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Dental radiology Radiology in Conservative Dentistry II. Size disorders on the X-ray image o Microdontia is described as teeth which are smaller than normal i.e. outside the usual limits of variation. o Macrodontia refers to teeth that are larger than normal. Shape disorders on the X-ray image Concrescence is a condition of teeth where the cementum overlying the roots of at least two teeth join together. The cause can sometimes be attributed to trauma or crowding of teeth. The phenomenon of gemination arises when two teeth develop from one tooth bud and, as a result, the patient has an extra tooth, in contrast to fusion, where the patient would appear to be missing one tooth. Fused teeth arise through union of two normally separated tooth germs Dilaceration refers to an angulation, or a sharp bend or curve, in the root or crown of a formed tooth. Shape disorders on the X-ray image Dens evaginatus is a condition found in teeth where the outer surface appears to form an extra bump or cusp. Premolars are more likely to be affected than any other tooth. The pulp of the tooth may extend into the dens evaginatus. Talon cusp is an extra cusp on an anterior tooth located on the inside surface of the affected tooth. Other names for talon cusp is eagle's talon. Dens invaginatus (dens in dente) is a malformation of teeth most likely resulting from an infolding of the dental papilla during tooth development or invagination of all layer of the enamel organ in dental papillae. Affected teeth show a deep infolding of enamel and dentin starting from the foramen coecum or even the tip of the cusps and which may extend deep into the root. Shape disorders on the X-ray image Taurodontism is a condition found in the molar teeth whereby the pulp chamber is enlarged vertically at the expense of the roots. As a result, the floor of the pulp and the furcation of the tooth is moved apically down the root. What reasons can lead to pulpitis Pulpitis is the most common cause of dental pain and loss of teeth. Causes: • bacterias penetrate through the dentin • traumatic exposure of the pulp • fracture of the crown or cusp • thermal or chemical irritation • cracked tooth syndrome PULPITIS UNTREATED DEATH OF PULP Spread of infection through the apical foramina into the periapical tissues bacterias PERIAPICAL PERIODONTITIS caries parodontium Classification of the periapical lesions http://pocketdentistry.com/1 0-diseases-of-the-pulp-andperiapical-tissues/ Periodontitis acuta on X-ray image Acute Apical Periodontitis Clinical features: • Thermal changes does not induce pain. • Slight extrusion of tooth from socket. • Cause tenderness on mastication due to inflammatory edema collected in PDL. • Due to external pressure, forcing of edema fluid against already sensitized nerve endings results in severe pain. Radiographic features: • Appear normal except for widening of PDL space. Periodontitis chronica on X-ray image (periapical granuloma) Most common result of pulpitis or apical periodontitis. Periapical granuloma is localized mass of chronic granulation tissue formed in response to infection. Clinical features: • • • • • Tooth involved is non vital/ slightly tender on percussion. Mild pain on chewing on solid food. Tooth may be slightly elongated in socket. Sensitivity is due to hyperaemia, edema and inflammation PDL. In many cases, asymptomatic. Radiographic features: • Thickening of PDL at root apex. • As surrounding bone resorption and proliferation of granulation tissue appears to be radiolucent area. • Thin radiopaque line or zone of sclerotic bone sometimes seen outlining lesion. • Long standing lesion may show varying degrees of root resorption. Dental X-ray of teeth origin cysts The radicular cyst is the most common cystic lesion of the jaw. It is caused by pulpal necrosis. It arises from epithelial residues in periodontal ligament as a result of inflammation. Types: • Periapical cyst • Lateral cyst Usually, the periapical cyst is asymptomatic, but a secondary infection can cause pain. On radiographs, it appears a round/ovoid radiolucency (dark area) around the apex of the root. These cysts may persists even after extraction of offending tooth; such cysts are called residual cysts. Radiographies by root treatment Radiographs in Endodontic Therapy • Diagnostic Radiographs: they help for proper diagnosis of the case and help in determining the prognosis by comparison with post operative and follow up radiographs • Working Radiographs (with file, with master cone) • Post operative Radiographs: they are used to evaluate the endodontic treatment. • Follow up Radiographs: are taken to evaluate the prognosis of the endodontically treated tooth. The parallax principle by root location Parallax method (by Clark and Richards): Principle: • 2 periapical views of the same object are taken from slightly different angles which can provide depth to the flat 2D picture depicted by each of the films individually. • Useful in distinguishing the buccal or lingual displacement of the canine. Oral diseases as risk factors for systemic health Focal infection: it has become increasingly clear that the oral cavity can act as the site of origin for dissemination of pathogenic organisms to distant body sites, especially in immunocompromised hosts such as patient suffering from malignancies, diabetes, or rheumatoid arthritis, etc. A number of epidemiological studies have suggested that oral infection, especially marginal and apical periodontitis, may be a risk factor for systemic diseases. Potential focus in the oral cavity: • Necrotic pulp • Gangrenous pulp • Periapical lesion, granuloma or cyst • Chronic marginal gingivitis • Chronic marginal periodontitis • Paranasal sinuses inflammation