Radiologic Diagnosis of Caries

Lecture 14 Chapter 17

Introduction
93% of the radiographic interpretation done in the dental office is devoted to acquiring information regarding dental caries, periodontal disease and peri-apical disease Caries is a pathological process consisting of localized destruction of dental hard tissue by organic acids produced by the microbial deposits adhering to the teeth DHCW must be come competent in radiologic interpretation of these diseases

Interpretation of Caries by Type and Location

Interproximal Enamel Caries
Between two adjacent surfaces

Lamellar Caries
A thin line running completely through the interproximal enamel into the dentin

Incipient Caries (Early)

small cone-shaped area in the outer enamel

Dentinal Caries
A lesion that is in the dentin

Interproximal Caries Progression

Rampant, Acute and Chronic

Interpretation of Caries by Type and Location

Occlusal Caries
The top surface in the pit and fissures, most prevalent

Facial/Lingual Caries
side surface in the pit and fissures

Pulpal Caries
The nerve chamber has been breached

Root or Cemental Caries

Starts at the CEJ; appears after cementum is exposed

Recurrent or Secondary Caries

is seen at margins of restorations

Arrested Caries - lesions that has stopped

Root Caries in the Elderly

Cementum is less resistant to caries than enamel and exposed due to gingival recession The elderly have more open contacts due to attrition, periodontal disease or poor restoration, resulting in food packing areas Older persons often have xerostomia due to salivary gland atrophy, medications etc

Early Carious Lesion

Inter-proximal Enamel Caries

Lamellar Caries

Interproximal Incipient Enamel Carious Lesion

Dentinal Caries

Classification of Radiographic Caries

Four Classes of Inter-proximal Caries

Rampant Caries

Acute Caries

Chronic Caries

Occlusal Caries

Occlusal Caries

Facial/Lingual Caries

Cervical Caries

Pulpal Caries

Root or Cemental Caries

Recurrent or Secondary Caries

Recurrent or Secondary Caries

Dentinal Caries

Arrested Caries

Factors Influencing Interpretation of Caries

Radiographic Underestimation of Caries Size
Radiographic Appearance of Caries and Demineralization Histopathologic Studies

Caries Progression Studies

Caries to Normal Tooth Ratio

Cervical Burnout at CEJ Radiolucent Restorative Materials (composites) Developmental/Acquried Defects in Enamel

Histopathology of Carious Lesion

Normal Tooth-to-Caries Ratio

Normal Tooth-to-Caries Ratio Radiograph

Cervical Burnout at CEJ

Cervical Burnout at CEJ

Restorative Materials that Mimic Caries

Anterior Composite Restorations

Enamel Hypoplasia Mimics Caries

Attrition Mimics Caries

Cervical Toothbrush Abrasion Mimics Caries

V-Shaped Toothbrush Abrasion Mimics Caries

Technique Errors That Will Affect Caries Detection

Common Errors in Projection
Improper Veritical and Horizontal Angulation

A) Improper Vertical Angulation Obscuring Caries

Improper Horizontal Angulation