RADIOGRAPH IN ENDODONTIC

Epita Sarah Pane

� Radiographs are an important and necessary adjunct in endodontic� Accurate radiographic techniques and � Accurate radiographic techniques and

proper interpretation are essential for sound diagnosis & treatment

Uses of radiographs in endo

� Determining tooth and pulpal anatomy prior to endodontic access opening� Establishing working lengthEstablishing working length� Confirming Master Cone placement� Evaluating the success of treatment� Information regarding case difficulty� Information regarding long term

prognosis

Stages

� Initial radiograph / diagnostic radiograph�Working length radiograph / Initial apical

file radiographfile radiograph�Master apical file radiograph / Master

apical cone radiograph� Post obturation radiograph� Post restoration radiograph� Recall radiograph

Initial Radiograph

� Diagnostic radiograph� Purpose:

– making a diagnosis– Demonstrate tooth, pulp chamber, root canal

anatomy prior to access

� Use single periapical radiograph� Use paralleling device to produce accurate

radiograph & reproducible angle

� Example of paralleling device : Rinn XCP� Occasionally need bite wing radiograph :

– to detect recurrent decay– to determine the depth of a calcified pulp

chamber, – to reveal a pulp chamber obscured by a large

amalgam

� If a fistula present, trace the area of pathosis by threading a fresh gutta-percha cone (size 30 or 40) through the percha cone (size 30 or 40) through the sinus tract and expose a radiograph.

� Radiographic bone loss is not evident until there is significant erosion of cortical plate.cortical plate.� Periradicular radiolucencies will not

appear on the radiograph even though there may be considerable bone destruction if the bone loss is confined to the cancelleous bone.

Diagnostic Interpretation

� Teeth with irreversibly inflamed pulps often fail to radiographically demonstrate periradicular changes. Changes ranging from a slightly widened PDL and loss of lamina a slightly widened PDL and loss of lamina dura.� Teeth with necrotic pulps do not necessarily

have associated periradicular lesions that are radiographically discernibel.

� Periradicular radiolucent lesions of pulpal origin will routinely demonstrate the loss of apical lamina dura.the loss of apical lamina dura.

Endodontic lesion characteristic

� Loss of lamina dura� Tear drop appearance� Persistent lesion apical location even � Persistent lesion apical location even

after angulation

Cone positioning

� Vertical angulation– Moving incisally or apically

� Horizontal� Horizontal– Moving mesially or distally

Working length radiograph

� Confirm estimation working length from diagnostic radiograph� Set file according to length with rubber � Set file according to length with rubber

stop� Insert initial file to canals� Take radiographs

SLOB principles

Same Lingual Opposite Buccal

Depends on the angulation, from mesial Depends on the angulation, from mesial or distal.

The first canal found from your angulation shift will be lingual

Latest technology

� Digital X-Ray

� Tomography

� Endoscopy

Safety

Effective Dose (µSv)

Equivalent chest flms

BERT

1 PA or BW 4 0,13 16 hours

BERT = Background Equivalent Radiation Times

Endo (4-5 PA’s) 16-20 0,6 – 0,8 3,3 days

Panoramic 7 0,2 28 days

Chest 30 1 4 days

Intra oral films taken @ 70kVp with D speed film and a round collimator

Referensi

�Walton & Torabinejad Bab 9 hal 174� Ingle Bab 9 hal 357