Radiographic

Interpretation
Dental Radiography

• Questions
• How does the radiographic
examination contribute to the
detection of caries?
• What factors may influence caries
interpretation?
• What is the radiographic appearance
of: incipient, moderate, advanced
and severe caries?
Detection of Caries

• Clinical examination and

radiographs are necessary to
detect dental caries
• Radiographs enable the dental
professional to identify carious
lesions that are not visible clinically
• It also allows the dental professional
to evaluate the extent and severity of
carious lesions
Clinical Examination

• Some carious lesions can be

detected simply by looking in the
mouth, and others cannot
• The mirror can be used to reflect
light, allow for indirect vision, and
retract the tongue
• The explorer can be used to detect
changes in consistency in pits,
grooves, and fissures of teeth
Clinical Examination

• Color changes may be observed

• Occlusal surfaces may show dark
staining in fissures, pits, and
grooves
• Smooth surfaces may exhibit a
chalky white spot or opacity
• An interproximal ridge may appear
discolored
Radiographic
Examination
• A carious area appears radiolucent
because decreased density allows for
greater penetration in the carious area
• The bite-wing radiograph provides the
dental professional with the greatest
amount of diagnostic information
• A periapical radiograph taken with
paralleling technique may also be used
Factors Influencing
Caries Interpretation
• Radiographs must be of
diagnostic quality
• Examples may include
• Improper horizontal angulation on a
bitewing film
• Errors in exposure with improper
contrast and density
Interproximal Caries
• Interproximal
• Between two adjacent surfaces
• Typically seen on dental radiographs at
or just below the contact point
• As caries progresses through the
enamel, it typically assumes a
triangular configuration
• When it reaches the DEJ, it spreads
laterally and progresses through
dentin
• Classified as incipient, moderate,
advanced, and severe
Incipient Interproximal
Caries
• Extends less than halfway
through the thickness of enamel
• An incipient or Class I lesion is
seen only in enamel
Moderate Interproximal
Caries
• Extends more than halfway
through enamel but does not
involve the DEJ
• A moderate or Class II lesion is
seen only in enamel
Advanced Interproximal
Caries
• Extends to or through the DEJ
and into dentin, but does not
extend into dentin more than
half the distance toward the
pulp
• An advanced or Class III lesion
affects both enamel or dentin
Severe Interproximal
Caries
• Extends through enamel and
dentin more than half the
distance toward the pulp
• A severe or Class IV lesion
involves both enamel and dentin
and may appear clinically as a
cavitation in the tooth
Occlusal Caries

• Caries that involve the chewing

surface of posterior teeth
• “A thorough clinical exam is the
method of choice for the detection
of occlusal caries”
• Early occlusal caries is difficult to
see on a dental radiograph
Incipient Occlusal
Caries
• Cannot be seen on a dental
radiograph
• Must be detected with an
explorer or DiagnoDent
Buccal and Lingual
Caries
• These are difficult to detect on
radiograph because they are
superimposed on tooth
structure
• If seen on film, they appear as a
circular radiolucent area
Root Surface Caries

• Ivolves only the roots of teeth

• On radiograph, it appears as a
cupped-out or crater-shaped
radiolucency below the CEJ
• Early lesions may be difficult to
detect on radiograph
Recurrent Caries

• Occurs adjacent to an existing

restoration
• It appears as a radiolucent area
just beneath a restoration
• It is most often located beneath
the interproximal margins of a
restoration
Rampant Caries

• Advanced and severe caries

affecting a number of teeth
• Associated with children with poor
diets and adults with decreased
salivary flow