Radiographic assessment of dental caries

1. Interpretation Of
Dental Caries

2. Rationale For The Use Of Intraoral
Radiographs
Intra-oral radiographyIntra-oral radiography
can reveal cariouscan reveal carious
lesions which mightlesions which might
not be detectednot be detected
during a thoroughduring a thorough
clinical examination.clinical examination.
Cavitating lesion
No-cavitation

3. Rationale For The Use Of Intraoral
Radiographs
Both clinical andBoth clinical and
radiographic examinationsradiographic examinations
are necessary in theare necessary in the
detection of dental cariesdetection of dental caries
N.B.N.B. Early carious lesionsEarly carious lesions
are difficult to detectare difficult to detect
radiographically particularlyradiographically particularly
when they are small andwhen they are small and
limited to the enamel.limited to the enamel.

4. EXAMINATIONS
PosteriorPosterior bitewing radiographsbitewing radiographs areare
the most useful for detectingthe most useful for detecting
caries.caries.
Periapical radiographsPeriapical radiographs areare
primarily used for detectingprimarily used for detecting
changes in the periapical andchanges in the periapical and
inter-radicular bone.inter-radicular bone.

5. EXAMINATIONS
Bitewing examinationBitewing examination
For childrenFor children : up to 3 years use: up to 3 years use
size 0 film, till 6 years use sizesize 0 film, till 6 years use size
1 and after that use size 2.1 and after that use size 2.
For adultsFor adults : the most useful: the most useful
adult bitewing examinationadult bitewing examination
consists of no. 2 size films forconsists of no. 2 size films for
separate premolar and molarseparate premolar and molar
projections.projections.
2
00
M.Ekram
2211
Up to 3 years
3-6 years After 6 years
and adults

6. Frequency
when radiographs are indicated ?
Radiographs are frequently used for detectingRadiographs are frequently used for detecting
caries when the teeth are incaries when the teeth are in tight contacttight contact andand
cannot be directly inspected.cannot be directly inspected.
Radiographs are especially used when theyRadiographs are especially used when they
contribute to the diagnosis of dental cariescontribute to the diagnosis of dental caries
e.ge.g in clinically inaccessible areas as the rootsin clinically inaccessible areas as the roots
of teeth.of teeth.

7. RadiographicRadiographic
AppearanceAppearance
Of CariesOf Caries

8. Occlusal cariesOcclusal caries

9. Incipient Occlusal Caries
Cannot be seen on a radiograph andCannot be seen on a radiograph and
must be detected clinicallymust be detected clinically with anwith an
explorer. usually radiographs are notexplorer. usually radiographs are not
effective till caries reach the dentine.effective till caries reach the dentine.

10. Incipient occlusal caries
Incipient occlusal caries
Not evident radiographically
But they require treatment

11. Incipient Occlusal Caries
The only detectableThe only detectable
evidence of an earlyevidence of an early
carious lesion at thecarious lesion at the
occlusal surface mayocclusal surface may
be abe a fine gray shadowfine gray shadow
just beneath the (DEJ).just beneath the (DEJ).
this should bethis should be
differentiated from thedifferentiated from the
optical illusionoptical illusion
calledcalled mach bandmach band..

12. Moderate Occlusal Caries
The classic radiographicThe classic radiographic
change is achange is a broad basedbroad based
of a thin radiolucent zoneof a thin radiolucent zone
in the dentine with little orin the dentine with little or
no changes in the enamelno changes in the enamel
..

13. Moderate Occlusal Caries
a broad based thina broad based thin
radiolucent zone inradiolucent zone in
the dentinethe dentine

14. Moderate Occlusal Caries
Differential diagnosis:Differential diagnosis:
a band of increased opacitya band of increased opacity
exists between the lesionexists between the lesion
and the pulp chamber. thisand the pulp chamber. this
line is not usually seen withline is not usually seen with
buccal caries .buccal caries .
N.B. careful clinicalN.B. careful clinical
examination should beexamination should be
carried out .carried out .
OcclusalCaries
B&Lingcaries

15. Severe Occlusal Caries
Readily observedReadily observed bothboth
clinically andclinically and
radiographically.radiographically.
Appears as aAppears as a largelarge
radiolucency in the crownradiolucency in the crown
of the toothof the tooth. the occlusal. the occlusal
surface may appearsurface may appear
collapsed.collapsed.

16. Pitfalls In The Interpretation
Of Occlusal Caries
1.Failure to recognize that1.Failure to recognize that occlusalocclusal
caries of enamelcaries of enamel will not ordinarily bewill not ordinarily be
detectable on radiographs.detectable on radiographs.
2. The carelessness of not observing the2. The carelessness of not observing the
the long thin radiolucency that first appears
at the ( DEJ) as a sign of occlusal caries.
3. Confusion between occlusal and buccal
caries
( clinical examination is essential).

17. Proximal cariesProximal caries

18. PROXIMAL CARIESPROXIMAL CARIES
Radiographic detection of carious lesions on theRadiographic detection of carious lesions on the
proximal surfaces of teeth depends onproximal surfaces of teeth depends on loss ofloss of
enough mineralenough mineral to result in a detectable changeto result in a detectable change
in radiographic densityin radiographic density
N.B.N.B. Approximately 40 %Approximately 40 % demineralization isdemineralization is
required.required.

19. Proximal caries susceptible -zone
Free
gingival
margin
Contact point
This region extends from the contact point
down to the height of the free gingival margin

20. Classification OfClassification Of
Proximal CariesProximal Caries
Proximal caries can be classified according toProximal caries can be classified according to
thethe depth of penetrationdepth of penetration of the lesion through theof the lesion through the
enamel and dentin into:enamel and dentin into:
Incipient class IIncipient class I
Moderate class IIModerate class II
Advanced class IIIAdvanced class III
Severe class IV

21. Incipient Proximal Caries
Extends less than halfwayExtends less than halfway
through the thickness of enamelthrough the thickness of enamel
( seen only in enamel ).( seen only in enamel ).
Non-cavitating lesion

22. Incipient proximal caries
The general radiographic appearance of anThe general radiographic appearance of an
incipient carious lesion is of a radiolucentincipient carious lesion is of a radiolucent
“notch”“notch” on the outer surface of the tooth.on the outer surface of the tooth.

23. AA magnifying glass is very useful foris very useful for
examining incipient carious lesions.examining incipient carious lesions.
Incipient proximal caries

24. Moderate Proximal Caries
Involve more than theInvolve more than the
outer half of theouter half of the
enamel but are notenamel but are not
seen radiographicallyseen radiographically
to extend into theto extend into the
(DEJ).(DEJ).

25. Moderate Proximal Caries
These lesions generally haveThese lesions generally have
one of three radiographicone of three radiographic
appearances :appearances :
1. A1. A triangletriangle with its broad base atwith its broad base at
the surface of the tooth.the surface of the tooth.
2.2. DiffuseDiffuse radiolucent image.radiolucent image.
3. A3. A combinationcombination of these twoof these two
types.types.

26. Advanced Proximal Caries
Extends to or throughExtends to or through
the (DEJ) and intothe (DEJ) and into
dentin but does notdentin but does not
extend through theextend through the
dentin more than halfdentin more than half
the distance towardthe distance toward
the pulpthe pulp (( the lesionthe lesion
involves both enamelinvolves both enamel
and dentinand dentin ).).

27. Advanced Proximal Caries
The configuration isThe configuration is
usuallyusually triangulartriangular butbut
may be diffuse or amay be diffuse or a
combinationcombination of them.of them.

28. Severe Proximal Caries

29. Severe Proximal Caries
Extends through theExtends through the
enamel , through theenamel , through the
dentin and more thandentin and more than
half the distance towardhalf the distance toward
the pulp. the lesionthe pulp. the lesion
approaches the pulpapproaches the pulp
and may appearand may appear
clinically as a cavitationclinically as a cavitation
in the tooth.in the tooth.

30. Pitfalls In The Interpretation
Of Proximal Caries
Proximal cariesProximal caries
may bemay be
confused withconfused with
Cervical
burnout.
CoveredbyboneCoveredbyenamel

31. Cervical Burnout

32. Pitfalls In The Interpretation
Of Proximal Caries
Proximal caries mayProximal caries may
be confused with:be confused with:
Hypoplastic pits
Concavities
produced by wear.

33. Facial , Buccal AndFacial , Buccal And
Lingual cariesLingual caries

34. Facial , Buccal And Lingual cariesFacial , Buccal And Lingual caries
When smallWhen small , appear, appear
as small roundas small round
radiolucent area.radiolucent area.
As they enlargeAs they enlarge theythey
become elliptic orbecome elliptic or
similunar in shape.similunar in shape.

35. Facial , buccal and lingualcaries (Con)Facial , buccal and lingualcaries (Con)
They demonstrateThey demonstrate sharpsharp
well-defined borderswell-defined borders
between the intact andbetween the intact and
deminiralized (radiolucent)deminiralized (radiolucent)
enamel.enamel.
Clinical examinationClinical examination with anwith an
explorer is necessary.explorer is necessary.
N.B.N.B. It is difficult to differentiate between buccal and lingualIt is difficult to differentiate between buccal and lingual
caries on a radiograph.caries on a radiograph.

36. Differential Diagnosis Of
Buccal And Lingual Caries
WITH PROXIMAL CARIESWITH PROXIMAL CARIES
A buccal or lingual carious lesion atA buccal or lingual carious lesion at
or near the mesial or distal lineor near the mesial or distal line
angle of the tooth may project ontoangle of the tooth may project onto
a proximal surface and appear asa proximal surface and appear as
a proximal lesion.a proximal lesion.
Different angulation may be used.Different angulation may be used.
N.B. Clinical examination is essential.
Proximal caries

37. Differential Diagnosis Of
Buccal And Lingual Caries
WITH OCCLUSAL CARIESWITH OCCLUSAL CARIES
It is necessary to examineIt is necessary to examine more than one viewmore than one view ofof
the area because a margin of a buccal or lingualthe area because a margin of a buccal or lingual
lesion may be superimposed on the (DEJ)lesion may be superimposed on the (DEJ)
suggesting occlusal caries.suggesting occlusal caries.

38. DIFFERENTIAL DIAGNOSIS OF BUCCAL AND LINGUAL
CARIES WITH OCCLUSAL CARIES(con)
Also, Occlusal caries will ordinarily be :
* more extensive than lingual or buccal caries
*it’s outline not as well defined
N.B. Clinical examination is is essential.

39. Root Surface CariesRoot Surface Caries
 Involves only the rootsInvolves only the roots
of the teeth and is alsoof the teeth and is also
calledcalled cemental cariescemental caries..

40. Root Surface CariesRoot Surface Caries
 Radiolucent , illRadiolucent , ill
defined saucer-likedefined saucer-like
lesions and if small , thelesions and if small , the
lesion will be notchedlesion will be notched
rather than saucerlike.rather than saucerlike.

41. Root Surface CariesRoot Surface Caries

42. Pitfalls In the Interpretation Of
Root Surface Caries
root surface caries may be confused withroot surface caries may be confused with
cervical burnoutcervical burnout
The true carious lesion may beThe true carious lesion may be
distinguished from thedistinguished from the intactintact surfacesurface
primarily by :primarily by :
Absence of an image of theAbsence of an image of the root edge.root edge.
The appearance of aThe appearance of a diffuse roundeddiffuse rounded
inner borderinner border where the tooth substancewhere the tooth substance
has been lost.has been lost.
N.B. clinical examination is essential.

43. Recurrent CariesRecurrent Caries
OccursOccurs adjacent to a preexisting restoration.adjacent to a preexisting restoration. CariesCaries
occur in this region because ofoccur in this region because of ::
Inadequate cavity preparationInadequate cavity preparation
Defective margins of restorationsDefective margins of restorations
incomplete removal of caries.incomplete removal of caries.

44. Recurrent cariesRecurrent caries
Appears radiographically as a
radiolucent area just beneath a
restoration.
The radiographic appearance
depends on :
* the amount of decalcification
present and
* whether a restoration is
obscuring the lesion.

45. Differential Diagnosis Between Caries
And Restorative And Base Materials
Radiographic appearance of restorative materialsRadiographic appearance of restorative materials
depends on their:depends on their:
thickness - density (atomic structure).
some can be confused with caries such as :some can be confused with caries such as :
old calcium hydroxide , composite , plastic orold calcium hydroxide , composite , plastic or
silicate.silicate.
They can be differentiated from caries by :They can be differentiated from caries by :
1. their well-defined and classic outline.1. their well-defined and classic outline.
2. dental history and clinical examination.2. dental history and clinical examination.

46. Differential Diagnosis Between Caries
And Restorative And Base Materials

47. Rampant CariesRampant Caries
 Rampant caries is anRampant caries is an
advanced and severeadvanced and severe
form of cariesform of caries that affectsthat affects
numerous teeth.numerous teeth.
Rampant caries isRampant caries is
typically seen intypically seen in childrenchildren
with poor dietary habits orwith poor dietary habits or
inin adultsadults with a decreasedwith a decreased
salivary flow.salivary flow.

48. Radiation CariesRadiation Caries
 Occurs in patients who haveOccurs in patients who have
received therapeutic radiationreceived therapeutic radiation
to the head and neck regionto the head and neck region
with a resultantwith a resultant xerostomiaxerostomia ..
 dark radiolucentdark radiolucent lesionslesions
appear at the necks of teethappear at the necks of teeth
(cervical caries )(cervical caries ) most obviousmost obvious
on the mesial and distalon the mesial and distal
aspects.aspects.

49. Radiation caries (con)Radiation caries (con)
 Variation in the depth ofVariation in the depth of
destructiondestruction may be present ,may be present ,
but generally their is uniformitybut generally their is uniformity
within a given region of thewithin a given region of the
mouth.mouth.
 Destruction may encircle theDestruction may encircle the
tooth causing thetooth causing the entire crownentire crown toto
be lost.be lost.

50. Thank YouQuestions ?