DHE 116 CHAPTERS 26,27,30

• Consisting of small, misshaped teeth located within a radiolucent fibrous capsule.
• 

• Hypodontia
• hyperdontia
• Dens in dente
• dilaceration
• supernumerary root
• fusion
• gemination

• Failure of a tooth or multiple teeth to develop
• third molars, second premolars, lateral incisors
• 

• Presence of supernumerary (extra) teeth
• distomolar; forth molar
• mesiodens; maxillary midline
• 

• Literally, a tooth within a tooth
• Dens invaginatus presents as an invagination of enamel within the body of the tooth.
• most common maxillary lateral incisors
• 

• A tooth root with a sharp bend or abnormal curvature.
• 

Tooth may abnormally form an extra root

• Developmental disturbance when two adjacent teeth fuse together during growth, forming one large tooth. 2 pulp chambers
• 

• Results when a single tooth germ divides and forms two joined teeth. 1 pulp chamber
• 

• Radiolucency surrounding apices or root tips of a tooth is indicative of pathological changes.
• caries, periapical abscess, granuloma, cyst

• Dentigerous or follicular cyst is observed as a radiolucency surrounding the crown only of an unerupted tooth.
• 

• Incisive canal cyst
• Arrows outline an incisive canal (nasopalatine) cyst in an edentulous maxilla. Note the well-defined corticated border

Globulomaxillary cyst. Interradicular globulomaxillary cyst.

• Overgrowth of cementum on the roots of the molar. Note that the PDL space and lamina dura surround this lesion indicating that it is attached to the tooth
• 

Retained root fragment in an extraction site

• considered normal
• the roots of primary teeth resorb in response to erupting permanent teeth

• is most often characterized by root-end resorption; not limited to the root apex, but can occur anywhere along a tooth root or crown.
• Idiopathic(cause is unknown) resorption of distal root of first molar
• 

• typically appears as a radiolucent widening of a tooth root canal, indicating the resorption process is taking place within the dentin.
• Idiopathic resorption(cause is unknown) noted as a widening of the pulp chamber
• 

–Odontogenic tumors result from abnormal proliferation of cells and tissues involved in odontogenesis.

• –Forms when enamel, dentin, and cementum form irregular shapes resembling small misshaped teeth
• 

–Sometimes called cementoma

• –Bone dysplasia derived from periodontal ligaments of fully developed and erupted teeth
• 

• Children are at a higher risk for caries than adults
• Childhood caries progress more rapidly as compared with adults

with physical characteristics such as a smaller, and sometimes more sensitive, oral cavity and behavioral considerations.

providing comprehensive preventive and therapeutic oral health care for children.

tooth loss and developing good oral self-care habits.

–12 months following eruption of the first primary tooth.

–Usually between 6 and 12 months of age

• radiographs.
• Patients without evidence of disease and with open interproximal contacts may not require a radiographic exam. 

signs, symptoms, and circumstances.

–Detection of caries and periodontal diseases

–Assessment of growth and development and orthodontic intervention

–Detection of congenital dental abnormalities

–Evaluation of third molars

–Diagnosis of pathologic conditions

–Assessment of the effect of trauma

– child’s age, oral cavity size, and cooperation level

standard size 2

anatomical limitations and tissue sensitivity

Oral health needs

Willingness to cooperate

Attention span and emotional state

Ability to understand and follow directions

Ability to hold still throughout exposure

• Size of opening to oral cavity
• Size and shape of teeth and dental arches
• Sensitivity of oral mucosa
• Operator’s ability to gain patient’s trust
• Operator’s ability to position image receptor
• Operator’s knowledge of and ability to adapt standard techniques

• –Recommendation is to expose four radiographic images, one anterior occlusal of each arch (maxilla and mandible) and one posterior bitewing on each side.
• 

, the first permanent teeth usually begin to erupt.

• –Recommendation is to expose a minimum of 12 radiographic images.
• Ten periapical radiographs should include one exposure in each of the four molar regions, four canine exposures, and two incisor exposures.
• Two bitewing radiographs should be exposed, one on each side.
• 

–all permanent teeth except third molars will have erupted.

–recommendation is to expose the same number of radiographs as a FMX for an adult patient.

Pano = does not image structures with the detail / limited in the ability to reveal early carious lesions.

However, ideal for viewing overall development of the dental arches and other oral and maxillofacial structures

placing an image receptor parallel to the long axes of the teeth


–Switch to a smaller

–lighter-weight image receptor holdermodifying an adult holder to increase a pediatric patient’s ability to tolerate placement

= increased slightly over the setting used for adult patients.

–No more than 10 degrees to avoid dimensional distortion

– child cannot tolerate paralleling or bisecting method

–Size 2 image receptor will better fit a child’s oral cavity

• Primary dentition
• (ages 3 to 6 years)
• type/ region; Bitewing/posterior
• size; 0 or 1
• number images; 1 on each side
• Line up behind distal half of mesially located Image receptor placement;primary maxillary or mandibular canine

• Pediatric Radiographic Techniques
• Primary dentition
• (ages 3 to 6 years)
• type/region;Occlusal anterior
• size; 2
• number; 1 on each arch
• Place long dimension across mouth (buccal to buccal;

• Posterior bitewing radiograph.
• (1) Primary maxillary canine, first, second molars. (2) Primary mandibular canine, first, second molars. (3) Permanent maxillary, mandibular first molars. (4) Note small image receptor size did not adequately record apical region to determine presence of premolars.

• Maxillary central-lateral incisors periapical radiograph.
• (1) Primary lateral incisor. (2) Unerupted permanent central incisors. (3) Roots of primary central incisors showing signs of physiological resorption. (4) Primary central incisors

• Mandibular central-lateral incisors periapical radiograph.
• (1) Unerupted permanent lateral incisor. (2) Caries on mesial surface of primary lateral incisor. (3) Permanent central incisors. (4) Large open apex on permanent teeth, indicating root formation still in progress.

• 27-12  Maxillary canine periapical radiograph.
• (1) Primary canine. (2) Unerupted first premolar. (3) Unerupted permanent canine—note radiolucent dental follicle surrounding crown. (4) Permanent central incisor—note widened pulp chamber indicating root formation still in progress. (5) Permanent lateral incisor—appears to be tipped toward distal overlapping with primary canine.

• Mandibular canine periapical radiograph.
• (1) Primary lateral incisor. (2) Primary canine with radiolucencies indicative of caries. (3) Primary first molar. (4) Unerupted first premolar. (5) Unerupted permanent canine. (6) Unerupted permanent lateral incisor.

(1) Permanent first molar. (2) Unerupted second premolar. (3) Unerupted first premolar. (4) Primary canine. (5) Primary first molar—note almost total resorption of roots. (6) Primary second molar.

–Possible increase in sensitivity of immature, rapidly growing cells and tissues

–Smaller stature and overall size placing radiation-sensitive tissues closer to the path of the primary beam of radiation

–Smaller, less dense bone structure requiring less radiation to produce an acceptable image


Generally, a reduction of radiation by one-half for children under 10 years of age and by one-fourth for children between the ages of 10 and 15 years is acceptable.

Once a child reaches adolescence, 15 or 16 years of age, the exposure settings should be the same as for an adult patient.

Image Gently® campaign.

ALARA recommendations that apply to both children and adult Includes use of: fast film digital image receptorsx-ray beam filtration and collimating devicesappropriately reduced child exposure settingsthyroid shielding.

Digital palpation

• Influence on Child’s first experience
• Child should be a willing participant in the process
• Modeling
• Communication
• Show-tell-do

address a variety of specific oral and maxillofacial diagnostic needs.

supplemental intraoral and extraoral imaging techniques.

of a diseased tooth by removing infected nerves and tissues from the pulp cavity and replacing with therapeutic filling material, usually gutta-percha

exposed to determine preoperative condition and to make a diagnosis

ensure the canal is filled and sealed satisfactorily.

• determine the number of canal(s)
• Shape of canal(s)
• length of a root canal (s)
• possible calcification or obstructions

precise placement of an image receptor in a standard holder.

• Impossible for a patient to bite down on the biteblock
• Bisecting
• Exposing multiple radiographs at different horizontal or vertical angulation

• Definitive evaluation method
• Right-angle method
• Tube shift method (buccal-object rule)

Especially valuable during root canal therapy and for determining facial or lingual position of impacted teeth and foreign objects

• Based on shadow casting principles
• An object positioned farther away from the image receptor will be magnified and less clearly imaged.
• Objects positioned more toward the facial or buccal will be farther away from the receptor.
• More likely to appear magnified and less clearly imaged

• ross-sectional occlusal radiograph places an image receptor at a right angle to a tooth or dental arch.
• In this position, the occlusal radiograph will image the object of interest clearly on the buccal or lingual.

• Most versatile method of localization
• Two radiographs are needed.
• If the structure or object in question appears to have moved in the same direction as the horizontal- or vertical shift of the dental x-ray tube, then the structure or object is located on the lingual.
• If the move is in the opposite direction of the shift of the tube, the structure or object is located on the buccal or facial.

• Examine large areas of the dental arches and skull
• Study growth and development of bone and teeth
• Detect fractures and evaluate trauma
• Detect pathological lesions and diseases
• Detect and evaluate impacted teeth
• Evaluate temporomandibular disorder (TMD)
• Plan treatment for dental implants and prosthetic appliances
• Serve as a substitute when an intraoral examination is not possible

• Evaluate trauma.
• Determine the location and extent of fractures.
• Locate impacted teeth, abnormalities, and malignancies.
• Evaluate injuries to the TMJ.

• View entire skull from side / sinus cavities
• Orthodontic
• Evaluate
• growth/ development, trauma, pathology, developmental abnormalities

• Entire skull in posteroanterior plane; orbit; frontal sinus
• examine facial growth/ development, disease, trauma, developmental abnormalities

• To evaluate maxillary, frontal, ethmoid sinuses
• Middle third of face to include zygoma, coronoid process, sinuses

• area; Condyles
• purpose; To examine fractures of condylar neck

• area; Base of skull; condyles; sphenoid sinus; zygoma
• purpose;To evaluate position/ orientation of condyles; fractures of zygomatic arch

• area; Head of condyle; glenoid fossa; temporal bone; TMJ in open, closed, and at rest positions
• purpose; Aids in diagnosing ankylosis (stiffening of TMJ); malignancies, fractures, and tissue changes caused by arthritis