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RADIOLOGY IN

ENDODONTICS

INTRODUCTION

Radiographs serve as indispensible diagnostic and prognostic aids in


endodontics

1895 Discovery of cathode rays by Roentgen

1895 Dr. Otto Walkoff took the 1st dental X ray

TYPES OF
RADIOGRAPHS

Intraoral Radiographs
Intraoral Periapical (IOPA)
Occlusal Radiographs
Bitewing Radiographs

Extraoral Radiographs
Panoramic Radiographs
Lateral Cephalograms
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Intraoral Periapical
Radiographs

Bitewing Radiographs

Occlusal Radiographs

Panoramic
Radiograph

Lateral Cephalogram

Disadvantages of Radiographs
2D image
only suggestive

Bucco-lingual dimension cannot be assessed


The bacterial status of the hard and soft tissues
cannot be determined
Chronic inflammatory tissues cannot be
differentiated from healed fibrous scar tissue

Lesions of the medullary bone are undetected in


the radiographs till there is substantial bone loss

and the involvement of cortical bone


For a hard tissue lesion to be evident on a
radiograph, there should be at least a mineral loss
of 6.6 %
Over exposure

Techniques Employed for IOPA

Paralleling Technique
Bisecting Angle Technique

ParallelingTechnique
Film is placed

parallel to the

long axis of the


tooth to be
radiographed
The film is
exposed using X
rays which are
perpendicular to
its surface
Requires special

Film Holding Devices

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Bisecting Angle
Technique

The X rays pass perpendicular to the


angular bisector of the angle formed

by the long axis of the tooth and the X


ray film

No film holding devices are required

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Normal Anatomical
Landmarks

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Enamel, Dentin &


Pulp

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Cervical Burnout

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Radical Pulp

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Lamina Dura

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Lamina Dura (extracted tooth)

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Periodontal Ligament Space

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Intermaxillary Suture

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Incisive Foramen

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Soft Tissue Shadow of the Nose

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Inferior Border of Maxillary Sinus

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Zygomtic Process of Maxilla

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Shadow of Nasolabial Fold

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Genial Tubercles

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Lingual Foramen

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Mental Foramen

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Mental Foramen

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Mandibular Canal

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Nutrient Canals

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Mylohyoid Ridge

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Coronoid Process of Mandible

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IOPA Radiographs in Endodontic Therapy

Diagnostic Radiographs
Working Radiographs

Post operative Radiographs


Follow up Radiographs

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Diagnostic Radiographs

Ideally, these radiographs should be taken using paralleling


angle technique

They should be of high quality without any foreshortening or


elongation

They help for proper diagnosis of the case

These radiographs helps in determining the prognosis by


comparison with post operative and follow up radiographs
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Comparison between
Diagnostic and Follow up
Radiographs

Periapical Cyst Before RCT

Complete Bony repair after RCT

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Working Radiographs

These radiographs are used for determining the position of


instruments files etc during the procedure

These radiographs are to be taken without removing the rubber


dam as it can cause contamination of the operating field

Bisecting angle technique can be used

A better alternative is the use of a hemostat as a film holding


device

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Radiograph showing Endodontic


Instruments & Rubber Dam Clamp

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Working Radiograph with Master Cone

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Working Radiographs of same


tooth using Different Angulations

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Postoperative
Radiographs

They are used to evaluate the endodontic


treatment
They are taken after removing the rubber dam
Ideally paralleling angle technique should be
used
They can be compared with the diagnostic
radiograph

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Post Operative
Radiograph

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Follow-up
Radiographs

These radiographs are taken to evaluate the


prognosis of the endodontically treated tooth
After obturation, the tooth may have to undergo
procedures like core build up, crown fabrication
etc
The follow up radiograph gives the health of the
periodontium and the tooth by evaluating the
presence of root resorption, other treatment
failures etc
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External Root Resorption


Before Bleaching

2 Years After
Bleaching

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Follow up
Radiographs After

RCT

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Vertical Angulation

Elongation Corrected by increasing the


vertical angle of the central ray

Foreshortening Corrected by decreasing the


vertical angle of the central ray

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Horizontal Angulation
Clarkes Rule (S.L.O.B Rule)

The object that moves in the SAME direction as


the cone is located toward the LINGUAL

The object that moves in the OPPOSITE direction


as the cone is located toward the BUCCAL

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Central Ray Perpendicular to


the Film

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Central Ray directed 20


Mesial to film

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Working Radiographs with


Instruments inside the Root
Canals

Superimposition of Files

4 separate Files in root


canals

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X-ray Beam passing


through Two Thicknesses
of Root
Structure

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X-ray Beam aimed 20 Mesially


through Single Thicknesses of
Hourglass Root

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Digital Radiography

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The digital systems relies on an electronic
detection of an X ray generated image that is
electronically processed and reproduced on a
computer screen

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Advantages

Reduced exposure to radiation


Increased speed of obtaining the image
Possibility for digital enhancement
Storage as digital data in computers
Ease of transmissibility
Elimination of manual processing steps

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Intraoral X ray
Sensors

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Digital Image
Enhancement

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Inversion

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Contrast

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Measurement of Angle of Root


Curvature

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Flash Light

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Magnification

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Pseudocolour

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Linear Measurement

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RECENT ADVANCES

CBCT
MRI
Nuclear imaging

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Conclusion

Radiograph is a very powerful tool for a dentist,


especially an Endodontist with which he are able
to examine the status of hard tissue which are
beyond the field of his naked eyes
Application of radiology gives new standards for
the diagnosis, treatment and prognosis of a
dental problem

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THANK
YOU

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