The radiologic examination is vital to determine an accurate treatment plan
Dental radiographs were and still are indispensable for a complete and secure dental examination. What has changed in time is the radiologic equipment. Presently modern clinics have devices with special systems that emit a lower level of radiation which is not dangerous for the patient. Plus the patient is protected by a lead apron. Besides the fact that they are safer, these devices are able to offer images of a high quality that facilitate the determination of a correct diagnosis.
Each radiologic examination should generate an optimum radiograph for the possibility to determine a precise diagnosis, incorporating the following functions:
The X-rays should record the complete areas of interest on the image. On the intraoral periapical radiograph the complete length of the root and also 2 mm of the periapical bone should be visible. When there are proves of a pathological situation the entire lesion area plus the bone surrounding it are visible on one of the radiographs. However sometimes this thing is difficult to realize on a periapical radiograph so both an occlusal projection and an extra-oral projection could be necessary. The bitewing view has to show at least once each proximal surface. Radiograph will have to have an as much reduced amount of distortions as possible. Most of the distortions are not caused by the curve of the structures that are examined or by the inaccurate position of the film, but by the wrong angulation of the fascicle of X-rays. Dental radiographs must have an optimum density and contrast, these being essential for their interpretation. When a radiograph is evaluated and its remaking is taken into consideration, the doctor must determine the original reason for making it.
The role of radiographs in the evaluation of periodontal diseases:
Radiographs play an essential role in the evaluation of the periodontal diseases. They provide exclusive information regarding the estate of the periodontium and the situation of the bone during the entire period of the disease evolution. The radiographs help the doctor to identify the destruction stage of the alveolar bone and, in many cases, they are valuable to evaluate specific points. It is important to emphasize that the clinical examination and the radiological one are complementary. The examination should include a bone sounding, a bleeding index, mobility diagrams and also an evaluation of the attached gingiva. The characteristics that are not enough radiologically highlighted are more obvious at the clinical examination and the characteristics noticed on the X-rays are harder to clinically identify and evaluate. Although a radiograph can prove an advanced stage of a periodontal lesion, other important changes of the periodontium are impossible to be seen on the X-ray. Therefore a complete diagnosis of the periodontal disease needs a clinical examination of the patient combined with the radiological examination.
The radiographs are useful especially to evaluate the following aspects:
- The present bone quantity
- The condition of the alveolar ridges
- The bone loss for furcation area
- The width of the periodontal space
- The local elements that determine the starting or the advancing of the periodontal disease
- Incorrect adapted restorations or over extended restorations
- The root length and the morphology
- The report between the root and the crown
- The position of the maxillary sinus related with the periodontal affection
- Supernumerary teeth
- Periapical lesions
- Radicular resorptions
Radiographs can offer an incomplete presentation of the periodontium estate, having three limits:
- The radiographs can offer a two-dimensional view of a tri-dimensional situation. Bone defects can be hidden because the radiologic image cannot reveal the tri-dimensional structure so the bone defects can overlap with the walls of the superior bone. Also because of the overlap of the tooth structure only the interproximal bone can be clearly seen. The subtle changes of the image of the root can indicate the oral and vestibular bone loss. Plus, the use of several images with different agulations, like a complete set of the mouth, allows the user to use the oral object to obtain tri-dimensional information.
- Usually the X-rays show a less severe bone destruction than the clinical examination presented. The early easy destructive bone lesions do not produce enough changes to be detected.
- Radiographs do not prove the relations between the hard tissue areas and the soft tissue areas so they cannot provide any information regarding the depth of the soft tissues.