This document provides an overview of how trauma, pulpal lesions, and periapical lesions appear on dental images. It describes various types of trauma such as fractures, luxations, and avulsions and how they present radiographically. It also discusses pulpal lesions including resorption, sclerosis, obliteration and stones. Finally, it outlines common periapical lesions like granulomas, cysts, abscesses and radiopacities including condensing osteitis, sclerotic bone and hypercementosis. The document uses dental terminology and images to illustrate the radiographic presentation of these conditions.
Differences between primary and permanent dentitionAkshMinhas
A longitudinal radiological study of children (N = 549) who participated in a comprehensive preventive maintenance program showed that caries related events in the approximal surfaces of permanent teeth differed from those in deciduous teeth. Changes in the approximal surfaces of the younger permanent teeth were more pronounced than of the older primary teeth and differed significantly from 1 year to 2.5 years. These findings can be explained by posteruptive maturation of tooth enamel.
Differences between primary and permanent dentitionAkshMinhas
A longitudinal radiological study of children (N = 549) who participated in a comprehensive preventive maintenance program showed that caries related events in the approximal surfaces of permanent teeth differed from those in deciduous teeth. Changes in the approximal surfaces of the younger permanent teeth were more pronounced than of the older primary teeth and differed significantly from 1 year to 2.5 years. These findings can be explained by posteruptive maturation of tooth enamel.
A presentation on the instructions to be given to complete denture patients at the insertion appointment. Dealing with patients can be hard at times but with a proper approach, a strong rapport can be formed with the patient.
some essential information about anatomy and morphology of teeth to learn ( specially dentistry students ) , collecting and presenting by Negin Aliyari
this presntation is on diagnosis of various radiopaque lesions of maxilla and mandible as well as normal anatomic structure which appear radiopaque on the radiograph. sunject oral medicine and radiology.
this contains the occlusal radiography methods for both maxillary and mandibular different occusal radiographic techniques, principles, classification, indications
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
A presentation on the instructions to be given to complete denture patients at the insertion appointment. Dealing with patients can be hard at times but with a proper approach, a strong rapport can be formed with the patient.
some essential information about anatomy and morphology of teeth to learn ( specially dentistry students ) , collecting and presenting by Negin Aliyari
this presntation is on diagnosis of various radiopaque lesions of maxilla and mandible as well as normal anatomic structure which appear radiopaque on the radiograph. sunject oral medicine and radiology.
this contains the occlusal radiography methods for both maxillary and mandibular different occusal radiographic techniques, principles, classification, indications
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This report, prepared by the student at the College of Dentistry, Hassan Atheed , in the third phase discusses scientific topics, but it maybe did not be 100% complete.
A radiograph is only one part of the diagnostic process. Usually one does NOT make a diagnosis solely from a radiograph. A diagnosis is made by the clinician once all the diagnostic information has been collected and analyzed collectively. An interpretation or a differential diagnosis is made from the radiograph.
One examines a radiograph and NOT an X-ray. Bear in mind that an X-ray cannot be seen. X-ray is a photon / beam of energy.
حسن عضيد
Tooth resorption is the progressive loss of dentine and cementum by the action of osteoclasts. This is a physiological process in the exfoliation of the primary dentition, caused by osteoclast differentiation due to pressure exerted by the erupting permanent tooth
Traumatized Teeth
Copyright by Dr. Khin Swe Aye
Department of Conservative Dentistry
University of Dental Medicine, Yangon
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2. Introduction
Purpose
To provide a brief overview of the common features
of trauma and pulpal and periapical lesions as
viewed on dental images
3. Trauma Viewed
on Dental Images (Cont.)
Trauma
Trauma is an injury produced by an external force.
It may affect the crowns and roots of teeth as well
as alveolar bone.
It may result in injuries of teeth and bone and
injuries such as intrusion, extrusion, and avulsion.
4. Fractures
The breaking of a part
May affect the crowns and roots of teeth or the
bones of the maxilla or mandible
Includes:
Crown fractures
Root fractures
Jaw fractures
Whenever a fracture is evident or suspected,
image examination of the injured area is
necessary.
5. Crown Fractures
This most often involves anterior teeth.
May involve enamel, dentin, and/or pulp
The dental image permits evaluation of the
proximity of the damage to the pulp chamber and
evaluation of the root for any additional
fractures.
Most crown fractures result from an accident
involving a fall or a motor vehicle.
7. Root Fractures
Root fractures most often occur in the maxillary
central region.
They may be vertical or horizontal, single or multiple.
If the x-ray beam is parallel to the plane of the fracture, it
will appear as a radiolucent line.
If the x-ray beam is not parallel to the plane of the
fracture, it may not be apparent at all.
Less common than crown fractures.
Result from an accident or traumatic blow.
With time, root fractures have a tendency to enlarge
because of displacement of root fragments, hemorrhage,
or edema.
9. Jaw Fractures
Jaw fractures are most often observed in the
mandible.
The panoramic image is the best film for visualizing
mandibular fractures.
On a dental image, the fracture appears as a
radiolucent line.
Frequently result from assaults, accidents,
and sports injuries.
Maxillary fractures are typically difficult to
detect on dental images.
Maxillary fractures occur less frequently and most
often involve the anterior alveolar bone and teeth.
11. Injuries
Trauma may result in the displacement of
teeth.
Displacement involves luxation (intrusion and
extrusion) and avulsion.
Dental images allow for the evaluation of
structures after tooth displacement.
12. Luxation
Luxation is the abnormal displacement of
teeth.
Intrusion is the abnormal displacement of teeth
into bone.
Extrusion is the abnormal displacement of teeth
out of bone.
Teeth that have been luxated should be evaluated
by a periapical image and examined for root and
adjacent alveolar bone fractures, damage to the
periodontal ligament, and pulpal problems.
15. Dental Avulsion
Complete displacement of a tooth from alveolar bone
The periapical image shows a tooth socket without a
tooth.
Result from trauma associated with an assault or
accidental fall.
Dental images are important in the evaluation of the
socket areas and should be used to examine the region
for splintered bone.
17. Resorption Viewed
on Dental Images
Physiologic resorption
A process seen with the normal shedding of primary teeth
The primary tooth is shed when resorption of the roots is
complete.
Pathologic resorption
A regressive alteration of tooth structure observed when
a tooth is subjected to abnormal stimuli
May be:
External resorption
Internal resorption
19. External Resorption
Seen along the periphery of the root surface
This is often associated with reimplanted teeth, abnormal
mechanical forces, trauma, chronic inflammation, tumors
and cysts, impacted teeth, or idiopathic causes.
It most often involves the apices of teeth.
The apical region appears blunted.
The length of the root is shorter than normal.
Both the lamina dura and the bone around the
blunted apex appear normal.
Not detected clinically and does not exhibit mobility.
No effective treatment.
21. Internal Resorption
Internal resorption occurs within the crown or root of a
tooth.
Involves the pulp chamber, pulp canals, and surrounding dentin
It is believed to be precipitated by factors such as trauma,
pulp capping, and pulp polyps.
It appears as a round-to-ovoid radiolucency in the midcrown
or midroot portion of the tooth.
Endodontic therapy is recommended if perforation has not
occurred.
Generally asymptomatic.
Treatment is variable.
If the tooth is weakened by the resorptive process,
extraction is recommended.
22. Internal resorption seen as a round
radiolucency in the cervical region of a
mandibular second premolar.
24. Pulpal Lesions Viewed
on Dental Images
Examination of the pulp chambers and canals is
impossible without dental images.
Dental images may detect conditions such as:
Pulpal sclerosis
Pulpal obliteration
Pulp stones
Many dental procedures require information about
the size and location of the pulp cavity before
treatment begins.
25. Pulpal Sclerosis
Pulpal sclerosis is diffuse calcification of the
pulp chamber and pulp canals of teeth.
Results in a pulp cavity of reduced size
It is associated with aging.
It is of little clinical significance unless
endodontic therapy is indicated.
Conditions such as attrition, abrasion, caries,
dental restorations, trauma, and abnormal
mechanical forces may act as pulpal irritants
and stimulate the production of secondary
dentin that results in obliteration of the pulp
cavity.
27. Pulpal Obliteration
The calcification, or deposition of hard
tissue, within the pulp cavity
The production of secondary dentin may
obliterate the pulp chamber.
These teeth are nonvital and do not require
treatment.
May be caused by attrition, abrasion, caries,
dental restorations, trauma, or abnormal
mechanical forces.
Tooth does not appear to have a pulp
chamber or pulp canals.
29. Pulp Stones
Pulp stones are dystrophic calcifications found
in the pulp chamber or pulp canals.
They appear on dental images as round, ovoid, or
cylindrical radiopacities.
They may vary in shape, size, and number.
They do not cause symptoms.
They do not require treatment.
33. Periapical Radiolucencies
Periapical granulomas, cysts, and abscesses are
commonly seen on dental images.
These lesions cannot be diagnosed on their dental
image appearance alone.
Diagnosis is based on clinical features and dental
image and microscopic appearance.
34. Infection of the pulp results in necrosis.
A periapical granuloma, cyst, or abscess
forms at the apex
35. Periapical Granuloma
This is a localized mass of chronically inflamed granulation
tissue at the apex of a nonvital tooth.
It is the most common sequela of pulpitis.
It may give rise to a cyst or to an abscess.
Treatment is either endodontic therapy or removal of the tooth
with curettage of the apical region.
On dental images it appears as a widened periodontal ligament
space at the root apex.
This results from pulpal death or necrosis, or inflammation
of the pulp.
Typically asymptomatic but has history of prolonged
sensitivity to heat or cold.
The lamina dura is not visible between the root apex and
the apical lesion
37. A periapical radiolucency associated
with a mandibular premolar. (Note
that the lamina dura is not visible.)
38. Periapical Cyst
Periapical cyst is a lesion that develops over a long
period.
It results from cystic degeneration of the periapical
granuloma.
It is the most common of all tooth-related cysts.
It is typically asymptomatic.
Treatment is either endodontic therapy or extraction with
curettage of the apical region.
Also known as a radicular cyst.
Results from pulpal death or necrosis.
Comprise 50% to 70% of all cysts in the oral region.
Appears as a round or ovoid radiolucency.
39. A well-defined round radiolucency seen
at the apex of a mandibular central
incisor
40. A large periapical radiolucent region
appears on this panoramic image in
the anterior mandible
41. Periapical Abscess
This is a localized collection of pus around the apex
of a nonvital tooth.
Results from pulpal death.
Acute
Painful, nonvital; sensitive to pressure, percussion, and heat
May not appear on dental images
Chronic
Usually asymptomatic; pus drains through bone or the
periodontal ligament space
Appears as a round or ovoid apical radiolucency
42. An increased widening of the periodontal
ligament space seen in the periapical
region of the mandibular first molar
44. Periodontal Abscess
Collection of pus that results from infection within
the periodontal tissues (surrounding the tooth
Acute destructive process
Occurs as a complication of advanced periodontal disease
Appears as a radiolucent area along the lateral aspect of
the root
Most common symptom is deep, throbbing pain
Therapy includes drainage, subgingival scaling, and
debridement of periodontal tissues
What is the difference between a periapical abscess
and a periodontal abscess?
46. Periapical Radiopacities
The following are a few of the common periapical
radiopacities that may be seen on dental images:
These may be diagnosed based on their appearance,
clinical information, and patient history
Condensing osteitis
Sclerotic bone
Hypercementosis
47. Condensing Osteitis
Condensing osteitis is a well-defined radiopacity.
It is seen below the apex of a tooth with a history of long-
standing pulpitis.
It may vary in shape and size; does not appear to be
attached to the tooth root.
It is the most common periapical radiopacity observed in
adults; most commonly in the mandibular third molar.
Also known as chronic focal sclerosing osteomyelitis.
The opacity represents a proliferation of periapical bone
that is a result of a low-grade inflammation or mild
irritation.
No treatment is necessary.
49. Sclerotic Bone
Sclerotic bone is a well-defined radiopacity seen
below the apices of vital, noncarious teeth.
It is of unknown cause.
It is not attached to the tooth.
It varies in size and shape.
Margins may be smooth or irregular and diffuse.
It is asymptomatic.
Also known as osteosclerosis or idiopathic
periapical osteosclerosis.
Usually discovered on a routinely taken image.
51. Hypercementosis
Hypercementosis is the excess deposition of
cementum on root surfaces.
May result from supereruption, inflammation, or trauma
Most often affects the apical area, which appears
enlarged and bulbous.
Affected teeth are vital and do not require treatment.
Root areas affected are separated from periapical bone
by normal-appearing periodontal ligament space and
lamina dura.
Changes associated with trauma, resorption, and pulpal and periapical lesions can all be viewed on dental images.
Trauma can be viewed on dental images.
Whenever a fracture is evident or suspected, image examination of the injured area is necessary.
Most crown fractures result from an accident involving a fall or a motor vehicle.
Figure 35-1 shows a crown fracture.
Less common than crown fractures.
Result from an accident or traumatic blow.
With time, root fractures have a tendency to enlarge because of displacement of root fragments, hemorrhage, or edema.
Figure 35-3 shows a root fracture.
Frequently result from assaults, accidents, and sports injuries.
Maxillary fractures occur less frequently and most often involve the anterior alveolar bone and teeth.
Figure 35-5 shows a fracture of alveolar bone.
Dental images allow for the evaluation of structures after tooth displacement.
Teeth that have been luxated should be evaluated by a periapical image and examined for root and adjacent alveolar bone fractures, damage to the periodontal ligament, and pulpal problems.
Figure 35-7 shows an intruded crown.
Figure 35-8 shows a partial avulsion (extruded crown).
Result from trauma associated with an assault or accidental fall.
Dental images are important in the evaluation of the socket areas and should be used to examine the region for splintered bone.
The primary tooth is shed when resorption of the roots is complete.
Both the lamina dura and the bone around the blunted apex appear normal.
Not detected clinically and does not exhibit mobility.
No effective treatment.
Generally asymptomatic.
Treatment is variable.
If the tooth is weakened by the resorptive process, extraction is recommended.
Many dental procedures require information about the size and location of the pulp cavity before treatment begins.
Without dental images, examination of pulp chambers and canals is impossible.
Refer to Figure 35-14.
Conditions such as attrition, abrasion, caries, dental restorations, trauma, and abnormal mechanical forces may act as pulpal irritants and stimulate the production of secondary dentin that results in obliteration of the pulp cavity.
May be caused by attrition, abrasion, caries, dental restorations, trauma, or abnormal mechanical forces.
Tooth does not appear to have a pulp chamber or pulp canals.
Refer to Figures 35-15 and 35-16.
On a dental image, pulp stones appear as round, ovoid, or cylindrical radiopacities.
A periapical lesion is located around the apex (tip of the root) of a tooth.
A definitive diagnosis can be established only with microscopic examination.
This results from pulpal death or necrosis, or inflammation of the pulp.
Typically asymptomatic but has history of prolonged sensitivity to heat or cold.
The lamina dura is not visible between the root apex and the apical lesion.
Refer to Figures 35-20 and 35-21.
Also known as a radicular cyst.
Results from pulpal death or necrosis.
Comprise 50% to 70% of all cysts in the oral region.
Appears as a round or ovoid radiolucency.
Refer to Figures 35-22 and 35-23.
Results from pulpal death.
Pain with acute abscess may be intense, throbbing, and constant.
Refer to Figures 35-24 and 35-25.
What is the difference between a periapical abscess and a periodontal abscess? (The periapical abscess is a collection of pus that results from a necrotic pulp [within the tooth]; a periodontal abscess is a collection of pus that results from infection within the periodontal tissues [surrounding the tooth].)
Refer to Figure 35-26.
Any one of these radiopacities found near a tooth apex may be diagnosed based on the characteristic dental image findings and corroborating clinical information.
Also known as chronic focal sclerosing osteomyelitis.
The opacity represents a proliferation of periapical bone that is a result of a low-grade inflammation or mild irritation.
No treatment is necessary.
Refer to Figure 35-27.
Also known as osteosclerosis or idiopathic periapical osteosclerosis.
Usually discovered on a routinely taken image.
Refer to Figure 35-28.
Root areas affected are separated from periapical bone by normal-appearing periodontal ligament space and lamina dura.
Refer to Figure 35-29.
