# Intraoral Radiograph Interpretation **Dr Dayea Oh** OMF Radiologist **Dr Dayea Oh** OMF Radiologist # Contents - Normal vs Abnormal findings - Systematic approach - Assessment of: - Caries - Periodontal disease - Periapical lesions - Normal vs Abnormal findings - Systematic approach - Assessment of: - Caries - Periodontal disease - Periapical lesions Line-art logo consisting of two interlocking hexagons in black outline on a white background. **Checklist** • Reason for x-ray • Previous x-rays • Optimal Viewing Conditions • Patient ID • Orientation -> • Identify the type of x-ray • Image Quality  #### Checklist - Reason for x-ray - Previous x-rays - Optimal Viewing Conditions - Patient ID - Orientation → - Identify the type of x-ray - Image Quality A composite radiographic figure displaying multiple dental X-rays arranged in a grid pattern. The image includes various views such as periapical (individual teeth) and bitewing (upper and lower arches). This visual corresponds to the checklist item 'Previous x-rays' and serves as an example for 'Identify the type of x-ray' and assessing 'Image Quality'. Normal vs Abnormal • Normal • Anatomical • Review tooth morphology • Bilateral & symmetrical (extra-oral imaging) • Abnormal • Pathological • Artefactual • Superimpositions **Description!!!** #### Normal vs Abnormal - Normal - Anatomical - Review tooth morphology - Bilateral & symmetrical (extra-oral imaging) - Abnormal - Pathological - Artefactual - Superimpositions **Description!!!** # Systematic Approach - Step 1. Teeth & Surrounding Structures - Count teeth - Tooth morphology - Crown – enamel, dentine, pulp chamber, etc. - Roots – PDL space, lamina dura, # of roots, root morphology - Periodontal bone - Other - Step 2. Identify existing restorative therapy, endodontic therapy & orthodontic therapy - Assess restorative margins – presence of overhangs? Insufficient margins? - Presence of voids? - Step 3. Identify & describe abnormal radiolucencies & radiopacities - Location - Size & Extent - Morphology & Borders - Effects on surrounding structures - Internal architecture - Step 4. Differential diagnosis #### Systematic Approach 1. Step 1. Teeth & Surrounding Structures - Count teeth - Tooth morphology - Crown – enamel, dentine, pulp chamber, etc. - Roots – PDL space, lamina dura, # of roots, root morphology - Periodontal bone - Other 2. Step 2. Identify existing restorative therapy, endodontic therapy & orthodontic therapy - Assess restorative margins – presence of overhangs? Insufficient margins? - Presence of voids? 3. Step 3. Identify & describe abnormal radiolucencies & radiopacities - Location - Size & Extent - Morphology & Borders - Effects on surrounding structures - Internal architecture 4. Step 4. Differential diagnosis # Caries - triangular - Dentinal caries is larger * **Approximal caries confined to enamel**: * **Approximal caries extending to enamel-dentine junction (EDJ)**: * **Approximal caries extending into dentine**: * **Occlusal caries extending into dentine. No obvious enamel shadow**: * **Buccal/lingual caries**: * **Root caries**: * **Caries adjacent to a restoration (secondary or recurrent)**:   - triangular - Dentinal caries is larger - **Approximal caries confined to enamel**: - **Approximal caries extending to enamel-dentine junction (EDJ)**: - **Approximal caries extending into dentine**: - **Occlusal caries extending into dentine. No obvious enamel shadow**: - **Buccal/lingual caries**: - **Root caries**: - **Caries adjacent to a restoration (secondary or recurrent)**: Labelled diagram of dental anatomy showing three stages of proximal caries progression. The left column features the text 'triangular' and 'Dentinal caries is larger'. The right column displays labels for: 'Approximal caries confined to enamel', 'Approximal caries extending to enamel-dentine junction (EDJ)', and 'Approximal caries extending into dentine'. Each panel illustrates the triangular shape of decay spreading from the contact point into the tooth structure. Labelled diagram of dental anatomy showing four types of caries locations. The panels are labelled: 'Occlusal caries extending into dentine. No obvious enamel shadow', 'Buccal/lingual caries', 'Root caries', and 'Caries adjacent to a restoration (secondary or recurrent)'. White arrows in each panel indicate the specific location and extent of the carious lesion relative to the tooth crown and root. # Recurrent Caries * **A (i) Lesion beneath the restoration** * Left side (Top): No caries shadow evident due to X-ray beam angle. * Center: Caries shadow evident. * Right side: Restoration shadow and Caries shadow identified; X-ray beam parallel. * **A (ii) Lesion hidden by the restoration** * Left side (Bottom): No caries shadow evident due to X-ray beam angle. * Right side: No caries shadow evident as lesion is obscured by the restoration. * **B Buccal and lingual lesions hidden by the restoration** * No caries shadow evident.      - **A (i) Lesion beneath the restoration** - Left side (Top): No caries shadow evident due to X-ray beam angle. - Center: Caries shadow evident. - Right side: Restoration shadow and Caries shadow identified; X-ray beam parallel. - **A (ii) Lesion hidden by the restoration** - Left side (Bottom): No caries shadow evident due to X-ray beam angle. - Right side: No caries shadow evident as lesion is obscured by the restoration. - **B Buccal and lingual lesions hidden by the restoration** - No caries shadow evident. Diagram illustrating 'Recurrent Caries' with two panels showing a tooth with a restoration. Top panel: X-ray beam angled; label 'No caries shadow evident'. Bottom panel: X-ray beam angled differently; label 'No caries shadow evident'. Both show the lesion obscured by the restoration angle. Diagram showing a tooth with a restoration and an X-ray beam passing through it horizontally. A black arrow points to the film area labeled 'Caries shadow', indicating the lesion is visible in this projection. Diagram showing a tooth with a restoration and parallel X-ray beams. Labels indicate 'Restoration shadow' and 'Caries shadow' on the film. Caption reads 'A (i) Lesion beneath the restoration'. Diagram showing a tooth with a restoration and parallel X-ray beams. The lesion is not visible as a shadow. Label reads 'No caries shadow evident'. Caption reads 'A (ii) Lesion hidden by the restoration'. Diagram showing a tooth with a restoration and parallel X-ray beams. Two small black dots represent buccal and lingual lesions that are not visible as shadows. Label reads 'No caries shadow evident'. Caption reads 'B Buccal and lingual lesions hidden by the restoration'.   Dental radiograph (labeled 'A') showing the occlusal relationship of upper and lower posterior teeth. The image displays multiple molar and premolar teeth with visible enamel, dentin, and pulp chambers. Dental radiograph (labeled 'C') showing a section of the dental arch with several restorations. Notable features include: two large amalgam fillings on adjacent molars; one filling appears to have a perforation or defect indicated by black arrows; another tooth has a smaller restoration; and a third tooth shows no apparent restoration. The roots are visible below the crowns.   Clinical radiograph showing a close-up view of posterior teeth. The image displays multiple molars with visible root structures and crowns. There appears to be some evidence of dental work or restorations on the upper right molar. Clinical radiograph showing another section of posterior teeth. This image also features several molars with visible roots and crowns. Similar to the first image, there are indications of dental procedures or conditions affecting the teeth. A B  A B Dental radiograph showing two panels labeled A and B. Panel A displays four teeth with visible root structures and periodontal ligament spaces; the rightmost tooth exhibits a large radiolucent lesion near the apex. Panel B shows similar anatomy but with different radiographic features, including what appears to be a restoration or filling material in one of the central teeth. The images are grayscale X-rays used for diagnostic evaluation of dental conditions.    Dental radiograph labeled 'B' showing multiple teeth with arrows pointing to specific areas of interest. The image reveals the internal structure of the teeth, including roots and crowns, with annotations indicating particular features or conditions. Dental radiograph labeled 'C' displaying a close-up view of several teeth with an arrow highlighting a specific area. The image provides detailed visualization of tooth structures, possibly indicating a condition or treatment area. Dental radiograph labeled 'D' focusing on a single tooth with a visible filling or restoration. The image shows the root canal and surrounding bone structure, providing insight into the internal anatomy and any potential issues. # Periodontal Disease * Periodontal bone loss * Horizontal * Vertical / angular bone defect * Furcation involvement * Alveolar crest $\rightarrow$ cortical? * Calculus * Periodontal ligament space widening * Anatomic considerations * Enamel pearl #### Periodontal Disease - Periodontal bone loss - Horizontal - Vertical / angular bone defect - Furcation involvement - Alveolar crest → cortical? - Calculus - Periodontal ligament space widening - Anatomic considerations - Enamel pearl   Radiograph: Panoramic dental X-ray showing multiple teeth with varying degrees of radiolucency in the pulp chambers and periapical regions. The image displays both upper and lower jaw sections with visible bone structures. Radiograph: Close-up view of three adjacent tooth roots showing detailed periodontal ligament spaces and alveolar bone structure. The image highlights root morphology and surrounding bony architecture.  Dental radiograph showing maxillary and mandibular anterior teeth. A white arrow points to the interproximal area between two lower central incisors, indicating a finding in that region.  Radiograph: Dental X-ray image showing the upper and lower molars. The teeth are visible with their roots extending into the jawbone. The image captures the detailed structure of the teeth, including the enamel, dentin, and pulp chambers. The surrounding bone structure is also visible, providing context for the dental anatomy.  Medical radiograph showing two panels (A and B) of dental anatomy. Panel A displays a lateral view with an arrow pointing to a specific feature on a tooth root, likely indicating a periapical lesion or anatomical variation. Panel B shows a frontal view of multiple teeth with visible roots and crowns, including some restorations. The images are grayscale X-rays used for diagnostic purposes.  Composite dental radiograph consisting of four quadrants displaying the maxillary and mandibular dentition. The image reveals multiple teeth with radiolucent periapical lesions suggestive of pathology (e.g., periapical periodontitis or cysts), particularly visible in the lower left quadrant around the premolar/molar region and upper right quadrant. Some teeth show restorations (radiopaque areas). Bone levels appear reduced in some areas. No visible labels or annotations are present on the image itself. **FIG. 20.14** (A) Loss of the lingual alveolar crest adjacent to this mandibular first premolar without associated interproximal bone loss. (B) Loss of the buccal cortical bone adjacent to the maxillary central and lateral incisors. The **black arrow** indicates the level of the buccal alveolar crest, which demonstrates more profound loss relative to the lingual alveolar crest (**white arrow**).  **FIG. 20.14** (A) Loss of the lingual alveolar crest adjacent to this mandibular first premolar without associated interproximal bone loss. (B) Loss of the buccal cortical bone adjacent to the maxillary central and lateral incisors. The **black arrow** indicates the level of the buccal alveolar crest, which demonstrates more profound loss relative to the lingual alveolar crest (**white arrow**). Clinical radiograph showing two panels: Panel A displays a mandibular first premolar with loss of the lingual alveolar crest but no interproximal bone loss; Panel B shows maxillary central and lateral incisors with buccal cortical bone loss. Black arrow points to the buccal alveolar crest indicating severe resorption compared to the white arrow pointing to the lingual alveolar crest.      Radiograph of maxillary posterior teeth showing multiple restorations. An arrow points to a radiolucent area at the root apex of a molar, indicating periapical pathology. Radiograph of mandibular premolars and molars. An arrow indicates a well-defined radiolucency at the apex of the second premolar, suggestive of periapical periodontitis. Lateral oblique radiograph of the mandible. An arrow points to a radiolucent lesion in the body of the mandible near the inferior border, possibly representing a cystic or neoplastic process. Occlusal radiograph showing a large radiopaque restoration (likely amalgam) with an adjacent tooth exhibiting internal resorption or perforation. An arrow highlights a vertical radiolucent defect extending from the pulp chamber toward the root canal system. Periapical radiograph of anterior teeth. An arrow points to a radiolucent lesion associated with the root of a central incisor, consistent with periapical pathology such as a granuloma or cyst.  Radiograph showing a combined endodontic-periodontic lesion with white arrows pointing to an angular bone defect on the mesial surface of the second molar. **Periapical Inflammatory Lesions** Abscess Granuloma Cyst **FIG. 22.1** The development of periapical inflammatory disease at the tooth root apex and dissemination into the adjacent bone. | Caries | -> | Necrotic pulp | -> | Periapical inflammatory disease | -> | Osteomyelitis | |---|---|---|---|---|---|---| | |^| | | | | | | Trauma |  **Periapical Inflammatory Lesions** - Abscess - Granuloma - Cyst **FIG. 22.1** The development of periapical inflammatory disease at the tooth root apex and dissemination into the adjacent bone. - Caries → Necrotic pulp - Trauma → Necrotic pulp - Necrotic pulp → Periapical inflammatory disease → Osteomyelitis Labeled medical diagram illustrating the progression of periapical inflammatory lesions. It depicts two etiological factors (Caries and Trauma) leading to a Necrotic pulp, which then progresses through Periapical inflammatory disease to Osteomyelitis, showing anatomical changes in the tooth and surrounding bone.     Schematic diagram illustrating three stages of root canal obturation. Panel A shows an ideal fit with no gaps between the gutta-percha filling and the canal walls. Panel B (arrow) indicates a void or underfill at the apical end of the canal. Panel C (arrow) depicts overfilling where material extends beyond the apex. Clinical periapical radiograph showing anterior teeth. The tooth on the far left exhibits a large radiopaque restoration. Adjacent teeth appear to have normal periodontal ligament space and lamina dura. Clinical periapical radiograph showing posterior mandibular molars. The image displays multiple roots and crowns with visible pulp chambers and canals. Clinical periapical radiograph focusing on a molar with a vertical root fracture indicated by a dark linear radiolucency extending through the root structure.   Radiograph showing a dental region with an arrow pointing to the alveolar bone crest adjacent to a molar tooth. Radiograph of a posterior dental region featuring multiple teeth with large restorations (crowns or fillings). An arrow points to the area of the maxillary sinus floor and the underlying alveolar bone.   Anatomical cross-section diagram of a tooth showing developmental and pathological features. Labels include: 'Thinner enamel layer', 'Irregular dentinal tubules', 'Cervical enamel bulge', 'Permanent tooth bud', 'Flattened pulp horns', 'Cervical circumferential groove', 'Interradicular canals arising from the pulp chamber floor', and 'Interradicular and apical root resorption'. The diagram illustrates the relationship between the developing permanent tooth bud and the resorbing roots of the overlying deciduous tooth. Dental radiograph showing two teeth with arrows pointing to radiolucent areas indicating root resorption and/or pathology at the cervical and interradicular regions. The image is labeled with the letter 'E' in the lower left corner.  Composite radiographic figure containing two panels labeled 'A' and 'B'. Panel A displays a dental periapical radiograph showing teeth with root canal treatments. Panel B presents an adjacent view highlighting a dark radiolucent lesion in the bone near the tooth roots, indicated by a black arrow.  Radiograph showing multiple teeth with visible root structures and surrounding bone density.  Split-panel dental radiograph. Panel A (left) shows a periapical view of mandibular posterior teeth with intact lamina dura and no obvious periapical pathology. Panel B (right) displays the same region post-treatment or after intervention, revealing altered bone density patterns and possible endodontic changes in the root canals. Both panels are labeled 'A' and 'B' respectively at bottom-left corners.  Medical radiograph figure showing three panels labeled A, B, and C. Panel A displays a periapical radiograph of anterior teeth with a tooth exhibiting a large radiolucent lesion at the apex. Panel B shows a panoramic or bitewing view of posterior teeth, with two black arrows pointing to the distal aspect of a molar, indicating possible pathology or anatomical features. Panel C is a close-up radiograph of molars with restorations, showing root canal treatment in one tooth and surrounding bone structure. before after A B Importance of clinical history  before after A B Importance of clinical history Comparison of dental radiographs labeled 'before' (A) and 'after' (B). Image A shows a pre-treatment view with visible pathology. Image B shows the post-treatment result demonstrating significant improvement in bone density and tooth structure. End End [^1]: Original PDF page 1: [[L6 Intraoral Radiograph Interpretation.pdf#page=1|L6 Intraoral Radiograph Interpretation, p.1]] [^2]: Original PDF page 2: [[L6 Intraoral Radiograph Interpretation.pdf#page=2|L6 Intraoral Radiograph Interpretation, p.2]] [^3]: Original PDF page 3: [[L6 Intraoral Radiograph Interpretation.pdf#page=3|L6 Intraoral Radiograph Interpretation, p.3]] [^4]: Original PDF page 4: [[L6 Intraoral Radiograph Interpretation.pdf#page=4|L6 Intraoral Radiograph Interpretation, p.4]] [^5]: Original PDF page 5: [[L6 Intraoral Radiograph Interpretation.pdf#page=5|L6 Intraoral Radiograph Interpretation, p.5]] [^6]: Original PDF page 6: [[L6 Intraoral Radiograph Interpretation.pdf#page=6|L6 Intraoral Radiograph Interpretation, p.6]] [^7]: Original PDF page 7: [[L6 Intraoral Radiograph Interpretation.pdf#page=7|L6 Intraoral Radiograph Interpretation, p.7]] [^8]: Original PDF page 8: [[L6 Intraoral Radiograph Interpretation.pdf#page=8|L6 Intraoral Radiograph Interpretation, p.8]] [^9]: Original PDF page 9: [[L6 Intraoral Radiograph Interpretation.pdf#page=9|L6 Intraoral Radiograph Interpretation, p.9]] [^10]: Original PDF page 10: [[L6 Intraoral Radiograph Interpretation.pdf#page=10|L6 Intraoral Radiograph Interpretation, p.10]] [^11]: Original PDF page 11: [[L6 Intraoral Radiograph Interpretation.pdf#page=11|L6 Intraoral Radiograph Interpretation, p.11]] [^12]: Original PDF page 12: [[L6 Intraoral Radiograph Interpretation.pdf#page=12|L6 Intraoral Radiograph Interpretation, p.12]] [^13]: Original PDF page 13: [[L6 Intraoral Radiograph Interpretation.pdf#page=13|L6 Intraoral Radiograph Interpretation, p.13]] [^14]: Original PDF page 14: [[L6 Intraoral Radiograph Interpretation.pdf#page=14|L6 Intraoral Radiograph Interpretation, p.14]] [^15]: Original PDF page 15: [[L6 Intraoral Radiograph Interpretation.pdf#page=15|L6 Intraoral Radiograph Interpretation, p.15]] [^16]: Original PDF page 16: [[L6 Intraoral Radiograph Interpretation.pdf#page=16|L6 Intraoral Radiograph Interpretation, p.16]] [^17]: Original PDF page 17: [[L6 Intraoral Radiograph Interpretation.pdf#page=17|L6 Intraoral Radiograph Interpretation, p.17]] [^18]: Original PDF page 18: [[L6 Intraoral Radiograph Interpretation.pdf#page=18|L6 Intraoral Radiograph Interpretation, p.18]] [^19]: Original PDF page 19: [[L6 Intraoral Radiograph Interpretation.pdf#page=19|L6 Intraoral Radiograph Interpretation, p.19]] [^20]: Original PDF page 20: [[L6 Intraoral Radiograph Interpretation.pdf#page=20|L6 Intraoral Radiograph Interpretation, p.20]] [^21]: Original PDF page 21: [[L6 Intraoral Radiograph Interpretation.pdf#page=21|L6 Intraoral Radiograph Interpretation, p.21]] [^22]: Original PDF page 22: [[L6 Intraoral Radiograph Interpretation.pdf#page=22|L6 Intraoral Radiograph Interpretation, p.22]] [^23]: Original PDF page 23: [[L6 Intraoral Radiograph Interpretation.pdf#page=23|L6 Intraoral Radiograph Interpretation, p.23]] [^24]: Original PDF page 24: [[L6 Intraoral Radiograph Interpretation.pdf#page=24|L6 Intraoral Radiograph Interpretation, p.24]] [^25]: Original PDF page 25: [[L6 Intraoral Radiograph Interpretation.pdf#page=25|L6 Intraoral Radiograph Interpretation, p.25]] [^26]: Original PDF page 26: [[L6 Intraoral Radiograph Interpretation.pdf#page=26|L6 Intraoral Radiograph Interpretation, p.26]] [^27]: Original PDF page 27: [[L6 Intraoral Radiograph Interpretation.pdf#page=27|L6 Intraoral Radiograph Interpretation, p.27]] [^28]: Original PDF page 28: [[L6 Intraoral Radiograph Interpretation.pdf#page=28|L6 Intraoral Radiograph Interpretation, p.28]] [^29]: Original PDF page 29: [[L6 Intraoral Radiograph Interpretation.pdf#page=29|L6 Intraoral Radiograph Interpretation, p.29]] [^30]: Original PDF page 30: [[L6 Intraoral Radiograph Interpretation.pdf#page=30|L6 Intraoral Radiograph Interpretation, p.30]]