Endo 3 - Radiology (Dr. Monteiro)

Bitewing radiograph

Which type of radiograph evaluates caries, existing restorations, and previously initiated therapy?

Bitewing radiograph

Which type of radiograph has an excellent projection to assess periodontal tissue?

Bitewing radiograph

Which type of radiograph presents an accurate representation of corona pulp anatomy?

Panoramic radiographs

Which type of radiograph is recommended in trauma cases to rule out fractures of teeth and the alveolus?

CBCT

Which type of radiograph is a dimensionally accurate view of tooth and surrounding structures?

Periapical radiograph

_______ are the most commonly used radiograph in endodontics

1. Mesial

2. Distal

3. Parallel

What 3 views can a periapical radiograph be taken from?

Periapical radiograph

Which type of radiograph is NECESSARY for periapical diagnosis, intraoperatively and post-operatively?

1. Crown

2. Post D Canal

3. PARL Mesial and Distal Root

What are the radiographic findings on #19?

1. Crown

2. PARL in Mesial and Distal Root

3. Discontinuation of LD

What are the radiographic findings on #19?

1. DO Composite

2. RCT

3. No PARL

4. LD intact

5. PDL normal

What are the radiographic findings on #4?

Bitewing

What image should be straight-on, with as little overlap as possible?

bitewing radiograph

which type of radiograph provides the only way to judge extent of decay, restorability and status of restorations?

bitewing radiograph

which type of radiograph shows the position of the bone in relation to the CEJ of the teeth?

bitewing radiograph

Which type of radiograph is necessary for understanding pulp chamber anatomy?

1. M Caries

2. Pulp stones

3. Pulp chamber receeded

What are the radiographic findings on #3?

1. Fracture Mesial-Distal

2. Caries approximating pulp chamber

What are the radiographic findings on #14?

1. Crown

2. Post

What are the radiographic findings on #13?

Conventional Film

What type of dental radiograph?

Digital Sensor

What type of dental radiograph?

1. Pedodontics

2. Small mouth

3. Gag reflex

size 1 sensor is indicated for

size 2

What size sensor is primarily used?

Lead apron

What MUST be placed on the patient to take EVERY Radiograph?

CBCT

What type of imaging system?

- 3D rendering of a small area

- Can be useful as an adjunct but is not yet the standard of care

- Used for re-treatments, resorptions cases and unusual anatomy

- Coronal, axial, and sagittal views

paralleling technique

ID the sensor technique

parallel

In the paralleling technique, the film/sensor is laid ________ to the long axis of the tooth.

perpendicular

In the paralleling technique, the source of x-ray beam is ________ to the long axis of the tooth

midline of the palate

(NOT placed against the palatal aspect of the teeth)

To obtain an accurate max radiograph, the sensor should be placed near the _______

foreshortening/missing structures

Improper sensor placement of maxillary radiographs will result in what?

tongue and the mylohyoid ridge

To obtain an accurate mandibular radiograph, the sensor should be placed between the _______ and _______

Relax the floor of the mouth and tongue

When taking a mandibular radiograph, what does the patient have to do?

anterior PA

This device is used to capture what type of radiograph?

bisecting angle technique

ID the sensor technique:

perpendicular

In the bisecting angle technique, the X-ray beam is directed ________ to the imaginary line which bisects the angle formed by the long axis of the tooth and the long axis of the film/sensor.

next to

In the bisecting angle technique, the film/sensor is placed _______ the tooth.

foreshortening

In the bisecting angle technique, if the vertical angulation is excessive, it will result in image _______

elongation

In the bisecting angle technique, if the vertical angulation is insufficient, it will result in image _______

1. More comfortable for the patient

2. No anatomical limitations

What are 2 advantages of the bisecting angle technique?

1. No Rinn-type holder: more opportunity for cone cuts and distortions

2. Film/sensor is more prone to move

What are 2 disadvantages of the bisecting angle technique?

paralleling technique

which radiographic technique is best used for an endo pre-op + post-op eval?

bisecting angle technique

which radiographic technique is best used for an endo intra-op eval?

paralleling technique

which radiographic technique is best used for an endo post-op eval?

bisecting angle technique

which radiographic technique is best used anatomical limitations like small mouth, shallow palate, torus?

Rubber dam must ALWAYS be on for clinical endodontic treatment!!!

What does this photo emphasize the importance of?

- Placement of hemostat on green tab

- Wind sensor cord around hemostat

- Placement under dental dam for maxillary anterior tooth

How can you place the size 2 film to take a radiograph of the maxillary central incisor?

• if an object moves in the SAME direction as tube shifts the object is LINGUAL

• If the object moves in the OPPOSITE direction the object is BUCCAL

SLOB rule stands for what?

At least 2:

- 1 PA straight on

- 1 PA with x-ray tube shifted from either mesial or distal direction

At least how many PAs do you need for the SLOB rule?

buccal

Is this foreign object lingual or buccal to the teeth?

B. Lingual (palatal) to the main mesiobuccal canal

A 35-year-old patient presents with spontaneous pain in the maxillary first molar. The pulpal diagnosis is symptomatic irreversible pulpitis and periapical diagnosis of symptomatic apical periodontitis, and nonsurgical root canal therapy is initiated.

During access preparation, the clinician identifies the mesiobuccal canal but suspects an additional

canal in the same root.

Two periapical radiographs are obtained:

- The first radiograph is taken with normal horizontal angulation.

- The second radiograph is taken with a distal horizontal tube shift.

On the second image, the suspected canal appears to move distally, in the same direction as the tube shift.

Based on these findings, where is the suspected canal most likely located?

A. Buccal to the main mesiobuccal canal

B. Lingual (palatal) to the main mesiobuccal canal

C. Apical to the main canal

D. Distal to the main canal

The ability to apply the SLOB rule

All of the following require a thorough knowledge of what?

- Distinguish between normal anatomical landmarks and the radiolucent shadows associated with pathosis of the roots of teeth

- Determine the buccal or lingual position of root fractures, perforations and resorptive processes

- Distinguish between internal and external root resorption

- Locate foreign bodies in trauma cases

- Locate anatomical landmarks (i.e. Mandibular canal, maxillary sinus) in relation to the root apex during periapical surgery

- Locate hidden apices prior to periapical surgery by placing a small opaque object (lead foil) on bone near the estimated apex

- Determine the number, location, shape, size, and direction of various roots and root canals during instrumentation and obturation

lamina dura

ID the structure:

A sheet of compact alveolar bone that lies adjacent to the periodontal membrane i.e. lining of the alveolus

lamina dura

ID the structure:

1. Alveolar crest

2. medullary bone

3. lamina dura

4. PDL space

what are the numbers

intermaxillary suture

ID the structure:

nasopalatine foramen

ID the structure:

nasopalatine foramen

ID the structure:

maxillary sinus

ID the structure:

maxillary sinus

ID the structure:

mental foramen (always near mand 2nd premolar)

ID the structure:

mental foramen

ID the structure:

external oblique line

ID the structure with the purple arrow:

inferior alveolar nerve canal

ID the structure with the green arrow:

submandibular gland fossa

ID the structure:

submandibular gland fossa

ID the structure:

Areas of rarefaction

ID the problems:

spliting canals

ID the problem:

spliting canals

ID the problem:

spliting canals

ID the problem:

spliting canals

ID the problem:

spliting canals

ID the problem:

fracture

ID the problem:

fracture

ID the problem:

vertical root fracture

ID the problem:

vertical root fracture

ID the problem:

- May not show on PA radiographs

Presents with signs of:

- J-shaped lesion/lateral radiolucency

- Isolated deep pocket

- Coronally located swelling or sinus tract

internal resorption

ID the problem:

- Ballooning out of root canal

internal resorption

ID the problem:

internal resorption

ID the problem:

Take a few different angles (SLOB rule)

How can you confirm if a root has internal resorption?

external resorption

ID the problem:

external resorption

ID the problem:

external resorption

ID the problem:

- 1 PA

- 1 BW

Which + how many radiographs should you take pre-op?

1. Locating canals

2. Guide file

3. Final file

4. Master cone

5. Sear down/ partial pack

6. Backfill

When should you take radiographs for intra-op?

1. PA with restoration and without rubber dam

2. Follow up

When should you take radiographs for Post-op?

Paralleling technique

What is the preferred radiographic technique in Endo?

Angulated radiographs

What type of radiographs are frequently used to identify superimposed objects or fractures?