Reporting on Clinical Radiographs - 2.5 PDF

**[Reporting on clinical radiographs - 2.5]** Bitewing - dot towards mandibular teeth Periapical - dot to crown Posterior cervical burnout = invagination of proximal root surfaces allows more x-rays to pass through so looks more radiolucent Anterior cervical burnout = space between enamel and bo...

**[Reporting on clinical radiographs - 2.5]** Bitewing - dot towards mandibular teeth Periapical - dot to crown Posterior cervical burnout = invagination of proximal root surfaces allows more x-rays to pass through so looks more radiolucent Anterior cervical burnout = space between enamel and bone overlying tooth looks more radiolucent than either the enamel or bone-tooth combination  Selection criteria = descriptions of clinical conditions derived from patient signs, symptoms and history that identify patients who are likely to benefit from a particular radiographic technique. Guidelines are not a rigid constraint on clinical practice, but a concept of good practice against which the needs of the individual patient can be considered **Levels of evidence - SIGN\* system of classification** (Scottish Intercollegiate Guidelines Network) Grade A = requires at least one randomised controlled trial as part of the body of literature, of overall good quality and consistency, addressing the specific recommendations Grade B = requires availability of well conducted clinical studies but no randomised clinical trials on the topic of the recommendation Grade C = requires evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities. Indicates absence of directly applicable clinical studies of good quality **Classification of radiographic caries** C-1 = enamel caries less than half way through enamel. Sometimes called incipient caries. Do not record these lesions if doubtful of their existence. C-2 = enamel caries penetrating more than half way through enamel but not involving dentino-enamel junction C-3 = caries of enamel and dentine at or through the dentino-enamel junction extending less than half way into dentine towards pulp cavity C-4 = caries of enamel and dentine extending more than half way into dentine towards pulp cavity **Selection criteria for child bitewings** High caries risk = 167 - 800% Moderate caries risk = 150 - 270% Low caries risk = significant number over clinical examination alone (one study shows 2-3x more carious lesions) Level of evidence B - caries should be diagnosed as early as possible to allow management before cavitation and pulpal involvement, and to identify caries-active pt and those at increased risk of caries in the future Level of evidence C - taking of routine radiographs based solely on time elapsed since last app is not supportable. Intervals between subsequent radiographic examinations must be assessed for each new period as individuals can move in and out of caries risk categories over time Level of evidence B: High caries risk = 6 month intervals Moderate caries risk = 1 year intervals Low caries risk = 12-18 months (primary dentition) and 2 years (permanent dentition)... until no new or active lesions detected **Selection criteria for adult bitewings** Level of evidence C: High caries risk = 6 month intervals Moderate caries risk = 1 year intervals Low caries risk = 2 year intervals... until no new or active lesions detected Selection criteria - newer radiographic methods and alternatives to radiographs for caries diagnosis B - CBCT should no be used as a routine method of caries diagnosis C - consideration should not be given to temporarily separating approximal surfaces where there is doubt whether or not cavitation has taken place and thus whether a filling is indicated C - FOTI\* should be used as an adjunct to bitewings for caries diagnosis. When used, a 0.5mm tip should be employed and training is recommended C - the development, testing and implementation of electrical detection and monitoring aids should be followed closely C - care should be taken in the interpretation of results using some optical caries detection devices as some can give false positives **Periodontal disease** - - - - **Selection criteria - periodontal assessment** C - CBCT is not indicated as a routine method of imaging periodontal bone support C - if a pt has generalised pocketing of 4-5mm (BPE scores of a max code 3 in any sextant) and little to no recession, horizontal bitewings are recommended. These may be supplemented by intraoral periapicals for selected anterior teeth but only if this is likely to change management of pt C - assessment of all teeth and their periodontal support can be achieved by an optimal-quality panoramic radiograph alone, a panoramic radiograph with supplementary periapical radiographs or a complete series of periapical radiographs. When determining which radiographic technique to use, consideration should be given to the clinical presentation, the required image quality and the relative dose-benefit based on the equipment available C - a periapical radiograph using a paralleling technique is indicated of a periodontal /endodontic lesion is suspected C - if a pt has pocketing of 6mm or more (BPE code 4), vertical bitewings are recommended, supplemented by intraoral periapical views using the paralleling technique at sites where alveolar bone image is not included. These may be supplemented by intraoral periapical for selected anterior teeth, but only is this is likely to change management of pt C - where CBCT images include teeth, care should be taken to check for periodontal bone levels when performing a clinical evaluation **Panoramic radiography**  **Selection criteria - panoramic radiography** C - where a bony lesion or unerupted tooth is of a size or position that precludes its complete demonstration on intraoral radiographs C - in pt with grossly neglected dentition, for who there is a clinically determined likelihood of multiple extractions B - for the assessment of third molars prior to surgical intervention. Routine radiography of unerupted third molars in not recommended C - as part of an orthodontic assessment where there is a clinical need to know the state of the dentition and the presence/absence of teeth. The use of clinical criteria to select pts rather than routinely screening of pts is essential B - panoramic radiographs should only be taken in the presence of specific clinical signs and symptoms. There is no justification for review panoramic radiographs at arbitrary time intervals