Endo I Final - 2 - Radiography

• 1.Diagnosis.
• –Identifying pathosis.
• –Determining root and pulpal anatomy.
• –Characterizing normal structures.
• 2.Treatment.
• –Determining working length.
• –Moving superimposed structures.
• –Locating canals.
• –Differentiating canals and PDL spaces.
• –Evaluating obturation.
• 3.Post operative evaluation or follow-up.
• –Identifying new pathosis.
• –Evaluating healing.
• –Evaluating final restoration.

• 1.Pre-op or diagnostic radiograph (s).
• 2.Working length radiograph (s).
• 3.Master cone radiograph (s).
• 4.Lateral condensation radiograph (s).
• 5.Final radiograph (s).
• Rubber dam isolation in place through 2-4.

• Primarily to detect pathosis and to provide general information on root and pulp anatomy.
• In most cases only a single PA is necessary, but the number of exposures depends on the situation.

• Less distortion and clearer images.
• Reproducibility.
• If can not be used, bisecting angle technique is the second choice (more dimensional distortion).

• separates and identifies the facial and lingual structures
• SLOB rule: Same-Lingual, Opposite-Buccal
• Indications:
• –Separation and identification of superimposed canals : working length, presence of perforation, or external resorption, identification of undiscovered canals.
• –Movement and identification of superimposed structures
• Disadvantages:
• –Decreased clarity
• –Superimposition of structures
• Buccal rule: the root canal farthest from the x-ray film moves a greater distance on the film in a horizontal plane than the root or canal closer to the film.

• In general require only a single exposure.
• If a root contains two superimposed canals, either a mesial or distal angled projection is absolutely necessary.

The same principles used with working length films apply.

If there is doubt about the accuracy of the lateral condensation. Errors in length or density can be corrected at this stage.

• 1 PA with parallel projection.
• The endodontically treated tooth should be temporized and rubber dam isolation removed.
• Teeth with multiple canals need angle projections to visualize separate superimposed canals for separate evaluation of each.

• PA exposure with paralleling technique.
• If treatment is deemed to be questionable or a failure, additional angled exposures -> search for a previously undetected canal or other abnormality.

• radiographs can be termed the great pretenders; they often are misleading as they are helpful.
• Only hard tissues are visible: periapical bony changes, possible etiologic factors, possible internal or external resorption, and or root canal anatomy

• Radiographic evidence of bony lesions happens after considerable bone resorption.
• Root location and thickness of the overlying cortical bone might influence the presence of radiolucent areas.

• Endodontic pathosis:
• –Radiolucent lesions
• –Radiopaque lesions
• Non-endodontic pathosis
• –Radiolucent lesions
• –Radiopaque lesions
• Anatomic structures
• –Mandible
• –Maxilla

Clinical (pulp) evaluation + radiographic evaluation

• Radiolucent lesions: apical/radicular lamina dura is absent (resorbed).
• Circumferential (ish) apical radiolucency.
• The radiolucency “stays” at the apex, regardless the cone angulation.
• A cause of pulp necrosis is usually (but not always) present.

condensing osteitis: opaque, diffuse app, diffuse borders or roughly concentric to the apex

• Mandible: mental foramen, may overlie the apex of a mandibular premolar.
• Maxilla: maxillary sinus, incisive canals, nasal fossa, zygomatic process, and anterior nasal spine.