Endodontics
Course Review
Enoch Ng, DDS 2014
Radiography
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Diagnosis/Case Selection Aid – # of roots/canals, curvatures, calcification, hard/soft tissue alterations
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Treatment Process Aid – EWL/CWL, localize difficult to find canals, determine relative position buccolingually
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Aid in evaluating patient’s response to treatment
Endodontic Radiographs
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Periapicals – diagnostic radiographs, working radiographs, post-op radiographs
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Bitewings (vertical) – RESTORATIVE ASSESSMENT, caries ID, location of pulp chamber, vertical defects
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Pan, occlusal, CBCT – difficult diagnosis, presurgical treatment planning for assessment of vital structures
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FMX – history of teeth (restorations, PA lesion progression, etc)
Diagnostic Radiographs
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Evaluate difficulty of case (case selection)
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Chamber and canal morphology
Calcified or obliterated chamber/canals, pulp stones
Internal root resorption
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Root morphology
Length, curvature, recurvature
Number, fused roots, possible C-shaped roots
External root resorption
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Crown, root, or alveolar fractures
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Previous endo access/treatment
Perforations, separated files, blocked/ledged canals
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Periodontal bone loss, periapical pathosis
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Proximity of anatomic structures
Sinus, mandibular canal, mental nerve
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Ease of exposing radiographs on patient
Small mouth, large tongue, shallow palate
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The more info, the better
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Case selection, anticipate anatomy, anticipate problems with isolation
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Fast break – indicates broad root canal has split into 2 smaller roots
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Bullseye – indicates root apex has curved either straight buccal or straight lingual
Radiolucent lesions of endodontic origin
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Trace PDL from coronal to apex outlining root end
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Intact lamina dura, uniform PDL
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Normal
widened PDL
apical lesions
large lesions
o
Loss of lamina dura, hanging drop of water appearance, doesn’t shift from apex in off-angle radiograph
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Destruction of cancellous bone may not be seen
Only seen on radiograph when cortical plate is affected
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Pulpal pathosis may not be differentiated on radiograph
o
Vital and necrotic pulps cast the same image on radiographs
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Tissue in pulp space looks the same regardless of if it is:
Normal
Reversibly/irreversibly inflamed
Necrotic
