Radiography in Children

Dr. Hasham khan

Professor of Paediatric Dentistry
Khyber College of Dentistry
Peshawar
 Radiographs
One of the most important and extensively used diagnostic tools
in the detection of disease and the interception of malocclusion

(i.e; most common special aid to diagnosis).

Shortcomings:
1. Radiographs shows a two dimensional picture of a three
dimensional object.

2. Radiographs provide information on calcified structures only.

Indications for Radiographs
1. Caries detection.
2. Anomalies .
3. Fractures.
4. Hard tissue pathology.
5. Foreign bodies.
6. Swelling, hemorrhage, pain etc.
7. Assessment of growth and development
i.e; developmental assessment.
8. During RCT and apexification.
9. For review of:
i. Traumatized incisors.
ii. Fissure sealants.
iii. Root treated teeth.
10. Pre-operative evaluation for:
i. Crown and bridge work.
ii. Extractions.
iii. Routine conservation.
11. Pulpal pathosis and pulpal evaluation.
Various Radiographic Views in Children

Intra-oral:
• Periapical
• Bitewing

• occlusal

Extra-oral:
• Bimolar
• OPG

• Cephalogram
Periapical Radiograph
Indications:
• Detection of caries.

• Examination of root and surrounding structures.

• Detection of periapical pathosis.

• Locating unerupted and impacted teeth (parallax technique).

• Detection and diagnosis of foreign bodies.

• Diagnosis of the fracture of crown or root.

• Diagnosis of ankylosis.

• Detection of developmental status of teeth.

• Approximation of size and shape of developing teeth.

• During RCT (radiographic length).

• Mixed dentition analysis.

Bitewing Radiographs

Indications:
1. Detection of caries on approximal and occlusal surfaces with
respect to depth and relationship to pulp.

2. Observation of the boundaries of the pulp chamber and the

height of pulp horns.

3. Inter-radicular pathology e.g; bone loss.

4. Observation of the location and position of the permanent tooth

bud and its relationship to the primary root.

Disadvantages:
1. Cooperation is needed.

2. Can be used only for posterior teeth.

Occlusal Radiograph

Used for the radiographic examination of the anterior

region only in upper or lower jaw.

It is usually used for:

1. Locating supernumerary teeth.

2. Missing anterior teeth.

3. Observing salivary gland or duct changes.

Bimolar Radiograph

Used in very young children or in children who are not

happy with intra-oral periapical radiographs.

It may be used for:

1. Detection of caries.

2. Developmental status of teeth (calcification, eruption etc).

3. Missing teeth in posterior quadrants.

OPG
Indications:
1. Observing T.M joints.

2. Detecting fractures of jaw bones.

3. Swellings of the jaw bones.

4. Locating supernumerary teeth and impacted teeth.

5. Ascertaining the relationship of the teeth.

6. Orthodontics.

7. Gives information on presence and position of teeth

or any other object, pathology of jaw bones and teeth.
( PPP = presence, position, pathology ).
Cephalogram

Usually used in Orthodontics.

Radiographic Survey in Paediatric Dentistry

Primary dentition survey (age 5 and under):

Eight intra-oral films are taken.
2 = Occlusal films
4 = Molar periapical films
2 = Posterior bitewings
Mixed dentition Survey (age 6 – 9 years):
Twelve intra-oral films are taken.
2 = Permanent incisor periapicals (max & mand)
4 = Primary canine periapicals
4 = Molar periapicals
2 = Posterior bitewings

Permanent second molars erupted:

14 = Periapical films
4 = Posterior bitewings
Localization of Canines and Supernumeraries

There are three steps in the localization of canines and

supernumeraries:

• Observation

• Palpation

• Radiographic examination
Radiographic Localization of
Supernumeraries and canines

Two methods:

• Parallax technique

• Two films at right angle

(CBCT is highly reliable and accurate but

expensive)
 Parallax Technique
It is the apparent displacement of an image, relative to a
reference object, caused by an actual change in angulation
of the x-ray beam.
Principle of parallax = SLOB
May be applied as:
• Horizontal Parallax Technique
» Carried out using two periapical radiographs or one periapical and
one anterior occlusal with a horizontal tube shift of approximately
450 between each exposure. The vertical angulation and the
centering point of the x-ray beam should remain the same for each
film exposure.
• Vertical Parallax Technique
» The panoramic film in combination with the anterior occlusal can
be used for localization of unerupted teeth or supernumeraries
using the vertical parallax shift technique.
 Two films at right angle
• Lateral skull cephalograph in conjunction with a postero-anterior view
provides excellent visualization in all three planes, giving information on
height, antero-posterior position, axial inclination, mesiodistal angulation and
the proximity of the unerupted tooth to the midline.
(lateral skull cephalograph give information on antero-posterior position, axial
inclination, and the height while postero-anterior radiograph give information
on proximity to the mid-line, height and mesiodistal angulation).

• The lateral skull cephalograph and panoramic film combination has also
proved successful in the location of supernumeraries and unerupted teeth.

• The panoramic film and postero-anterior film provide almost similar

information on the position of supernumeraries and unerupted teeth.
Other methods for localizing supernumeraries
and unerupted teeth

1. Using the panorex film alone.

2. Differential magnification.
3. Anterior vertex occlusal.

These methods are not always reliable and may not be

recommended.
4. CBCT (Highly Reliable & Accurate but Expensive)
 Inter-radicular radiolucency in primary molar teeth
(when permanent successors are present)

• It has been observed that infection of the primary molar pulp leads to
rarefaction (radiolucency) of the crest of the inter-radicular bone rather
than the periapical rarefaction seen in permanent molars ( because of
accessary canals in the floor of the pulp chamber of primary molars or
coronal 1/3 of the root or porous dentine in the floor of the pulp
chamber).

• Because of the local anatomical arrangement, apical abscess formation

and bone resorption in the apical area is less marked and may not be
demonstrable radiographically.

• Because of the enamel organ, infection of the primary teeth don not
spread to the permanent tooth germ in most of the cases.
Resorption of roots of primary teeth

• Starts from apex and proceed along the pulp canal.

• May occur somewhere else but we may not see it on

x-ray as x-rays are two dimensional. That is why root
canal of primary teeth is not usually recommended.