Radiographic Considerations during the Endodontic Treatment and the Evaluation

Radiographic Considerations during the Endodontic Treatment and the Evaluationdrg. Shanty Chairani, M. Si.

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Radiographic series of endodontic treatment Preoperative radiograph: To assess diagnosisTo assess tooth restorability. To assess the root canal anatomyThe difficulty of the case should be evaluated.

GUIDELINES FOR INTERPRETING PERIAPICAL IMAGESOverall critical assessmentTechnique (lm OR digitally-captured images) Is the required tooth shown? Is the apical alveolar bone shown? Has the image been taken using the bisected angle or paralleling technique? How much distortion is present? Is the image foreshortened or elongated? Are the crowns overlapped? Has there been any coning off or cone cutting?

Overall critical assessmentExposure factors (lm-captured images) Is the image too dark and so possibly over- exposed? Is the image too light and so possibly under-exposed? What effect do the exposure factors have on the appearance of the apical tissues?Processing (lm-captured images) Is the radiograph correctly processed? Is it overdeveloped? Is it underdeveloped? Is it correctly xed? Has it been adequately washed?

Systematic viewing

Analysis of endodontic case difficulty and risk

Radiographs and Different Teeth Groups Maxillary central incisor : the only tooth where the mesial-distal dimension and the buccal-lingual dimension are similarMaxillary lateral incisor : it is wider mesiodistally than buccolingually. The probability of a sharp apical curvature is high. Maxillary canine : it is wider labiolingually than mesiodistally. The average length is 26.5 mm. This is the longest tooth in the mouth, so it can be problematic to visualize the apex in the radiograph.

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First maxillary premolars : it has two canals located in the buccal and lingual surfaces.Maxillary molars :. The frequent superimposition of portions of the other roots on each other, superimposition of bony structure (such as sinus floor or zygomatic process) on root structures, and shape and depth of the palate can obstruct the visualization of the roots.

Lower central and lateral incisors : The possibility of second canals is high (around 40%).Mandibular canines : similar with maxillary canine, except that the dimensions are smaller. The root canal outlines are narrower in the mesial-distal dimensions but usually very broad buccolingually. They may have two roots, located in buccal and lingual surfaces

Mandibular premolars : theres possibility of two canals in the buccal-lingual dimension. The buccal pulp horn is much larger and more pronounced, and extends further coronally.Mandibular molars : The radiographic image of the pulp chamber is frequently calcified. The tooth has usually two roots with one, two, or three canals per root. The mesial root in mandibular molars is commonly considered to have two canals, with an isthmus in between.

Mandibular molars : The radiographic image of the pulp chamber is frequently calcified. The tooth has usually two roots with one, two, or three canals per root. The mesial root in mandibular molars is commonly considered to have two canals, with an isthmus in between.

The preoperative radiograph can be good aids to the design of the access preparation. Pulp chamber: Wide or calcified: When working in a wide pulp chamber, a round bur can be introduced in the chamber until an empty space is felt. However, when working in a calcified chamber, the round bur needs to be used very carefully and the dentinal layers removed slowly Angle of emergence of canals: In order to achieve a straight line access to the apex, the angle of emergence needs to be analyzed, and the amount of dentin that is to be removed must be determined

2.Radiograph for verification of the working lengthRadiographs are used to confirm working length of the rootThis radiograph, taken with a small file placed in the canal File smaller than #15 is not recommended because it will not be visible in the radiograph. This radiograph will show the relationship between the file and the apex of the tooth.If the file is seen trespassing the apex by more than 2 mm, a new radiograph with an adjusted measurement should be taken at this point

Once the radiograph is taken, it is important to analyze the following two aspects:Is the real length (RL) the same as the estimate length (EL)? (RL = EL) orIs RL greater than or less than the EL? (RL> or < than EL)

Canal preparationUsually, no radiographs are needed at this stage. However, if a mishap occurs during this phase, a radiograph is mandatory to diagnose the problem and evaluate the possible outcome of the tooth.The errors that most often occur during canal preparation include loss of working length (blockage), deviation from normal canal, and inadequate canal preparation, perforation, and/or separation of root canal instrument.

4. Radiograph for verification of master apical file (MAF)The MAF is the largest file that achieves the working length. This radiograph is vital to confirm that the length of the MAF is to working length and the shapes of the canals are adequately tapered 5.Cone fit radiographThis radiograph is taken by placing the master cone in the prepared canal just before obturation. This radiograph should reveal a cone which is not kinked or deformed in any way

6.Postoperative radiographPostoperative radiographs should be taken with the same technique as the preoperative radiograph. In this radiograph, the evaluation of the obturation is made. Length, density, configuration, and the general quality of the obturation in each canal are determined. This final radiograph will be the one that the clinician will use during follow-up appointments and with which comparisons will be made

Radiographic evaluation of healing processes of periapical lesionEndodontic success is usually described as the absence, clinically and radiographically, of signs of apical periodontitis. In practice, the radiographic analysis is carried out by comparison of recall radiographs with preoperative or immediate postoperative radiographs of the tooth in question. For teeth without a preoperative lesion, a failure is recorded when the periapical area becomes more radiolucent; otherwise, it is a success. For teeth with a lesion, the comparison looks for healing, which may be recorded when the change is clearly in favor of the recall Xray

Many cases showed that the increased radiographic density may often be seen after a few weeks and quite regularly at 36 monthsHowever, a period of 1 year may be necessary to assess the overall outcome after treatment of chronic apical periodontitis; even those cases that require longer time for complete healing generally improve sufficiently to be classified as clinically successful after 1 year

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Progressive development of apical scar. This permanent artifact frequently follows through-and-through osseous destruction of both labial and palatal cortical plates. A, Before cyst enucleation. B, Six months following surgery. C, One year following surgery. D, Two years following surgery; scar is permanent

A, Three prefabricated posts in mandibular molar with post-treatment disease. B, Access was prepared through the crown and posts were removed; canals were dressed with calcium hydroxide. C, Completed root canal re-treatment. D, At 6 months, the lesion is reduced and the tooth is symptom free, indicating that healing is in progress.

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