X-ray in endodontics

2. Outlines and objectives:
• What is endodontics?
• Why must we properly use radiation in endodontics?
• Indications for radiology in endodontics.
• Types of films used.
• Using radiology in endodontics.
• Radiology hazards in endodontics.
• Postoperative assessment of endodontic treatment.
• Radiographic imaging techniques in endodontics.

3. Team Participants
Anas Mohamed 42210773
Ramy Ibrahim 42210780
Nawal Wahib 42210757
Yahya Basim 42210762
Ziad Gamal 42210786

4. INTRODUCTION
- Endodontics is a subspecialty of dentistry concerned
with the examination, diagnosis , and management of
dental pulp and the tissues that surround tooth roots.
What’s endodontics?

5. Why must we properly use
radiation in endodontics?

6. A) Improved diagnostic
capabilities:
Digital radiograph and CBCT detect complex canal anatomy,
periapical diseases, fractures, and resorption by providing
precise and detailed pictures of the tooth and surrounding
structures.

7. B) Accurate Treatment
Planning.
C) Improved treatment
outcomes.
D)Enhanced assessment
and follow up

8. E) Image-Guided Endodontic Surgery:
Sophisticated software combined with
CBCT scans allows physicians to build 3D
virtual models of the patient's anatomy.
With increased accuracy and precision,
these models can then be used to plan
and direct surgical procedures like root-
end resections and apicoectomies.

9. Indications for radiology in endodontics
Locating roots and
canals
Diseases Diagnosis Moving superimposed
structures
Evaluating treatment
progress

10. Diseases Diagnosis even before
symptoms start to appear
A patient with altered apical PDL and
external resorption that’s occurring in
the absence of symptoms which
indicates poor tooth prognosis.

11. Moving superimposed
structures
C. The radiolucent area located above
the apex may be mistaken as pathosis.
D. By conducting pulp testing (to
determine vital response) and
adjusting the horizontal and vertical
angulation to a more distal position, it
becomes apparent that the
radiolucency is caused by the buccally
positioned mental foramen.

12. Locating roots and canals
E . The first premolar root outlines
are not clear.
F . By shifting the horizontal angle by
20 degrees proximally, the outlines of
the palatal and buccal roots are
identified.

13. Evaluating treatment
progress
A) Length of the root canal
B) Density of the root canal filling
C) Presence of any root canal anomalies

14. Types of films used :
• - We have 5 types of films .
• #0 for child PA and BW .
• #1 for adult ant. PA.
• #2 for adult PA, BW and for child
occlusal.
• #3 for extra oral BW .
• #4 for occlusal in adults .

15. Types of films used :
• Periapical radiographs :
- They are the most commonly used
modality in endodontics .
- The paralleling technique is preferred
for standardization and for more
accurate dimensions (not affected by
human factor).

16. Types of films used :
• Bitewing x-ray film :
- The term bitewing comes from how patient
just bite down on the film .
- They are often taken to evaluate
restorability before initiating treatment or to
check for coronal leakage and decay .

17. Types of films used :
• Sensors:
The newer, Better, Clearer, easier and faster
method .

18. Difference between opacity and
translucency of tooth tissue

19. - Normal pulp: enamel appears
opaque but the dentin less opaque.
- Pulpitis: causes changes in the
opacity and translucency of tooth
tissue making the tooth darker due
to entrance of inflammatory
exudate into dentinal tubules.
⬆️ Dentin opacity ➡️ Reactive dentin
formation.
⬇️ Dentin translucency ➡️ 2ry Dentin
deposition or mineralization.
Difference between opacity and
translucency of tooth tissue

20. • Additional disinfection is
necessary in pulp necrosis.
• Treatment Monitoring:
x-rays before, during and
after treatment.
Understanding the difference between opacity and
translucency of endodontic tissue by:

21. Using radiology in Endodontics

22. Using radiology in
Endodontics
- Endodontics requires
radiographic imaging for
diagnosis, treatment
planning, therapy, and
follow-up .

23. 1) PRE-OPERARTIVE
RADIOGRAPH :
- It must be taken before
every root canal treatment.
NOTE:
X-ray never detect pulp
exposed Cause it shows only
2D.

24. 2) TREATMENT:
We place the film at the
appropriate length to
determine the length of
the root canal to
determine the working
length .

25. A&B) radiograph during working to determine the length of the
dental canal to determine the working length .
C) RADIOGRAPH BEFORE STARTING OF TTT (DIAGNOSIS) .
E&F) RADIOGRAPH AFTER WORKING (TO FOLLOW UP).

26. 3) Radiographic diagnosis of
injured pulp:
"Radiography is a crucial tool
in evaluating and diagnosing
dental pulp injuries, guiding
appropriate treatment."

27. How do
radiographic
techniques
benefit in
diagnosis and
treatment ?!
• Identifying Types of Injuries
• Assessing Severity
• Guiding Treatment
• Follow-up and Post-
Treatment Evaluation

28. Radiology hazards in
endodontics
• Exposure to Ionizing rays during
endodontic radiotherapy can cause cancer.
• Exposure of the thyroid gland cause
thyroid dysfunction .
• Radiation affects genetics and can affect
the next generations.
• Pediatric Patients or Children are more
sensitive to radiation due to their
continuously growing tissues.
• dental professional faults e.g. exposure
to unnecessary x-rays.

29. Factors that influence outcome:
1
Preoperative status
of the periapical
tissues
2 Quality of the root
canal filling

30. Preoperative status of the periapical tissues:
It’s favorable prognosis by a percentage of
95% when we have :
- vital pulp, inflamed pulp or necrotic
uninfected pulp.
But favorable by a percentage of 85% when
we have infected pulp.

31. Quality of the root canal filling:
- The root canal filling is
overextended because microbes
and infected debris are extruded in
such a case .
- Quality of the coronal
restoration.
- There should be no marginal
defects or recurrent caries.

32. Conventional
radiographs vs.
Cone beam
computed
tomography
(CBCT)
We will take this case as an example.

33. Conventional radiographs vs. Cone beam computed tomography (CBCT)
Using conventional just after endodontic
treatment and postoperative assessment
after 1 year.
Using CBCT as postoperative assessment of
root canal treatment after 1 year

34. 1. Cone Beam Computed
Tomography (CBCT).
Radiographic imaging techniques in dentistry are constantly
evolving, incorporating several advanced and recent
technologies:

35. 2. Single-Photon Emission Computed Tomography/Computed
Tomography (SPECT/CT).
Radiographic imaging techniques in dentistry are constantly
evolving, incorporating several advanced and recent
technologies:

36. Radiographic imaging techniques in dentistry are constantly
evolving, incorporating several advanced and recent
technologies:
3. Micro-Computed
Tomography (Micro-CT).
4. Advanced Ultrasound
Imaging Techniques.

37. Techniques of films used and the indication of them
1. Periapical X-rays
(PA).
2. Bitewing X-
rays.

38. Techniques of films used and the indication of them
3. Panoramic X-rays.
Or (Orthopantomogram
(OPG).)
4. Cone Beam Computed
Tomography (CBCT): Detailed 3D
images.

39. How does the
indication vary
depending on the
techniques and the
patient’s clinical
condition ?
- Precision and Detail
- 3D Capabilities
- Tailored Clinical Usage
- Radiation Consideration

40. REFERENCES :
3. Patel S, Durack C, Abella F, et al. European
Society of Endodontology position
statement: the use of CBCT in endodontics.
Int Endod J. 2014;47(6):502-504.
4. Patel S. Cone beam computed tomography
in endodontics. Braz Dent J. 2012;23(3):179
-191.
1. Patel, S., & Barnes, J. J. (2020). The principles of Endodontics. Oxford
University Press.
2. Torabinejad, M., Fouad, A. F., Shabahang, S., & Walton, R. E. (2021).
Endodontics: Principles and practice. Elsevier.
5. Simon, S., et al. (2019). Pulpal and Periapical Changes of Teeth with
Pulpitis. Journal of Endodontics, 45(12), 1454-1461.

41. Thank You