1. EO 005.06 Abnormal Radiographic Anatomy
UNCLASSIFIED//REL TO NATO/ISAF

2. Radiographic Interpretation of Dental Caries

3. Severity of Caries
Early, incipient
Moderate
Advanced and Extensive

4. Caries Progression

5. Location of Caries Occlusal, incisal Proximal Lingual, palatal Facial
Cemental
Recurrent

6. Incipient Caries

7. Incipient Caries

8. Occlusal Caries

9. Occlusal Caries

10. Occlusal Caries

11. Proximal Caries

12. Proximal Caries

13. Proximal Caries

14. Cemental Caries

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

16. Recurrent Caries

17. Recurrent Caries

18. Caries: Xerostomia Therapeutic radiation Xerostomia
Caries begins at cervical region

19. Occlusal Caries

21. Cervical Burnout

22. Adumbration

23. Adumbration Between CEJ and alveolar crest Diffuse radiolucency
Ill-defined borders
Presence of the edge of root
Clinical evaluation

24. Adumbration

25. Rampant Caries

26. Rampant Caries

27. Caries associated with an impacted tooth

28. Periodontal And Periapical Diseases

29. Periodontal Disease

30. Usefulness of Radiographs
Amount of bone present
Condition of alveolar crest
Bone loss in furcation areas
Width of periodontal ligament
Local factors: calculus, overhanging restorations
Crown/root ratio

31. Limitations of Radiographs
No indication of morphology of bony defects
No indication of successful management
No indication of hard/soft tissue relationship, i.e., depth of pockets

32. Normal Alveolar Crest 1.0-1.5 mm apical to cemento-enamel junction
Parallel to line joining the CEJ of adjoining teeth
Smooth
Continuation of lamina dura, has the same radiopacity

33. Normal Alveolar Crest

34. Normal Alveolar Crest

35. Normal Alveolar Crest

36. Evidence of Early Periodontitis
Localized erosion of crest of bone
Blunting of crest- anterior teeth
Loss of sharp angle between lamina dura and crest
Widening of PDL near crest

37. Evidence of Early Periodontitis

38. Periodontitis radiograph evaluation

39. Local Factors Calculus Overhanging restorations
Poor restoration contours

40. Calculus

41. Overhanging Restoration

42. Direction Of Bone Loss
Horizontal Bone Loss: Crest of bone is parallel to CEJ line between adjoining teeth. The remaining bone is still horizontal but may be positioned apically.

44. Direction Of Bone Loss Vertical bone loss
Crest of remaining bone is not parallel to the CEJ line between adjoining teeth (displays an oblique angulation to the CEJ line )

47. Bone Loss In furcation Areas

48. Bone Loss In furcation Areas

49. Bone Loss In furcation Areas

50. Bitewing Radiographs Most Reliable For Crestal Bone Evaluation

53. Periapical Lesions

54. Periapical Inflammatory Lesions
Bone destruction around apex of tooth, mostly secondary to pulp exposure due to caries or trauma.
Bacterial invasion of pulp produces toxic metabolites which escape to the periapical bone through apical foramen and cause inflammation.

55. Periapical Inflammatory Lesions
Periapical granuloma: Localized mass of chronic granulation tissue containing PMN’s, lymphocytes, plasma cells.

56. Periapical Granuloma
Radiographicall y, widening of PDL or variable size of periapical radiolucency may be present

57. Periapical Granuloma

58. Periapical Granuloma

59. Periapical Abscess
Periapical abscess: When pus forms in the area. It may develop directly as an acute process or develop in a pre- existing granuloma. Radiographically, appears identical to granuloma.

60. Periapical Granuloma Or Abscess
Can one differentiate between the two on the basis of radiographs alone?

61. Radicular cyst (periapical cyst):
A cyst is an epithelium lined cavity which is filled with fluid or semi-solid material.
Radicular cyst is the ONLY cyst related to non-vital pulp.

62. periapical cyst

63. periapical cyst

64. Periapical Inflammatory Lesions
Can you definitively differentiate between a periapical granuloma, abscess or radicular cyst on the basis of radiograph alone?

65. Periapical Inflammatory Lesions

66. Periapical Inflammatory Lesions
Sclerosing osteitis (chronic sclerosing osteomyelitis). Occasionally, the reaction to periapical inflammation is predominantly osteoblastic, i.e., more sclerotic bone is formed (radiopaque mass).
Usually occurs in children or young adults when the resistance is high.
Most common location is mandibular 1st molar.

67. Sclerosing Osteitis

68. (Idiopathic) Osteosclerosis

69. Osteosclerosis
How do you differentiate between osteosclerosis and condensing osteitis?
In osteosclerosis, the pulp is vital. There are no clinical signs or symptoms. No treatment is necessary.
Sclerosing osteitis is secondary to pulp exposure. Patient is symptomatic. Endodontic treatment or extraction is indicated.

70. Calcific Degeneration
Secondary to Trauma to the Tooth

71. Calcific Degeneration

72. Radiographic Evidence Of Non-vital Teeth
Widening of apical PDL or periapical radiolucency ( associated with indication of pulp exposure)
Discontinuity of lamina dura
Displacement of lamina dura
Sclerosing osteitis
Calcific degeneration (metamorphosis)
Radiographic indication of pulp exposure

73. Periapical Cemental Dysplasia
Also called Cementoma. Localized alteration in periapical area. Osseous structure is replaced by fibrous tissue, cementum-like material, abnormal bone or combination of these.
Pulp is vital. Patient is asymptomatic. There are no clinical signs.
No treatment is required.
Mean age is 39 years.

74. Periapical Cemental Dysplasia
85% patients are females.
3 times more common in African- americans.
Most commonly seen in mandibular anterior areas.
May be multiple.
May be bilateral.
Well-defined radiolucency, opacity or mixed.

75. Periapical Cemental Dysplasia

76. Apical Scar (Fibrous Scar )
Variation in healing process. Normally surgical site fills with blood clot which organizes and eventually mineralizes and remodels like surrounding bone.
Occasionally, normal mineralization and remodeling fails to occur.
Patient is asymptomatic and no treatment is required.

77. Fibrous Scar

78. Apical Scar (Fibrous Scar )

79. Apical Scar (Fibrous Scar )

80. Developmental anomalies of Teeth

81. Microdontia Smaller than average Most commonly involved:
Maxillary 3rd molars
Maxillary laterals
(sometime called “peg” laterals)
Maxillary premolars

82. Macrodontia (larger than normal)
Tooth size larger than average
Unknown cause
May involve a single tooth
or group of teeth
Detectable by clinical
examination

83. Gemination During development,
single tooth germ attempts to divide into two.
Usually results in bifurcation of a part of crown
Unilateral or bilateral
Normal complement of
teeth is present

84. Gemination

85. Fusion During development, union of two adjoining tooth germs
Clinically, identical to gemination, i.e, bifurcated crown
One tooth is missing
Unilateral or bilateral
Primary or permanent dentition

86. Concrescence
Union of two teeth either during development or after they are completely formed
Joined with cementum
Radiographic diagnosis can be difficult

87. Dilaceration Unusual angulation of roots
Cause is either trauma to a developing tooth or unknown
Diagnosed radiographically
Surgical removal of dilacerated teeth can be difficult

88. Root Bifurcations

89. Dens Invaginatus (Dens-in-dente)
Invagination of a layer of enamel and dentin into pulp.
Creates a potential space for entrapment of food debris and bacteria.
Wide variation in size.
Clinically, either not discernible or seen as a prominent pit at the cingulum.

90. Dens Invaginatus (Dens-in-dente)
Frequently, caries, pulp exposure and periapical pathology develops without any clinical indication.
Most frequently (95%) in
maxillary lateral incisor.
Bilateral in half the cases.
Prophylactic restoration
recommended.

91. Dens Invaginatus (Dens-in-dente)

92. Dens Evaginatus Due to outfolding of an enamel organ
Usually on the occlusal surface of a premolar or a molar
The outgrowth is covered with enamel, dentin and contains pulp
Detectable clinically

93. Talon cusp

94. Taurodontia
Bifurcation of molar pulp chamber into root canals displaced apically, resulting in an extremely large pulp chamber and short root canals. Usually in permanent molars.
Most patients asymptomatic; does not require treatment.
Frequently, bilateral.

95. Taurodontia

96. Localized Enamel Hypoplasia- Miscellaneous Causes
Local or systemic disturbances during development of permanent teeth.
Examples: nutritional disturbances, childhood infections, etc.
Usually affect permanent anterior teeth and first molars bilaterally.

97. Localized Enamel Hypoplasia- Miscellaneous Causes

98. Localized Enamel Hypoplasia- Miscellaneous Causes

99. Localized Enamel Hypoplasia- Congenital Syphilis
Affects permanent incisor or 1st molar
Affected incisor is named Hutchinson’s incisor; 1st molar is named mulberry
molar

100. Localized Enamel Hypoplasia- Congenital Syphilis

101. Anomalies of Tooth Number
Hypodontia: Few missing teeth
Oligodontia: More than half the number missing in any dentition (permanent or primary)
Anodontia: All teeth missing

102. Hypodontia
Frequency of congenitally missing permanent teeth, in the following order:
3rd molars
Maxillary 2nd premolars
Mandibular 2nd premolars
Maxillary laterals
Mandibular canines
Other

103. Hypodontia

104. Hypodontia

105. Supernumerary (Hyperdontia)
80-85% of all supernumerary in maxilla
Mesiodens. Midline of maxilla %
Paramolars. Buccal or lingual to maxillary molars
Distomolars (4th molars, distodens). Distal to maxillary 3rd molars

106. Mesiodens

107. Mesiodens

108. Paramolar

109. Distodens

110. Supernumerary premolars

111. Impacted Canines

112. Supernumerary Roots

113. Regressive Changes of Teeth
Attrition
Abrasion
Erosion

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

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

116. Attrition

117. Attrition

118. Abrasion Non-physiologic wearing away Habits Toothbrush trauma
Dental floss injury
Occupational hazards

119. 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

120. Abrasion

121. Erosion Chemical cause No bacteria involved
Diet: Labial surfaces are affected
Regurgitation: Lingual surfaces are affected
Occupational hazards

122. Erosion

123. Resorption Phenomenon
External
Internal

124. External Resorption Pathological
Inflammation: Trauma, Chronic Apical Periodontitis
Infection
Cysts: OKC
Benign and malignant neoplasm

125. External Resorption Non pathological
Mechanical force: orthodontic tooth movement
Idiopathic
Impacted teeth

126. External Resorption
Trauma
Periapical Path

127. External Resorption: Orthodontic

128. Ext. Resorption: Tumors/cysts

129. Ext. Resorption: Tumors/cysts

130. External Resorption

131. External Resorption: Idiopathic

132. Internal Resorption
Trauma
Idiopathic

133. Internal Resorption

134. Dental Trauma

135. Dental Trauma
Coronal fracture
Root fracture
Alveolar fracture

136. Fracture: Crown

137. Fracture: Crown, Root

138. Fracture: Root

139. Vertical Fracture: Root

141. UNCLASSIFIED//REL TO NATO/ISAF
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UNCLASSIFIED//REL TO NATO/ISAF