RADIOGRAPHIC

INTERPRETATION
OF DENTAL CARIES
DRG. SHANTY CHAIRANI

DENTAL CARIES

Radiographic examination use :

1.
2.
3.

Bitewing Film
Periapical film
Panoramic (but it has a limited diagnostic value)

Because the carious process results in

demineralization, the affected area of the tooth
is more radiolucent (or less radiodense) than
the unaffected portions of the tooth.
Approximately 50 % demineralization is
required for radiographic detection of a lesion

Radiographs is used to aid detection of

carious lesions.
Advanced carious lesions of the occlusal,
cervikal and other exposed portions of a
tooth are not difficult to diagnose by
clinical examination.
The purpose of a radiograph, therefore, is
to diagnose early carious lesions or those
which lie hidden under restorations, or in
the interproximal areas and to know the
extent of the carious lesion.

Factors affecting
appearance of caries:
Buccolingual thickness of tooth.
The thicker the tooth, the more
difficult it is to see the extent of the
caries.
Two-dimensional film. Cannot see
the extent of carious involvement
in a buccolingual direction.

X-ray beam angle (horizontal or

vertical). This is especially important
when trying to identify recurrent caries,
since changes in angulation may cause
the superimposition of the existing
restoration with the carious lesion.
Exposure factors. Caries detection is
improved with a lower kVp setting,
which provides a higher contrast. If the
density of the film is too light or too
dark, the diagnostic potential of the film
is limited.

Caries Classification
I

I = Incipient (Stage I)
M = Moderate (Stage II)
A = Advanced (Stage III)
S = Severe (Stage IV)

Incipient
Moderate
Advanced

Interproximal Caries
(Incipient)
I
Up to half the thickness of enamel
Usually not restored unless patient
has high level of caries activity (high
risk). Treat with fluoride.

The arrow points to incipient lesion on

the distal #10

Interproximal Caries
(Moderate)

More than halfway through the

enamel (up to DEJ)

The bottom arrow points to a moderate lesion on

the distal of # 20. The upper arrow points to one of
several incipient lesions on the molar and
premolars.

Interproximal Caries
(Advanced)

Advanced lesion identified by arrows.

Advanced lesion

Interproximal Caries
(Severe)

More than halfway

through the dentin

Severe lesion

Severe lesion

Occlusal Caries
Must have penetrated into dentin
Diagnosed from clinical exam
May be seen as thin radiolucent
line or cup-shaped zone underlying
occlusal enamel, but difficult to see
on radiographs unless lesion is
large.

Occlusal caries

Occlusal caries

Buccal/Lingual Caries

Should be identified from clinical exam.

On a dental radiograph, caries that
involves the buccal or lingual surface will
appear as a small, circular radiolucency in
middle of tooth , although it is not very
radiolucent.
In order to determine the location of the
lesion, a clinical examination with an
explorer is necessary.
Depth can not be determined
radiographically.

Lingual caries (Cant tell whether its buccal

or lingual from one radiograph

Buccal caries with severe interproximal

caries on # 12

Root Caries

On a dental radiograph, root surface

caries appear as a cupped-out or cratershaped radiolucency just below the
cemento-enamel juction (CEJ). Early
lesions may be difficult to detect on a
dental radiograph.
Usually found on older individuals with
prominent recession and/or
periodontitis. May have xerostomia due
to medications.
May be confused with cervical burnout.

Root caries

Root caries

Cervical Burnout
o

Cervical burnout is an apparent

radiolucency found just below the CE
junction on the root due to anatomical
variation (concave root formation
posteriorly) or a gap between the enamel
and bone covering the root (anteriorly).
Cervical burnout appears as a collar or
wedge-shaped radiolucency on the mesial
and distal root surfaces near the CEJ of a
tooth and may be confused with root
caries.

The differences between cervikal

burnout and root/cemental caries :
The area of relatively radiolucency in the
cervikal burnout occurs between the part of
the root covered by alveolar bone and the
enamel-covered crown.
This phenomenon can be found in all the
teeth that are projected in the film, usually in
premolars which size are small.
But this radiolucency usually disappears
when another film of the region is examined.

Caries does not occur on the root of the

tooth unless there is loss of alveolar
bone and gingival tissue due to
recession or periodontitis.

Cervical burnout

Posterior cervical burnout.

The invagination of the proximal root
surfaces allow more x-rays to pass through
this area, resulting in a more radiolucent
appearance on the radiograph. X-rays
directed at a different angle usually pass
through more tooth structure and the
radiolucency disappears.

Radiolucency seen at left (arrow)

disappears on periapical film of
same tooth. This is cervical burnout.

Anterior cervical burnout.

The space between the enamel and the
bone overlying the tooth will appear more
radiolucent than either the enamel or the
bone-tooth combination.

bone level

Cervical burnout in the

anterior region due to
gap between enamel
(red arrows) and
alveolar bone over root
(blue arrows).

Recurrent Caries
Radiolucency extends into the
dentin (with/without extends to pulp)
adjacent to an existing restoration.
May be due to unusual susceptibility
to caries, poor oral hygiene, failure
to remove all of the caries during
cavity preparation, a defective
restoration or a combination of the
above.

Recurrent caries

Recurrent caries

Rampant Caries
Extensive and rapidly
progressing caries usually found
in children and teens with poor
diet and inadequate oral hygiene

Radiation Caries
Found in head/neck
radiation therapy patients
with xerostomia
Fluoride used for control

Before radiation

1 year after radiation

Mach Band
Optical illusion giving appearance of increased
radiolucency at the junction of differing tissue
densities, such as enamel and dentin. If you
block off the enamel with a fingernail, the
radiolucency will disappear if due to the mach
band effect. If the radiolucency persists, it may
be caries.