CARIOLOGY

DENTAL RADIOGRAPHY IN
CONSERVATIVE DENTISTRY
BY
MUTEBI PETER
21/U/19802/PS
 outline

 Introduction
 Indications for dental radiographs
 Role of dental radiographs in conservative dentistry
 Limitations of dental radiographs
 Radiographic appearance of caries
 Classification of radiographic methods used in
conservative dentistry
 Practical techniques and indications for conservative
dentistry
 INTRODUCTION

• The radiograph is one of the most important tools in making a

a diagnosis. Without radiograph case selection, diagnosis and
treatment would be impossible as it helps in examination of
oral structure that would otherwise be unseen by naked eye.
• The carious process leads to demineralization of the affected
area of the tooth and that area appears radiolucent on the
radiograph.
• The presence of radiolucency in the tooth substance is
considered as caries.
• Radiographs have certain limitations; therefore, the
combination of clinical examination along with the
radiographic aid is considered mandatory for diagnosing
caries. The mere presence of radiolucency may be misleading.
 Indications for dental radiographs
• Deep carious lesion
• Large restoration
• History of pain
• Impacted teeth
• Mobility of teeth
• Swelling in relation to teeth
• Presence of sinus/fistula
• Unusual tooth morphology
• Missing teeth with unknown reasons
• Growth abnormalities
Role of dental radiographs in conservative
dentistry
 Help in establishing diagnosis
 Determining the prognosis of tooth
 Disclosing the presence and extent of caries
 To look for any lesion associated with toot
 To see the number, shape, length and patte
the root canals
 Limitations of dental radiographs

 Radiograph gives two dimensional picture of a three

dimensional object
 Caries is always more extensive clinically when
compared to radiograph
 Radiographic appearance of caries
1. Occlussial caries
Radiographs are not effective until the occlusal caries involves
dentin.A significant manifestation of occlusal caries in dentin
is the presence of a band of increased opacity at the base of
carious lesion near the pulp chamber.
The white band represents the calcification within the primary
dentin; such a band may not be evident in buccal caries.
 Cont;d
2. Proximal caries
A considerable loss of mineral content is mandatory before
it becomes visible on a radiograph. The initial loss of
mineral content, may be distributed in the broad proximal
area, is not evident in radiographs. The actual depth of the
lesion is always deeper than may be seen radiographically
 Con’d
3. Root caries
Root lesions usually have ill-defined saucer-like
appearances and are progressive in nature. These are
usually observed within 2.0 mm area of cemento-enamel
junction. Radiographic picture shows area of radiolucency
in cementum alone or in cementum and dentin and pulp
involvement can be evident
 Cont’d
4. secondary/ recurrent carries
Diagnosis of secondary caries is usually dependent on the
clinical examination as the radiographs do not detect the
lesion until only in advanced stages.
There is no clinical parameter, which distinguishes
between active and inactive lesions.
 Cont’d
5. Hidden caries
A term used to describe a carious lesion whereby the
occlusal surfaces appear intact, and the radiographs show
radiolucency in dentin. These caries develop through tiny
enamel defects, progressing under seemingly intact tooth
structure
 Classification of radiographic methods

1. Conventional radiography
a) Periapical radiography
b) Bitewing radiography
c) Occlusial radiography
d) Panoramic radiography
2. Xeroradiography
 Con’d
3. Modified radiographic techniques
I. Digital radiography
II. Comuter image analysis
III. Subtraction radiography
IV. Computed tomography
V. Micro-computed tomography
VI.Cone beam computed tomography
VII.Magnetic resonance imaging
Limitations of conventional radiography
• Radiographs are two-dimensional image of a three-
dimensional object.
• Overlapping of proximal contacts.
• The lesion depth may appear increased or decreased due
to change in angulation. Difficulty in analyzing occlusal
lesions.
• Radiolucency on radiograph can be because of caries or
resorption or any other defect is difficult to analyze.
• The demineralized area on the buccal and lingual
surfaces may appear as proximal carious lesion.
• Fracture of one lingual cusp may appear as radiolucent
proximal lesion.
 Cont’d
• Tilt of maxillary lateral incisors appears as caries on the
mesial side of the lateral incisors.
• Cervical burn out areas may mimic cervical caries.
• Conventional radiography may not correlate the
relationship between depth of the radiographic lesion
and the clinical cavitation.
 Practical radiographic techniques and
their indications for conservative dentistry
1. Periapical radiographs
• Are useful for detecting changes in and around the tooth
tissues, such as extent of caries, cervical margins of the
restoration, alveolar crest height, lamina dura as well as
the size of the pulp chamber.
• The paralleling technique is considered superior to
bisecting technique for detecting caries in both anterior
and posterior teeth.
 Cont’d
2. Bitewing radiographs
Are important to detect incipient lesions at the contact
areas.
With this technique, six to eight teeth in one radiograph can
be visualized.
The technique can be used for anterior as well as posterior
teeth.
The film is available in different sizes to suit the area to be
radiographed. One long film can also be used to capture
the area from first premolar to the last molar; however,
conventional films provide better results.
 Cont’d
• Posterior bitewing radiographs are preferably utilized to
detect interproximal caries.
• Recurrent caries at the cervical margins is best observed
in bitewing films, since the central ray is directed along
the plane of the cervical areas.
• Bitewing radiographs are useful in monitoring and
evaluating the progress or arrest of dental caries.
 References

1. Dental caries by Vimal K Sikri

2. Essentials of dental careis 3rd edition by Edwina A. M.
Kidd
3. Text book of operative dentistry 2nd edition by Nisha
Gard. Amit Garg
Thank u for your attention