Keterangan
Diagnostic radiology includes defining and differentiating various normal structures in addition to establishing the existence and kind of pathosis. It also requires determining root and pulp anatomy. Not only must the roots and canals be recognised and counted, but also atypical tooth structure, such as dens invaginatus and a C-shaped arrangement, as well as curvatures, canal relationships, and canal position, must be identified. Characterizing the cross-sectional structure of certain roots and canals is another aspect of identification.
Ringkasan
- Preoperative radiographs are crucial in endodontics, but dentists often misjudge them, leading to root canal failures. Dentists need to carefully analyze these radiographs to avoid errors and ensure treatment success.
- Using a DC X-ray machine is recommended for high-quality radiographs, as it produces high-energy photons. Film holders and RVG positioners are also essential for standardization, especially when assessing periapical lesion healing in follow-up X-rays.
- The long-cone paralleling technique minimizes shortening and elongation. Placing a cotton roll in the maxillary posterior region can help avoid superimposition of the zygomatic arch. It's preferable to use film holders when possible, but adjustments are needed for geometric accuracy.
- There's no set rule for the number of preoperative X-rays needed, but paralleling, mesial, distal, and bitewing views are recommended. The goal is to diagnose the patient correctly.
- An ideal preoperative radiograph allows differentiation between enamel, dentin, and restorations, shows 2-3 mm of periapical area, and has no overlapping or blur. The approach to analyzing the radiograph is critical, involving a step-by-step evaluation of the crown, pulpal system, root outlines, periapical lesion, anatomical structures, surrounding bone, and difficulty assessment.
- When examining the crown, look for amelodentinal integrity and secondary caries, especially their proximity to the pulp. The pulp chamber's size and the presence of pulp stones are important factors. The canal outline should be traced from the exit of the pulp chamber, looking for centrality and abrupt diminishment.
- Root outlines are assessed by following the PDL space and lamina dura, looking for widening or loss of lamina dura. Crossing PDL lines and double PDL spaces are also important indicators. The character and location of periapical radiolucencies need assessing, along with sinus tract tracing using gutta-percha.
- Mental and incisive foramina can mimic periapical lesions, necessitating horizontal angulation changes to visualize roots accurately. Periapical radiographs are limited to two dimensions, but CBCT imaging is reserved for cases with complex anatomy, root fractures, or surgical endo failures.
- C-shaped canals can be suspected from periapical radiographs based on radical fusion, proximity, canal size variations, and a blurred image of a third canal. Vertical root fractures can be identified by visible separation, isolated angular crystal bone loss, J-shaped lesions, and peri-radical radiolucencies in the furcation area.
- In summary, using a DC unit, film holders, and following a structured approach with a roadmap are crucial. Avoid overconfidence and spend time analyzing the preoperative radiographs thoroughly.
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