Lecture 4 Radiographic Interpretation of Dental Caries ODRP

Lecture 4: Radiographic Interpretation of Dental Caries ODRP 755 Radiology II Theory & Interpretation Heidi L. Christensen, DDS, MS 1

Dental Caries • A process of decalcification • 50% of calcium and phosphorus in a particular area must be destroyed before decreased density can be seen on radiographs 2

Radiographic Criteria • Description of Depth of Lesion – E 0 = Sound, no caries – E 1 = Caries in the outer 1/2 of enamel – E 2 = Caries into the inner 1/2 of enamel to DEJ – D 1 = Caries through DEJ, into the outer 1/3 of dentin – D 2 = Caries into the middle 1/3 of the dentin – D 3 = Caries into the inner 1/3 of the dentin 3

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Occlusal Caries 5

Occlusal Caries 6

Interproximal Caries • Most difficult to detect clinically • Interproximal caries usually begin just below the contact point 7

Caries Progression – Interproximal Caries 8

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Interproximal Caries 11

Incipient Caries 12

Interproximal Caries 13

Interproximal Caries 14

Interproximal Caries 15

Interproximal Caries 16

Interproximal Caries 17

Facial or Lingual Caries 18

Facial or Lingual Caries 19

Facial or Lingual Caries 20

Recurrent Caries • • • Caries immediately next to a restoration Inadequate margins or excavation Pulpal necrosis Metallic restorations often hide Clinical examination 21

Recurrent Caries 22

Recurrent Caries 23

Recurrent Caries 24

Recurrent Caries 25

Root or Cemental Caries 26

Root or Cemental Caries 27

Cervical Burnout • Often mistaken for root caries 28

Cervical Burnout • Caused by – The great density difference between the cervical neck of the tooth and the tissues above and below it – Shape of CE contour – Root configurations – Poor horizontal angulation of the beam 29

Cervical Burnout • Found between CEJ and alveolar crest • Diffuse radiolucency generally viewed on periapical but not on bitewing • Clinical evaluation important – lesion looks BIG, if it is decay, you would be able to find it! 30

Cervical Burnout 31

Cervical Burnout vs. Root Caries 32

Radiation Caries • A result of therapeutic radiation • Caused by xerostomia, a common side effect • Caries begins at cervical region • Extensive decay very quickly • Pre-therapy dental evaluation and treatment is very important 33

Radiation Caries 34

Rampant Caries • • • Children Poor dietary habits Extensive caries Proximal and smooth surface Socio-economic factors 35

Rampant Caries 36

Regressive and Traumatic Alterations of Teeth 37

Regressive Alterations • Attrition • Abrasion • Erosion 38

Attrition • • Physiologic wearing away Incisal, occlusal and interproximal surfaces Part of aging process Bruxism – pathologic attrition 39

Attrition – Radiologic Features • • • Change in normal outline Flat occlusal plane Loss of mamelon Pulp chamber, canal size Hypercementosis 40

Attrition 41

Attrition 42

Attrition 43

Abrasion • • • Non-physiologic wearing away Habits Toothbrush trauma Dental floss injury Occupational hazards 44

Abrasion – Radiologic Features • • Radiolucent defects at the cervical region Well-defined semilunar defects Pulp chambers sclerosed In case of dental floss injury, distal surfaces more involved 45

Abrasion 46

Abrasion 47

Abrasion 48

Erosion • • • Chemical cause No bacteria involved Diet Regurgitation Occupational hazards 49

Erosion - Radiologic Features • • Radiolucent defects Dietary acids – labial surface Regurgitation – mandibular lingual surface Occupational – all surfaces 50

Acid Erosion Soft Drinks 51

Erosion 52

Erosion 53

Questions? 54