RADIOPAQUE

White to Light Gray

Radiobaque structures are dense &
absorb X-ray, e.g. enamel, dentine, &
bone.
 RADIOLUCENT
Dark Gray to Black
A structure that lack density appear
radiolucent e.g. soft tissue & spaces
 I) Density
Represents the degree of
darkening of an exposed x-
ray film (white to black)
Exposure factors (mA, kVp, exposure
time). An unnecessary increase in any of
these factors results in an increase in film
density.

Object thickness: the larger the patient’s

head, the more x-rays that are needed to
produce an ideal film density
Object density: determined by
type of material (metal, tooth
structure, composite, etc.) and by
amount of material
 II)Magnification
Increase in size

Magnification affected by:

Source-object distance
Object-film distance
 Magnification
Increase source-object distance, decrease magnification

Target
16” Target
8”

Decrease object-film distance, decrease magnification

Target
16”
III) Distortion
Change in the true shape or size
of the object

Distortion affected by:

1. Film-teeth relationship
2. Beam alignment
Paralleling
Bisecting angle
 Ideal Radiograph

1. Image same size as object

2. Image same shape as object
3. Image has good detail
4. Image has good density and
contrast
Mandibular molar periapical film comes closest
to satisfying properties of an ideal radiograph
(either paralleling or bisecting)
Objectives:
•The importance of radiographic
interpretation.
•The difference between interpretation &
diagnosis.
•Rules of radiographic interpretation.
•Image analysis.
•Steps of interpretation.
The importance of interpretation:

Radiographic interpretation is an
essential part of the diagnostic
process. The ability to evaluate &
recognize what is revealed by a
radiograph enable us to detect
diseases, lesions & conditions
which can’t be identified clinically.
Interpretation Vs. Diagnosis:

Interpretation refers to an
explanation of what is viewed on
a radiograph while diagnosis
refers to the identification of
disease by examination or
analysis.
In other words the interpretation
is a step in the diagnosis.
Rules of radiographic interpretation
1. The area to be examined must be
completely shown at optimal angulations
2. All the boundaries of the area of interest
must be shown with normal structures
around it.
3. Knowing and familiarity with all normal
anatomical landmarks as well as all
various pathological conditions that may
affect the area of interest.
4. Optimum viewing condition.
 Steps of interpretation

• Localization.
• Observation.
• General consideration.
• Interpretation.
• Correlation.
 Localization

I. Localized or generalized
II. Position in the jaw
III. Single or multiple
IV. Size
How to identify the position of the
periapical film?

Embossed dot identify right from

left and the anatomical land mark
to identify the jaw and the area.
 Upper left

Lower left
Upper right Lower anterior
premolar
 Observation

• All shadows, other than the localized

shadows of the normal landmarks must be
observed.
• For example: shadows in crowns, cervical
area, roots, restorations, size of root canals,
periodontal membrane space, periapical
area, alveolar crest, foreign bodies, integrity
of bone …………
 General consideration
A radiograph shows only 2 dimensions of a 3
dimensional object (width and height but not
the depth)
Cervical burnout: usually appears as cervical
RL and misinterpreted by caries; this occurs
due to less density and more penetration of
rays.
Pulp exposure never to be determined from
radiograph but only the proximity to the pulp.
 Interpretation
Studying the features of teeth and bone:

Teeth
Study the whole tooth,(crown, root enamel,
pulp….), number of teeth and finally
supporting structures, (Periodontal
membrane space, lamina dura, alveolar
crest)
 Bone

Changes in bone may include:

1- Changes in density.
2- Changes in the margin
3- Changes inside the lesion.
4- Effect on surrounding tissues.
5- Changes in structure
 Correlation
The final step is to correlate all of the
radiographic features to reach a
radiographic differential diagnosis.
Then to draw a final diagnosis, we
have to correlate other data as case
history, clinical examination, and other
diagnostic aids with the radiographic
differential diagnosis.
GOOD BAD

RADIATION
 CHILD (PRIMARY CHILD ADOLESCENT ADULT, DENTATE A
DENTITION) (TRANSITIONAL (PERM. OR PARTIALLY E
DENTITION) DENTITION) EDENTULOUS

Periapical/ Post. Bitewing with Post. Bitewing with (same) B

occlusal or post. either OPG or OPG si
bitewing periapical

Post. Bitewing at (same) (same) Post. Bitewing at

6-12mons interval 6-18mons interval

Post. Bitewing at (same) Post. Bitewing at Post. Bitewing at

no 12-24mon interval 18-36mon interval 24-36mon interval
ED Clinical (same) (same) (same)
judgement/
tal periapical/
bitewing

r Clinical (same) Clinical Usually not (same)

g judgement judgement/ indicated
al panoramic/
ento periapical

hip

Clinical (same) (same) (same) (same)

other judgement
al
,
e/endo

eated
al
 PRECAUTIONS
• use of the fastest image
receptor (that is, the fastest
film speed or digital speed);
• reduction in the size of the x-
ray beam to the size of the
image receptor whenever
possible;
• use of proper exposure and
processing techniques;
• use of leaded aprons and,
whenever possible, thyroid
collars.
• for pregnant patient.
Defects and Variations in Tooth Density

Trauma and Exodontia

Periodontal Disease

Endodontic Treatment of Teeth

Developmental Defects and Anomalies

Swellings, Cysts and Neoplasm

Metabolic Diseases

Orthodontic treatment
FRACTURE
PERIAPICAL RADIOLUCENCY
ENDODONTICS
DENTIGEROUS CYST
MALOCCLUSION
 BITEWING

INTRAORAL
RADIO-
GRAPHS

PERI-
OCCLUSAL
APICAL
BITEWING

• Reveals the crown, neck and

coronal third roots of both upper
and lower posterior teeth and
dental arches.
• Detects interproximal lesions.
• Useful for determining the
proper fit of a crown/cast
restoration and marginal
integrity of fillings.
 PERIAPICAL
• Highlights the entire tooth.
• Shows tooth apices and
surrounding structures in a
particular intra oral area.
• Detects changes in the
bone surrounding the
roots of the tooth.
• Used to study crown &
root length and tooth
morphology.
• To evaluate root apex
formation.
 OCCLUSAL
• Shows relationship of the
teeth to underlying
structures in the alveolar
process (such as cysts,
abscesses)
• Nearly the full upper or
lower arch is shown.
• To determine buccolingual
position of impacted teeth
• To examine cleft palate.
 PANORAMIC

CT-SCANS TOMOGRAMS

EXTRAORAL
RADIO-
GRAPHS

CEPHALO
SIALOGRAPHY
METRICS
ORTHOPANTOGRAM (OPG)
• Shows a 2-dimensional view
of a half circle from ear to
ear.
• Temporomandibular Joint
Dysfunction and ankylosis.
• Diagnosis of bone tumors
• Also known as Panorex.
SIALOGRAPHY CEPHALOMETRICS
Evaluate the image quality
• Too light/dark
• Contrast
• Processing
• Distortion/Superimposition
Identify species, location &
structures.

Examine whole x-ray left to right

Check each tooth for:
• Changes in contour/density of dentin
• Bone level around root
• Bone density & integrity of lamina dura
• Pulp chamber and PDL space

Examine the jaw

• If any lesion present, record its site, size, shape,
symmetry, borders, contents & association with
other structures
Attempt a diagnosis/ assess the need for
other tests
EXPOSURE STEPSDEVELOPMENT

WASH (STOP
FIXING
BATH)

WASHING DRYING
 DIGITAL RADIOGRAPHS

• Dental radiographs produced with a special

computer create digital images (computerized
dental radiographs) that can be displayed
and enhanced on the computer monitor.
• It involves the use of a radiography machine
like that used for conventional xrays. But
instead of using films, the clinician makes
digital images using a small electronic sensor
or an image receptor placed in mouth to
capture the image.
 • DOSE REDUCTION
• IMAGE MANIPULATION
• TIME
ADVANTAGES • STORAGE
• TELERADIOLOGY
• ENVIRONMENTALLY
FRIENDLY

• COST
• CROSS-INFECTION
CONTROL
DISADVANTAGES