The dental x-rays provide information to be able to carry out prevention, diagnosis, informed prognosis and treatment plan. they constitute a complementary test of interest in the diagnosis of the existing pathology.
To adequately interpret an X-ray it is of interest to always follow the same system, for example: start at the crown, go down through the roots and observe the canals and finish with the bone. In the Crown The degree of destruction due to caries, the size of the restorations, pulp protections, pulpotomies and developmental anomalies can be observed by radiography. In the root You could see root calcification which is indicative of pulp aging. Periodontal disease visible on an x-ray may be due to pulp necrosis.
WHAT IS THE IDEAL X-RAY IN ENDODONTICS?
Endodontic X-rays are useful to confirm the diagnosis, assess the location, shape, size and direction of the roots and root canals. With them you also have the option of calculating the working length before instrumentation, locating difficult canals or revealing unsuspected canals or helping to locate the coronally calcified pulp. The relative position of the structures can also be established, help to assess the final filling of the root canals, as well as facilitate the localization of metallic foreign bodies (files, amalgam or inter-root posts) and the examination of the location of tooth fragments or excess of filling material. Finally, thanks to radiography, evolution can be assessed through long-term radiographic controls.
To proceed with an endodontic treatment, four periapical radiographs:
- The first for him diagnosis
- The next for the conductometry (determine tooth length)
- The other for the conometry (check root canal filling)
- The last one for him immediate control (Once the sealing of the ducts and the obturation is done).
There is an optional fifth radiograph for the late check, depending on the pathology treated, especially in apical lesions to verify a favorable evolution of this. It is usually done between 6 and 12 months if it is pulpitis and between 1 year to 3 years if it is periodontitis.
Sometimes it is necessary to carry out 3D radiographs, a CBCT, to be able to see the tooth or teeth in three dimensions and thus be able to define a diagnosis and establish a treatment plan.
The CBCT allows a clear and precise diagnosis of accessory canals, resorptions, root fractures, being able to see the extent of calcifications, as well as observing the proximity of vital structures. This three-dimensional radiograph also allows the assessment of dentoalveolar trauma (fractures, dislocations, dental displacements, or to see the state of the alveolar process). In addition, it allows to determine the possible cause of a failure of the endodontics, for example, small periapical lesions, if there are root resorption or root fractures. Finally, the CBCT is suitable for a study prior to periapical surgery.
Currently, with digital systems and the very notable reduction in radiation, it is not inconvenient for the patient to carry out X-rays since the radiation dose is minimal.
