This document discusses endodontic radiography and the importance of radiographs in endodontic diagnosis and treatment. It provides a brief history of radiography and describes common types of radiographs used in endodontics like intraoral periapical radiographs and cone beam computed tomography (CBCT). Intraoral periapical radiographs allow visualization of the root structure and surrounding bone. CBCT provides high quality 3D images with less radiation compared to traditional CT. The document emphasizes that radiographs are essential for endodontic diagnosis, treatment planning, working length determination, and follow-up care.

1. ENDODONTIC
RADIOGRAPHY
BDS 3rd YEAR
Name:- Paankhi
Sharma

2. CONTENT
 INTRODUCTION
 HISTORY
 INTERPRETATION OF RADIOGRAPH
 TYPES
 IMPORTANCE OF RADIOGRAPH
 INTRAORAL PERIAPICAL RADIOGRAPHS
 CONE BEAM COMPUTED TOMOGRAPHY

3. INTRODUCTION
 Radiograph is one of the most important clinical
tool in making a diagnosis in endodontic therapy.
• It permits visual examination of oral structures that would
be unseen by naked eye.
•Radiographs can contain information on the presence of
caries that may involve or may threaten to involve pulp.
•Radiographs may show number, course, shape, length and
width of root canals which provides proper detail for
undergoing endodontic treatment.

4. HISTORY
 1895- Discovery of cathode rays by Roentgen
 1895- Otto Walkhoff took 1st dental X ray of his own teeth
 1899- Edmund Kells used Radiograph to check working length
 1900- Weston Price advocated radiograph to check quality of
obstruction
 1901- WH Rollins presented first paper on dangers of X ray
 1904- WA Price introduced Bisecting technique
 1913 & 1920- Eastman Kodak Company introduced ‘prewrapped
dental films’ and ‘machine made film packets’
 1925- HR Raper introduced Bitewing technique
 1947- FG Fitzgerald introduced paralleling cone technique

5. INTERPRETATION OF RADIOGRAPH
ACCORDING TO APPEARANCE
APPERANCE TENTATIVE FINDINGS
Black/Gray area a) Decay
b) Pulp
c) Gingiva or space between teeth
d) Abscess
e) Cyst
White area a) Enamel
b) Restoration [ metal, gutta percha,
etc. ]
Creamy white area Dentin appears as creamy white area
White line around teeth Lamina dura around teeth

6. FIGURE- RADIOGRAPH SHOWING ENAMEL, PULP, DENTIN
AND RESTORATION

7. TYPES
 INTRAORAL RADIOGRAPHS
•Intraoral Periapical
 Used to detect any abnormalities of the root structure and
surrounding bone structure
•Occlusal Radiographs
 Show full tooth development and placement
•Bitewing Radiographs
 Used to detect decay between teeth and changes in the bone
density caused by gum disease
 EXTRAORAL RADIOGRAPHS
•Panoramic Radiograph
•Lateral Cephalograms
•Cone Beam Computed Tomography

8. IMPORTANCE OF RADIOGRAPHS IN
ENDODONTICS
 Radiographs are essential to all phases of endodontic therapy.
1. DIAGNOSIS
 Helps in identifying pathosis i.e. Pulpal, Periapical, Periodontal
 Determining the root and pulpal anatomy:
• No. of roots/ root canals
• Unusual root morphologies
• Root curvatures
• Canal locations with respect to chambers
• Calcifications
 Characterizing normal structures

9. 2. TREATMENT
 Determining working lengths
 Evaluation of obturation
 Moving superimposed structures
 Differentiating canals and PDL spaces.
3. RECALL/FOLLOW UP
 Most times the patient does not know the status of the root canal
treatment
 In most cases, the patient may be asymptomatic, only radiographs help
diagnosing the endodontic failure
 There may be evidence of the development of new lesions

10. INTRAORAL PERIAPICAL
RADIOGRAPHS
 To use radiographs properly, the clinician must have the
knowledge and skill necessary to interpret them correctly
 Understanding of the underlying:-
• Normal anatomical structures
• Anomalous anatomy
• Changes that occur due to aging, trauma, disease and healing
 Only then will these two dimensional black-and-white
shadows on processed film have meaning
 The information contained within a radiograph is so
essential to dental practice, it is important that
radiographs be of excellent quality

11.  To produce an excellent radiograph, one must master the
necessary skills:
• Proper placement of the film in the patient’s mouth
• Correct angulation of the cone in relation to the film and
oral structures to prevent distortion of the anatomical
images
• Correct exposure time, so that images are recorded with
identifiable contrasts
• Proper developing technique to ensure a clear, permanent
record that can be retained and stored for future use

12. FIGURE- FULL MOUTH INTRAORAL PERIAPICAL RADIOGRAPH

13. CONE BEAM COMPUTED
TOMOGRAPHY
 It’s a diagnostic imaging modality that provides high quality,
accurate three-dimensional representation of the osseous
elements of the maxillofacial skeleton
 It is a form of computed tomography in which only a focused,
cone-shaped beam of X-ray is projected at the imaged tissue
 The limited volume significantly reduces the amount of
radiation compared with traditional computed tomography
 The resolution of the CBCT image is low, which allows
visualization of very small objects, such as difficult to find
canals [pixels resolution ranging from 0.4 mm to 0.076 mm]

14. FIGURE- CBCT PROVIDING THREE-DIMENSIONAL VIEWS IN
AXIAL, CORONAL AND SAGITTAL DIRECTIONS

15.  STEPS IN PROCESSING
 According to Scarfe et al., following are the steps
involved in CBCT image processing:
1. Acquisition configuration
2. Image detection
3. Image reconstruction
4. Image display

16.  APPLICATIONS IN ENDODONTICS
 The applications of CBCT in endodontics include:
• Diagnosis of periradicular lesions
• Canal visualization
• Assessment of internal and external resorption
• Detection if root fractures and other dentoalveolar
trauma
• Preparation for endodontic surgery
• Detection of calcific metamorphosis

17.  ADVANTAGES
• Rapid scan time
• Beam limitation
• Image accuracy
• Reduced patient radiation dose
• Interactive display modes applicable to maxillofacial
imaging
• Multiplanar reformation
• Three dimensional volume rendering

18.  LIMITATIONS
• Artifacts ( X-ray beam related, patient related, cone
beam related and scanner related )
• Image noise
• Poor soft tissue contrast

19.  IMPORTANT POINTS
 The sensitivity of CBCT is higher than that of
Periapical Radiography in detecting periapical
lesions and identifying vertical root fractures
 It’s spartial resolution is however poor compared
to conventional radiographs

20. THANK YOU