Preoperative

radiograph in
endodontics

Supervisor by
Dr. Thulfikar Al-Khafaji

Dr. Ahmed Ghanim

Name

‫زين العابدين قحطان هادي‬

Group B
In all endodontic cases, a good intraoral radiograph is mandatory as it gives excellent
details and help in diagnosis and treatment planning. They help to diagnose tooth
related problems like caries, fractures, root canal treatment or any previous restorations,
abnormal appearance of pulp cavity or periradicular tissues, periodontal diseases and
the general bony pattern. Radiographs must be taken together with the clinical
examination to provide a definitive diagnosis. Radiographic changes should be
characterized as localized or generalized, and the position of the defect within the jaw
should be noted. The borders of the lesion should be described as well or ill defined.
Lesions may present with a regular or irregular shape and may have scalloped borders.
The internal structure should be described as radiolucent, radiopaque or a mixed lesion.
The effects of the radiographic changes on neighboring teeth, lamina dura, and the PDL
should be described, including displacement, widening, or resorption. This is
particularly important in lesions of non-endodontic origin. Similarly, the presence of
corticated or sclerotic bone adjacent to lesions or periosteal reactions should be noted.
These findings are associated with reactive processes and are often indicative of slow-
growing lesions. Lastly, any effect on the inferior alveolar nerve canal or mental
foramen should be noted, including displacement or erosion of border architecture.

Periapical films are the most commonly examined radiographs for endodontic
diagnosis. Bitewing radiographs are additionally useful to evaluate caries, existing
restorations, periodontal involvement and previously initiated endodontic therapy. In
addition, bitewing radiographs provide an accurate representation of the location and
size of the pulp chamber and can aid in the design of the endodontic access preparation.
Panoramic radiographs are often recommended to assess trauma cases, particularly to
rule out the presence of alveolar fractures. CBCT is increasingly useful in all facets of
endodontic diagnosis and treatment and is covered in greater detail later in this chapter.
Radiographic modalities are compared in (Fig 1).
 Fig. 1

Periapical lesions of endodontic origin have

following characteristic features (Fig. 2):

• Loss of lamina dura in the apical region.

• Apparent etiology of pulpal necrosis.

• Radiolucency remains at the apex even if

radiograph is taken by changing the angle. Fig. 2

• Establishing diagnosis.

• Determining the prognosis of tooth.

• Disclosing the presence and extent

of caries (Fig. 3).

• Check the thickness of periodontal

ligament.

• To see continuity of lamina dura.

Fig. 3
• To look for any periodontal lesion associated with tooth (Fig. 4).
• To see the number, shape, length and pattern of the root canals (Fig. 5).

Fig. 4 Fig. 5

• To check any obstructions present in the pulp space.

• To check any previous root canal treatment if done (Fig. 6).
• To look for presence of any intraradicular pins or posts (Fig. 7).

Fig. 6 Fig. 7

• To see the quality of previous root canal filling (Figs 8 and 9).

• To see any resorption present in the tooth (Fig. 10).

• To check the presence of calcification in pulp space.

• To see root end proximal structures.

 Fig. 9
Fig. 8

Fig. 10
Fig. 11

• Help in determining the working length, length of master gutta-percha

cone and quality of obturation (Figs 11 and 12).

• During the course of treatment they help in knowing the level of instrumental
errors like perforation, ledging and instrumental separation (Fig. 13).

Fig. 13
Fig. 12
1- They are only two dimensional picture of a three-dimensional object.

2- Pathological changes in pulp are not visible in radiographs.

3- The initial stages of periradicular diseases produce no changes in the

radiographs.

4- They do not help in exact interpretation for example radiographic picture of

an abscess, inflammation and granuloma is almost same.

5- Misinterpretation of radiographs can lead to inaccurate diagnosis.

6- Radiographs can misinterpret the anatomical structures like incisive and

mental foramen with periapical lesions.

7- To know the exact status of multirooted teeth, multiple radiographs are

needed at different angles which further increase the radiation exposure.

1. Endodontics Review: A Study Guide by Brooke Blicher DMD, Rebekah

Lucier-Pryles DMD and Jarshen Lin BDS DDS (2016);6:88-90.

2.Textbook of Endodontics 3rd Revised edition by Nisha Garg and Amit

Garg (2013);7:79-82.

3. American Association of Endodontists. The Recommended Guidelines of

the American Association of Endodontists for the Treatment of Traumatic
Dental Injuries. Revised 2013. www.aae. org/clinical-resources/trauma-
resources.aspx. Accessed 21 January 2016.