This document provides guidance on radiographic interpretation through a systematic method of image analysis. It discusses acquiring diagnostic images of appropriate quality and number, and optimal viewing conditions. It describes a step-by-step process for analyzing intraoral and extraoral images that involves localizing abnormalities, assessing features like shape and borders, analyzing internal structure and effects on surroundings, and formulating a radiographic interpretation and differential diagnosis. The goal is to provide a thorough yet organized evaluation of what is seen on dental radiographs.

1. Seminar
Principlesof radiographicinterpretations

2. Introduction
• Interpretation: an explanations
• Radiographic interpretation is an explanation
of what is viewed on dental radiograph
• Diagnosis: the identification of a disease by
examination or analysis.

3. Aim:
• systematic method of image analysis
ACQUIRING APPROPRIATE DIAGNOSTIC IMAGES
• Quality of the Diagnostic Image
• Number and Type of Available Images

4. • VIEWING CONDITIONS:
.Ambient light in the viewing room should be reduced.
.Intraoral radiographs should be mounted in a film holder.
.Light from the view box should be of equal intensity
across the viewing surface.
.The size of the view box should accommodate the size of
the film. If the viewing area is larger than the film, an
opaque mask should be used to eliminate all light from
around the periphery of the film. This mask can be
fabricated from a sheet of opaque material cut to fit
the entire view box, leaving an opening for one film.
.An intense light source is essential for evaluating dark
regions of the film.
.A magnifying glass allows detailed examination of small
regions of the film.

5. A. Wardray viewing box incorporating an additional central
bright-light source for viewing over-exposed dark films.
B. The SDI X-ray reader — an extraneous light excluding
intraoral film viewer with built-in magnification.

7. Image analysis
• INTRAORAL IMAGES
1. IOPA before bitewing
2. Rt. Maxilla lft. Maxilla lft. Mandible rt.
Mandible
3. Identify the anatomic structure, examine the
bone & character of the trabecular bone.
4. Compare the same area on adjacent and
corresponding areas of other side.

8. • 2nd visual circuit
1. Examining the ht. and cortication of alveolar
bone relative to teeth.
2. Examine alveolar bone for extent and
severity of bone loss
3. Areas of erosion; difference in trabeculae
pattern

9. • 3rd visual circuit
1. dentition and associated structures
2. Each tooth in sequence, using all available
images
3. Examine PDL space & lamina dura of each
tooth.

10. EXTRAORAL RADIOGRAPHY
• Analysis of Intraosseous Lesions
1. picture matching, or "Aunt Minnie,"method
2. step-by-step analysis

11. step-by-step analysis
STEP 1: LOCALIZE THE ABNORMALITY

12. cherubism

13. • Position in the jaws Soft tissue
Within jaws
• Odontogenic origin
Coronal to tooth
• Odontogenic origin
Above IAC
• Neural or vascular origin
Within IAC
• Not of odontogenic origin
Below IAC
• Cartilagenous or osteochondromas
Condylar region

15. Specific epicenters
CGCG
• Mandible- anterior to 1st molar
• Maxilla- anterior to cuspid
Osteomyeli
tis
• Mandible more common
Periapical
cemental
dysplasia
• Periapical region of teeth

16. • Single or multifocal
periapical cementa! dysplasia, odontogenic
keratocysts, metastatic lesions, multiple
myeloma, leukemic infiltrates
• Size- may aid in the differential diagnosis

17. STEP 2: ASSESS THE PERIPHERY AND
SHAPE Well defined
borders
Punched out
sclerotic margin
radiopaque lesion
with radiolucent
margins
corticated margin
Ill defined
borders
blending border
invasive border/ p
ermeative

20. • Shape
Circular/
hydraulic cyst
Scalloped/
multilocular
Cyst, cystlike lesions, tumors

22. STEP 3: ANALYZE THE INTERNAL
STRUCTURE
radiolucent
mixed
radiopaque
Radiolucent lesions:
Unilocular- eriapical cyst,
granuloma,, abscess, PA cemental
dysplasia.
Multilocular- OKC, CGCG, botryoid
odntogenic cyst, aneursymal bone
cyst,cherubism
Moth eaten - osteomyelitis,
osteosarcoma, lymphoma,multiple
myeloma
radiopaque lesions:
Focal opacity- PA cemental dysplasia, condensing
osteitis,sclerotic bone
Target lesions- benign cementoblastoma, complex
odontome
Multifocal confluent- osteitis deformans, florid
osseous dysplasia
Mixed- AOT, CEOT, compound odontome, KCOT,
ossifying fibroma
Irregular- osteosarcoma, chondrosarcoma
Ground glass- FD, ostetis deformans, osteopetrosis,
hyperthyroidism

25. STEP 4: ANALYZE THE EFFECTS OF THE
LESION ON SURROUNDING STRUCTURES
• stimulate bone resorption or
formation.
Inflammatory
lesion
• slowly creates its own space by
displacing teeth and other
surrounding structures
space-
occupying

27. Epicentre above the
crown
Apical displacement of tooth eg;
follicular cyst, odontomas
Epicentre in ramus
push teeth in an anterior
direction eg; cherubism
Papilla of developing
teeth
push the developing tooth in a coronal
direction eg; lymphoma, leukemia,
Langerhans‘ cell histiocytosis
Widening of the
periodontal
membrane space
Malignant lesions; an irregular widening
and destruction of the lamina dura
Resorption of teeth
chronic or slowly growing process; more
commonly related to benign processes

28. Presence of reactive
bone at periphery
slow, benign growth and possibly the
ability to stimulate osteoblastic activity
in the surrounding bone
IAN canal superior
displacement Fibrous dysplasia
IAN canal widening
with cortical boundary
benign lesion of vascular
or neural origin
IAN canal widening with
cortical destruction
malignant neoplasm growing
down the length of the canal

29. • Periosteal new bone
formation
Slow growing
lesion
• Missing of cortical plate
Rapidly
growing
lesions
• Lift the periosteum
• Recurrence cause onion skin
pattern
Inflammatory
lesion with
exudation

31. STEP 5: FORMULATE A RADIOGRAPHIC
INTERPRETATION

32. Decision 1
Decision 2
Decision 3

33. Systematic approach
• The entire radiograph
• Specific lesions

34. The entire radiograph

35. Specific lesions
A systematic description of a lesion should include
its:
• Site or anatomical position
• Size
• Shape
• Outline/edge or periphery
• Relative radiodensity and internal structure
• Effect on adjacent surrounding structures
• Time present, if known.

36. references
• White & Pharoh Oral Radiology,4th Edition
• White & Pharoh Oral Radiology, 5th Edition
• Eric Whaites ; Essentials Of Dental
Radiography & Radiology, 3rd Edition
• Karjodhkar; Textbook Of Dental & Maxillofacial
Radiology 2nd Edition
• Dental Radiography Principles And
Techniques; Haring & Howerton, 3rd Edition