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Radiographic Description
• Extrinsic Features:• Erupted Teeth, LD and
PDL• Unerupted Teeth, Follicle
space and cortex• Canals• Sinus• Cortex• Periosteum• Midlines• Soft Tissue
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Number of Lesions
Solitary
Localized
Multiple
Descrete
Generalized
Diffuse
Florid Cemento-
Osseous Dysplasia
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Location of Lesion
Location
Maxilla
Anterior or Posterior
Involving Antrum or Nasal Cavity
Cancellous Bone / Cortical
Bone
Mandible
Above or Below Canal
Anterior, PosteriorRamus, Condyle
Cancellous Bone / Cortical Bone
Soft Tissue
Bone Lesion Involving Soft TissueSoft Tissue Lesion Involving Bone
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LOCALIZATION
Right Angle Views
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Female
9 Years
Asymptomatic
Localization
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Localization
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SIZE OF LESION
• Is the entire lesion visible?
• Benign lesions can become large
• Rate of growth is more important than size
Dentigerous Cyst
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Shape of Lesion
Regular, Oval Regular, Circular Regular, Oval,
Scalloped
Irregular
Lateral
Periodontal
Cyst
Residual
Cyst
Metastatic
Thyroid Ca
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Periphery of Lesion
Well Defined
Uncorticated
Punched-Out
Well
Defined
Corticated
Well Defined
Radiolucent Border
Corticated Rim
Poorly Defined
Uncorticated
Irregular
Infiltrative
Well Defined
Corticated
Scalloped Border
Well Defined
Uncorticated
Radiolucent Rim
Lateral Periodontal CystComplex Odontoma Metastatic Thyroid Ca
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Internal Structure of Lesion
Radiolucent Radiopaque Mixed
Rarefying
Osteitis
Dense Bone
Island
(Idiopathic
Osteosclerosis)
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Internal Structure of Lesion
Ground Glass
•Fibrous Dysplasia
Cotton Wool
•Pagets Disease
•Florid Cemento-Osseous Dysplasia
Moth Eaten
• Malignancy
•Osteomyelitis
An Approach to Radiographic Interpretation of a Lesion
Fibrous Dysplasia Squamous Cell Carcinoma
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Internal Structure
Multiloculoar
Soap Bubble
Multilocular
Honey Comb
Multilocular
Tennis Racket
Multilocular
Fine, Wispy
Multlocular
Tubular
Mixed
Ameloblastoma Periapical Cemento-Osseous Dysplasia
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Extrinsic Factors
• Erupted Teeth• Lamina Dura and Periodontal ligament Space
• Unerupted Teeth• Follicle Cortex and Follicle Space
• Canals
• Sinus
• Cortex
• Periosteum
• Midlines
• Soft Tissue
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Effect On Erupted Teeth
Not Involved Interdigitating Hanging In
Space
Displacement Resorption
An Approach to Radiographic Interpretation of a Lesion
Lymphoma
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Effect on Lamina Dura and Periodontal Ligament Space
Not Involved
Normal
Widened PDL
Loss of LD
Involved
Not Affected
Loss of LD
Loss of PDL
Multiple Myeloma
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Effect on Unerupted Teeth and Follicle Space and Cortex
Displacement
Time of Development
Impaction Follicle Enlargement
Loss of Cortex
Displacement of
Tooth in Follicle
Loss of Cortex
Irregular Follicle
EnlargementLeukemia
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Effect on Canal
Not Involved Involved
Not Affected Displaced Expanded Altered
CourseDestroyed
Fibrous Dysplasia
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Effect on Sinus
Halo Shadow Extrinsic Intrinsic Encroachment Expansion Destruction
Infiltration
Odontogenic Cyst Squamous Cell Carcinoma
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Effect on Cortex
Not Involving
Inferior Cortex
Thinned and Expanded
Intact Cortex Cortical Destruction
Dentigerous Cyst Squamous Cell Carcinoma
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Periosteal Reactions
Onion Skin
Osteomyelitis
Sun Ray
Hair-On-End
Malignancy
Codman Triangle
Malignancy
Metastatic Breast Ca Osteosarcoma
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The Assessment of Diffuse Bone Sclerosis
Increasing bone sclerosis decreases the contrast between cortical bone and
cancellous bone.
Increasing bone sclerosis increases the contrast between canal and cancellous
bone.
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Assessment of Diffuse Bone Sclerosis
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Midlines and Sutures
• Respected = Benign Violated = Malignant
OsteosarcomaIncisive Canal Cyst
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Cases
Richard Bohay, DMD, Dip Oral Rad, MSc, MRCD(C)
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Radiographic
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
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Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 52: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/52.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 53: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/53.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 54: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/54.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 55: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/55.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 56: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/56.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 57: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/57.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 58: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/58.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 59: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/59.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 60: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/60.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 61: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/61.jpg)
Describe the Lesion. What is the most likely Diagnosis?
![Page 62: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/62.jpg)
Describe the Lesion at 38. What is the most likely Diagnosis?
![Page 63: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/63.jpg)
Describe the Lesion. What is the most likely Diagnosis?
![Page 64: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/64.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 65: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/65.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 66: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/66.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 67: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/67.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 68: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/68.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion
![Page 69: Principles of Basic Interpretation - Canaray · · 2015-12-11Principles of Basic Interpretation. Assessment Types ... Caries Assessment. General Assessment •Assessment 6 : Previous](https://reader034.vdocuments.mx/reader034/viewer/2022051801/5ae784177f8b9a8b2b8eb273/html5/thumbnails/69.jpg)
Describe the Lesion. What is the most likely Diagnosis?
An Approach to Radiographic Interpretation of a Lesion