1. Essentials of Dental Radiography for Dental Assistants and Hygienists CHAPTER Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson NINTH EDITION Recognizing Deviations from Normal Radiographic Anatomy 23

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Objectives Define the key words. Identify the radiographic appearance of dental materials. Identify the radiographic appearance of developmental anomalies. Identify the radiographic appearance of periapical abscess, cyst, and granuloma. Identify the radiographic appearance of external and internal tooth resorption.

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Objectives Identify the radiographic appearance of calcifications and ossifications. Identify the radiographic appearance of odontogenic tumors. Identify the radiographic appearance of nonodontogenic tumors Identify the radiographic appearance of fractures.

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Key Words Abscess Amalgam Amalgam tattoo Ameloblastoma Anodontia Anomaly

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Key Words Base material Benign Carcinoma Composite Condensing osteitis Crown

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Key Words Cyst Dens in dente Dentigerous cyst Dilaceration Exostosis External resorption Follicular (eruptive) cyst

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Key Words Foreign body Fracture line Fusion Gemination Globulomaxillary cyst Granuloma Gutta percha

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Key Words Hypercementosis Idiopathic resorption Incisive canal cyst Internal resorption Malignant Mesiodens Nonodontogenic cyst Odontogenic cyst

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Key Words Odontoma Ossification Osteosclerosis Overhang Periapical cemental dysplasia (PCD) Phleboliths

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Key Words Post and core Pulp stone Radicular cyst Residual cyst Resorption Retained root Retention pin Rhinoliths

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Key Words Sarcoma Sclerotic bone Sialolith Silver point Supernumerary tooth Taurodontia Torus Tumor

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Introduction The most important skill in interpreting radiographs that a dental hygienist and dental assistant can possess is the ability to recognize deviations from normal.

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Introduction Although the dentist is responsible for the final diagnosis and treatment of dental disease, all members of the oral health care team should be able to recognize radiographic deviations from the normal. Patient care is enhanced when the entire team views and interprets the radiographs.

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson PROCEDURE 23-1 Sequence for interpreting a full mouth series for deviations from normal radiographic anatomy

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Procedure 23-1 (continued) Sequence for interpreting a full mouth series for deviations from normal radiographic anatomy

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Radiographic Appearance of Dental Restorative Material Metallic restorations Non-metallic restorations Identification of common restorative materials

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson TABLE 23-1 Metallic and Nonmetallic Restorations

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-1 Dental materials. (1) Amalgam. (2) Porcelainfused- to-metal crown. (3) Post and core. (4) Gutta percha. (5) Base material. (6) Full metal crown, which is the posterior abutment of a three-unit bridge. (7) Retention pin. (8) Metal pontic (part of the three-unit bridge).

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-2 Comparision of radiopaque and radiolucent appearance of composite. (1) Radiopaque composite. (2) Radiolucent composite (or acrylic resin or silicate). (3) Porcelainfused-to-metal crowns. Overexposure (darkness) of this radiograph makes it especially difficult to view the porcelain on the left lateral incisor. (4) However, the overexposure made it possible to image the cement under this crown. (5) Silver point endodontic filler.

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-3 Overhang. (1) Amalgam overhang. (2) Base material. Note the many shapes and sizes of the amalgam restorations.

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-4 Amalgam fragment (1) embedded in the soft tissue, probably left after an extraction. Clinically called an amalgam tattoo because the amalgam fragment produces a bluishpurple spot on the gingiva.

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-5 Stainless steel crown (1). Note the “see-through” appearance.

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-6 Retention pins. (1) Radiopaque pins help retain the radiolucent composite restorations. (2) Small radiopaque amalgam restorations.

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-7 Endodontic treatments. (1) Post and core within the root canals. (2) Gutta percha. Endodontic filling material will also be present when a post and core restoration is observed. (3) Amalgam restorations.

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-8 Implants take the shape of the missing teeth roots.

26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-9 Orthodontic appliance. (1) Note the root-end external resorption caused by trauma of orthodontic treatment.

27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-10 Surgical materials. (1) Surgical wire used to treat a fractured mandible. (2) Mandibular fracture indicated by the radiolucent line.

28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-11 Congenitally missing tooth. (1). Second premolar did not develop under this primary molar. (2) Severe caries. (3) Severe caries.

29. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-12 Supernumerary tooth. (1). Impacted supernumerary premolar.

30. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-13 Mesiodens. (1) A small supernumerary tooth, located in the midline between the central incisors.

31. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-14 Dens in dente. (1) An invagination of the enamel within the body of the lateral incisor.

32. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-15 Hypercementosis. (1) Overgrowth of cementum on the roots of the molar.

33. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-16 Dilaceration. (1) A sharp bend in the root of the second premolar. (2) Torus palatinus, a radiopaque benign overgrowth of bone on the midline of the palate.

34. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-17 Fusion. (1) Two joined adjacent incisors.

35. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-18 Periapical pathology. (1) Caries on the distal surface of the left central incisor. (2) Round radiolucent lesion that may be a periapical abscess, a granuloma, or a cyst.

36. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-19 Dentigerous cyst (1) involving (2) the impacted third molar. (3) Note the expansion and thinning of the cortical bone of the mandible in response to the cyst. (The image receptor was purposely placed in a vertical position instead of the usual horizontal position to better record this condition.)

37. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-20 Follicular cyst (1) surrounds the crown of the unerupted second premolar. (2) Incipient caries on the first permanent molar. (3) Advanced caries on the primary second molar. (4) Erupting second premolar. (5) Primary first molars about to be exfoliated. Note the physiologic external resorption of the primary roots.

38. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-21 Incisive canal cyst. Arrows outline an incisive canal (nasopalatine) cyst in an edentulous maxilla.

39. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-22 Globulomaxillary cyst. Arrows outline a globulomaxillary cyst between the maxillary lateral incisor and the canine.

40. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-23 External resorption. (1) Idiopathic resorption of the distal root of the first molar.

41. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-24 Internal resorption. (1) Idiopathic resorption noted as the widening of the pulp chamber.

42. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-25 Retained root (1) fragment in an extraction site.

43. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-26 Pulp stones. (1) Ovoid radiopaque calcifications observed in the pulp chambers.

44. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-27 Sialolith (1) in a salivary gland. Note the edentulous mandible.

45. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-28 Condensing osteitis. (1) Radiopaque, sclerotic (hardening of) bone.

46. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-29 Osteosclerosis. (1) Diffuse idiopathic osteosclerosis.

47. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-30 Ameloblastoma. (1) Large radiolucency. (2) Resorption of the molar roots caused by pressure of the tumor.

48. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-31 Odontoma. (1) Consisting of small, misshaped teeth located within a radiolucent fibrous capsule.

49. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-32 Periapical cemental dysplasia (PCD). (1) Early PCD (radiolucent). (2) Late stage of development (radiopaque). The teeth are vital.

50. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Radiographic Appearance of Nonodontogenic Tumors Benign –Exostosis –Torus Malignant –Carcinoma –Sarcoma

51. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 23-33 Foreign object. (1) Broken dental bur, which probably lodged here when it was used during removal of the third molar.

52. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Review: Chapter Summary The dental hygienist and dental assistant should possess the ability to recognize deviations from the normal.

53. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Review: Chapter Summary Common radiographic observations that the dental hygienist and dental assistant should be able to identify radiographically include the appearance of restorative materials, developmental anomalies, periapical pathology and other pathological conditions, and the effect of trauma.

54. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Recall: Study Questions General Chapter Review

55. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study You have just accepted a position in a large oral health care clinic at a university- based dental school where your primary role will be to process, mount, and prepare a preliminary interpretation of full mouth series of radiographs taken on incoming patients.

56. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study You know how valuable it is to follow a systematic order when mounting films, so you decide to apply an orderly system to interpreting the radiographs as well.

57. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study Design a form that will guide you and other radiographers through the interpretive process. Your form should include the following: 1.A place to record basic information (the patient’s name, date the radiographs were exposed, name of the person interpreting the radiographs, date of interpretation, etc.).

58. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study 2.A step-by-step guide to where to begin and end the interpretive process. 3.A list of common conditions or deviations from normal that you will be looking for. (Organize the conditions you will be interpreting logically.) 4.Organize the conditions according to what you will examine the radiographs for first, second, third, etc.

59. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study 5.Prepare columns, rows of boxes, or whatever your design requires as a place to record or list the condition. 6.Label the columns, rows of boxes, or whatever your design uses, with the appropriate headings. 7.Prepare a place to document that the condition needs a referral to the dentist.

60. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study 8.Prepare your form in such a manner that other professionals may be able to use the form. Prepare written instructions for using the form as needed.

61. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Relate: Laboratory Application Proceed to Chapter 23, Laboratory Application, to complete this activity.