RADIOGRAPHIC CONSIDERATIONS

DURING THE ENDODONTIC

TREATMENT AND THE EVALUATION

drg. Shanty Chairani, M. Si.

Radiographic series of
endodontic treatment
1.

Preoperative radiograph:
a. To assess diagnosis
b. To assess tooth restorability.
c. To assess the root canal anatomy
d. The difficulty of the case should be

evaluated.

GUIDELINES FOR INTERPRETING

PERIAPICAL IMAGES

Overall critical assessment

Technique (lm OR digitally-captured images)

Is the required tooth shown?

Is the apical alveolar bone shown?
Has the image been taken using the bisected
angle or paralleling technique?
How much distortion is present?
Is the image foreshortened or elongated?
Are the crowns overlapped?
Has there been any coning off or cone cutting?

Overall critical assessment

Exposure factors (lm-captured images)

Is the image too dark and so possibly over- exposed?

Is the image too light and so possibly under-exposed?
What effect do the exposure factors have on the
appearance of the apical tissues?
Processing (lm-captured images)
Is the radiograph correctly processed?
Is it overdeveloped?
Is it underdeveloped?
Is it correctly xed?
Has it been adequately washed?

Systematic
viewing

Analysis of endodontic case difficulty

and risk

Radiographs and Different Teeth

Groups

Maxillary central incisor : the only tooth where

the mesial-distal dimension and the buccallingual dimension are similar
Maxillary lateral incisor : it is wider mesiodistally
than buccolingually. The probability of a sharp
apical curvature is high.
Maxillary canine : it is wider labiolingually than
mesiodistally. The average length is 26.5 mm.
This is the longest tooth in the mouth, so it can
be problematic to visualize the apex in the
radiograph.

First maxillary premolars : it has two

canals located in the buccal and lingual
surfaces.
Maxillary molars :. The frequent
superimposition of portions of the other
roots on each other, superimposition of
bony structure (such as sinus floor or
zygomatic process) on root structures, and
shape and depth of the palate can obstruct
the visualization of the roots.

Lower central and lateral incisors : The

possibility of second canals is high (around
40%).
Mandibular canines : similar with maxillary
canine, except that the dimensions are
smaller. The root canal outlines are
narrower in the mesial-distal dimensions
but usually very broad buccolingually. They
may have two roots, located in buccal and
lingual surfaces

Mandibular premolars : theres possibility of two

canals in the buccal-lingual dimension. The
buccal pulp horn is much larger and more
pronounced, and extends further coronally.
Mandibular molars : The radiographic image of
the pulp chamber is frequently calcified. The
tooth has usually two roots with one, two, or
three canals per root. The mesial root in
mandibular molars is commonly considered to
have two canals, with an isthmus in between.

Mandibular molars : The radiographic

image of the pulp chamber is frequently
calcified. The tooth has usually two roots
with one, two, or three canals per root.
The mesial root in mandibular molars is
commonly considered to have two
canals, with an isthmus in between.

The preoperative radiograph can be good aids

to the design of the access preparation.
Pulp chamber: Wide or calcified: When working in a

wide pulp chamber, a round bur can be introduced

in the chamber until an empty space is felt.
However, when working in a calcified chamber, the
round bur needs to be used very carefully and the
dentinal layers removed slowly
Angle of emergence of canals: In order to achieve a
straight line access to the apex, the angle of
emergence needs to be analyzed, and the amount
of dentin that is to be removed must be determined

2. Radiograph for verification of the working length

Radiographs are used to confirm working length of

the root
This radiograph, taken with a small file placed in the
canal
File smaller than #15 is not recommended because
it will not be visible in the radiograph.
This radiograph will show the relationship between
the file and the apex of the tooth.
If the file is seen trespassing the apex by more than
2 mm, a new radiograph with an adjusted
measurement should be taken at this point

Once the radiograph is taken, it is important

to analyze the following two aspects:

Is the real length (RL) the same as the

estimate length (EL)? (RL = EL) or

Is RL greater than or less than the EL? (RL>
or < than EL)

3.

Canal preparation
Usually, no radiographs are needed at this

stage.
However, if a mishap occurs during this phase,
a radiograph is mandatory to diagnose the
problem and evaluate the possible outcome of
the tooth.
The errors that most often occur during canal
preparation include loss of working length
(blockage), deviation from normal canal, and
inadequate canal preparation, perforation,
and/or separation of root canal instrument.

4. Radiograph for verification of master apical file

(MAF)
The MAF is the largest file that achieves the working

length.
This radiograph is vital to confirm that the length of
the MAF is to working length and the shapes of the
canals are adequately tapered

5. Cone fit radiograph

This radiograph is taken by placing the master cone in

the prepared canal just before obturation.

This radiograph should reveal a cone which is not
kinked or deformed in any way

6. Postoperative radiograph
Postoperative radiographs should be taken with the

same technique as the preoperative radiograph.

In this radiograph, the evaluation of the obturation
is made.
Length, density, configuration, and the general
quality of the obturation in each canal are
determined.
This final radiograph will be the one that the
clinician will use during follow-up appointments and
with which comparisons will be made

Radiographic evaluation of healing

processes of periapical lesion

Endodontic success is usually described as the absence,

clinically and radiographically, of signs of apical
periodontitis.
In practice, the radiographic analysis is carried out by
comparison of recall radiographs with preoperative or
immediate postoperative radiographs of the tooth in
question.
For teeth without a preoperative lesion, a failure is
recorded when the periapical area becomes more
radiolucent; otherwise, it is a success.
For teeth with a lesion, the comparison looks for healing,
which may be recorded when the change is clearly in
favor of the recall Xray

Many cases showed that the increased

radiographic density may often be seen after a
few weeks and quite regularly at 36 months
However, a period of 1 year may be necessary
to assess the overall outcome after treatment
of chronic apical periodontitis; even those
cases that require longer time for complete
healing generally improve sufficiently to be
classified as clinically successful after 1 year

Progressive development
of apical scar. This
permanent artifact
frequently follows throughand-through osseous
destruction of both labial
and palatal cortical plates.
A, Before cyst enucleation.
B, Six months following
surgery. C, One year
following surgery. D, Two
years following surgery;
scar is permanent

A, Three prefabricated
posts in mandibular molar
with post-treatment
disease. B, Access was
prepared through the
crown and posts were
removed; canals were
dressed with calcium
hydroxide. C, Completed
root canal re-treatment. D,
At 6 months, the lesion is
reduced and the tooth is
symptom free, indicating
that healing is in progress.

THANK YOU