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2. Interpretation terminology
Interpret: to offer an explanation
Interpretation: an explanation
Radiographic interpretation : an explanation of what
is viewed on dental radiograph.
Diagnosis: the identification of a disease by
examination or analysis
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3. IMPORTANCE
Dental radiographs are essential for diagnostic
purposes.
All dental radiographs must be carefully reviewed
and interpreted.
A great deal of information about the teeth and
supporting bone is obtained from radiographic
interpretation.
It enables the dental professional to play vital role in
the detection of diseases , lesions and conditions of
the teeth and jaws that cannot be identified clinically.
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5. Essential requirements for dental
radiographs
Optimum viewing conditions
Understanding the nature and limitations of the
black, white and grey radiographic image
Knowledge of what the radiographs used in
dentistry should look like, so a critical assessment of
individual film quality can be made.
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6. Detailed knowledge of the range of
radiographic appearances of normal
anatomical structures
Detailed knowledge of the radiographic
appearances of the pathological conditions
affecting the head and neck
A systematic approach to viewing the entire
radiograph and to viewing and describing
specific lesions
Access to previous films for comparison.
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7. NEVER INTERPRET A FAULTY
RADIOGRAPH
Ideal radiograph:
Visual : density & contrast
Geometric : sharpness/detail, resolution/definition,
magnification, distortion
Anatomical accuracy of radiographic images
Adequate coverage of anatomical region of interest.
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8. RADIOGRAPHIC INTERPRETATION
CLINICAL EXAMINATION
QUALITY OF DIAGNOSTIC IMAGE
NUMBER &TYPE OF AVAILABLE IMAGES
VIEWING CONDITIONS
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9. Examples of how variations in radiographic technique
can alter the images produced of the same object. A
Correct projection. B Incorrect vertical angulation
producing an elongated image. C Incorrect vertical
angulation producing a foreshortened image. D and E
Incorrect horizontal angulations producing distorted
images.
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10. Examples of how variations in exposure
factors can alter the image quality of the
same object
. A Overexposed. B Slightly overexposed.
C Correctly exposed.D Underexposed.
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11. Viewing conditions
This should be done in a quiet, darkened room
At least two good, evenly-lit viewing boxes are required
A bright light illuminator is required for relatively over-
exposed areas
Mounted in holder
Appropriate size of view box to accommodate film
Magnifying glass-detailed examination of small regions
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12. A, ward ray viewing box incorporating an additional incorporating
bright light source for viewing overexposed dark films
B, SDI xray reader- an extraneous light excluding intra oral film
Viewer with built in magnification
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13. The effect of different viewing conditions on same periapical
Radiograph A, with a black surround B, with white surround
Note , increased details visible in A, particularly around molar teeth.
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14. Image analysis
Systematic radiographic examination -Identify
normal anatomy and examinate the entire film
Extra oral images - panoramic films , cephalometric
views & TMJ views
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15. First visual circuit: intraoral images
Periapical before bitewing images
Right maxilla to left; left mandible to right
One anatomic structure at a time
Eg: posterior maxilla-maxillary
sinus,tuberosity,zygomatic process
Normal anatomy
bones, canals, foramina
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16. Second visual circuit
Examination of bone:
Height of alveolar bone
Crest relative to teeth
Loss of height-more than 1.5 mm-periodontal
disease
Cortication
Lamina dura + PDL space + tooth roots
Carcinoma-erosion of alveolar crest+ ill defined
borders.
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18. Aunt minny approach
Aunt Minny represents an abnormality which
looks like one that the evaluator has seen
before, or been told about.
It would be difficult to recognise new findings
using this approach
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19. Analysis of intra osseous lesions
STEP 1:LOCALIZE THE ABNORMALITY
LOCALIZED OR GENERALIZED
POSITION IN THE JAWS
SINGLE OR MULTIFOCAL
UNILATERAL OR BILATERAL
SIZE
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20. Characteristics of lesional tissue
Described as
miltilocular,unilocular,circumscribed or not.
Indicates
well circumscribed –benign or cystic
poorly circumscribed-malignant.
Radiolucent lesions without septations have three
pattern of bone destruction
geographic,moth eaten and permeative.
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21. Geographic Pattern
Single ,large area
More than 1 cm
Signifies
large area of lysis
Less aggressive form of
malignant lesion
Monolocular or non septated
benign lesion
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22. Moth Eaten Pattern
Smaller areas of bone
destruction
Less well defined
3 to 5 mm
Signifies
Can in both benign and
malignant
Inflammatory conditions
like osteomyelitis and
osteonecrosis
More destructive lesion
than with geographic
pattern.
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23. Permeative Pattern
Much smaller and
poorly defined
1-2 mm in size
Signifies
Aggressive,rapidly
destructive lesion.
Cortex involvement
with this ,indicates
rapid destruction.
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24. Radiolucent Lesions with Septations
True septations
vascular lesions
False septations
Erosion or scalloping of endosteal surface
.eg.ameloblastoma
Filaments of remnant host boneform locules within
lesion.eg.aneurysmal bone cyst,central giant cell
granuloma
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25. Honeycomb Pattern
Loculations are small
and numerous
Represent earlier
change than soap
bubble pattern
ameloblastoma
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26. Soap Bubble Pattern
Larger and less
numerous loculations.
Signifies
Breakdown of
honeycomb pattern
ameloblastoma
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27. Tennis Racket Pattern
Septa intersect at
right angles.
Odontogenic
myxoma
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28. Scalloped Pattern
Incompete septation
gives a false
impression of
multilocularity.
Odontogenic
keratocyst
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29. LOCATION AND EXTENT
Location –helps in diagnosis
maxilla /mandible
unilateral/bilateral
incisor /premolar/molar
angle/ramus/body area
localized and generalized
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31. Position in jaws
Epicenter -coronal to tooth- odontogenic epithelium
Epicenter of the lesion is above the mandibular
canal-odontogenic in origin
Epicenter -below IAC-non odontogenic (likely)
Cartilaginous lesions, osteochondromas –condylar
region.
If the epicenter of the lesion is in the sinus, not
odontogenic in origin-alveolar process of maxilla
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32. A ,cropped panoramic image of a lesion where epicenter
Is coronal to the mandibular first molar b,an occlusal view of
Same lesion.
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34. A cropped panoramic image displaying a lesion
(developmental salivary gland defect) below the inferior
alveolar canal and thus unlikely to be of odontogenic
origin.
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35. A lateral oblique view of the mandible revealing
a lesion within the inferior alveolar canal. The smooth
fusiform expansion of the canal indicates a neural lesion
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36. The lack of a peripheral cortex on this benign cyst
indicates that it originated in the sinus and not in the alveolar
process. It therefore is unlikely to be of odontogenic origin.
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37. STEP 2:ASSESS THE PERIPHERY &SHAPE
WELL DEFINED OR ILL DEFINED?
Sharp margins
Corticated margins
Sclerotic margins
Radiolucent band
Blends into adjacent area
Irregular margins
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43. Note, the thin radiolucent positioned between the internal
radiopaque structure of this odontoma and radiopaque outer cortical
border.
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46. Periapical (A) and occlusal (B) films revealing a squamous cell carcinoma
in the anterior maxilla. Note the invasive margin that extends beyond the
lateral incisor (arrow) and the bone destruction immediately behind this
margin
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56. A lateral oblique view of mandibular lesion
showing an internal Septa that divides the lesion
into several compartments
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57. A periapical film showing soft tissue mass of
shadow of polyp emanting from edentulous ridge
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58. STEP4:ANALYSE THE EFFECTS OF THE
LESION ON SURROUNDING STrUCTURES
Teeth , lamina dura , periodontal membrane space
Inferior alveolar canal & mental foramen
Maxillary antrum
Surrounding bone density & trabecular pattern
Outer cortical bone & periosteal reaction
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62. Step 5 : formulate a radiographic
interpretation
Decision 1: Normal V/S Abnormal
Decision2: Developmental V/S Acquired
Decision 3: Classification
Decision 4: Ways To Proceed
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63. Step 5 : formulate a radiographic
interpretation
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64. Analysis of radiographic interpretation
Step 1: Localize the Abnormality
Anatomic position (epicenter)
Localized or generalized
Unilateral or bilateral
Single or multifocal
Step 2: Assess the Periphery and Shape
PERIPHERY
Well defined
Punched out
Corticated
Sclerotic
Soft tissue capsule
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66. Surrounding Structures
Step 4: Analyze the Effects of the Lesion on
Teeth, lamina dura, periodontal membrane space
Inferior alveolar nerve canal and mental foramen
Maxillary antrum
Surrounding bone density and trabecular pattern
Outer cortical bone and periosteal reactions
Step 5: Formulate a Radiographic Interpretation
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67. A cropped panoramic image of a lesion related to the unerupted
mandibular first molar. B, An occlusal
projection providing a right-angled view of the same lesion
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68. Location. The abnormality is singular and
unilateral,and the epicenter lies coronal to the
mandibular firstmolar.
Periphery and shape. The lesion has a well-
defined cortical boundary and a spherical or round
shape.
The periphery also attaches to the cemento enamel
junction.
Internal structure. The internal structure is totally
radiolucent.
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69. Effects. This lesion has displaced the first molar
in an apical direction, which reinforces the decision
that the origin was coronal to this tooth. Also, the
lesion has displaced the second molar distally and
the second premolar in an anterior direction. Apical
resorption distal root of the second deciduous molar
has occurred.
The occlusal radiograph reveals that the buccal
cortical plate has expanded in a smooth, curved
shape, and a thin cortical boundary still exists.
RADIOGRAPHIC DIAGNOSIS: follicular cyst
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70. Radiographic report
Patient & general information
Imaging procedure
Clinical information
Findings
Radiographic interpretation
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71. Systematic viewing
This approach ensures that all areas of the film are
observed and that the important features of the
tooth apex are examined.
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72. GENERAL OVERVIEW OF ENTIRE RADIOGRAPH
1. Note the chronological and development age of
the patient
2. Note the position, outline and density of all the
normal I superimposed anatomical shadows
including any developing teeth
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73. EXAMINE EACH TOOTH ON THE RADIOGRAPH
AND ASSESS
3. THE CROWN
Note particularly:
The presence of caries
The state of existing restorations
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74. THE ROOT(S)
Note particularly:
• The length of the root
• The number(s)
• The morphology
• The size and shape of canals
• The presence of:
a. Pulp stones
b. Root fillings
c. Internal resorption
d. External resorption
e. Root fractures www.indiandentalacademy.com
75. THE APICAL TISSUES
Note particularly:
• The integrity, continuity and thickness of:
a. The radiolucent line of the periodontal
ligament space
b. The radiopaque line of the lamina dura
• Any associated radiolucent areas
• Any associated radiopaque areas
• The pattern of the trabecular bone
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76. Diagrams showing the
various radiographic
appearances of infection
and inflammation in the
apical tissues.
A Normal.
B Early apical change —
widening of the
radiolucent periodontal
ligament space (acute
apical periodontitis)
(arrowed).
C Early apical change —
loss of the radiopaque
lamina dura (early
periapical abscess}
(arrowed).
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77. D Extensive destructive
acute inflammation —
diffuse, ill-defined area of
radiolucency at the apex
(periapical abscess).
E Low grade chronic
inflammation — diffuse
radiopaque area at the
apex (sclerosing osteitis).
F Longstanding chronic
inflammation — well-
defined area of
radiolucency surrounded
by dense sclerotic bone
(periapical granuloma or
radicular cyst).
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78. THE PERIODONTAL TISSUES
Note particularly:
• The width of the periodontal ligament
• The level and quality of the crestal bone
• Any vertical or horizontal bone loss
• Any calculus deposits
• Any furcation involvements
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79. REFERENCES
1. Oral Radiology Principles and Interpretations –
White and Pharoah edition 5.
2. Dental radiology principles and techniques-
Joen Iannucci Haring edition 2.
3. Essentials of dental radiography and radiology
– Eric Whaites – 3rd edition.
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