This document provides an overview of radiographic interpretation for periapical and panoramic dental x-rays. It defines dental radiography and describes the main intraoral and extraoral views. Periapical radiographs show the entire tooth and surrounding structures, and are useful for detecting dental issues like caries, periapical pathology, implants and more. Panoramic radiographs provide a wide view of the jaws and are used to assess issues like gross caries, fractures, cysts and tumors. The document outlines the normal radiographic anatomy seen in these views and provides guidance on interpreting radiographs through steps like localization, observation, interpretation and correlation to arrive at a diagnosis.

1. Radiographic Interpretation
(Peri-apical and OPG)
Presented by:
Syed Moiz Rafiq

2. Objectives:
• The students should know the normal
anatomy of the tooth under dental
radiograph.
• The students should interpret the pathology
of the tooth under dental radiograph.

3. What is dental radiograph ?
Dental radiography :
It is the art of producing an image or picture for
intra-oral or extra-oral structures on a dental
film using X-rays.

4. Dental radiographic views
• Intra oral :
-Peri-apical
-Bitewing
-Occlusal
• Extra oral :
-OPG
-Cephalometry
-Sialography

5. Periapical radiograph

6. • Periapical radiograph:
It is the most frequently used intra-
oral view radiograph, which shows the
entire tooth and surrounding
structures on the film.

7. Need for prescribing peri-apical
dental radiograph
• Extent of carious involvement in the tooth
• Interproximal decay under the contact point
• Periapical pathological changes
• Traumatic injuries to dento-alveolar process
• Periodontal diseases

8. • Dental anomalies
• Occult diseases
• Prognostic assessment during treatment planning
• Post obturation assessment of endodontic therapy
• Working length measurement during root canal
therapy
• Implants

9. Normal Radiographic Anatomy
(Peri-apical)

10. Normal radiographic anatomy

11. • ENAMEL
Most radiopaque structure
• DENTINE
Slightly lighter than enamel
• PULP CAVITY
Radiolucent lines within the tooth

12. • ALVEOLAR CREST
Gingival margin of the alveolar process appear as a
radiopaque line
• PDL SPACE
Narrow radiolucent line around tooth surface
• LAMINA DURA
Radiopaque line representing tooth socket

13. Radiographic interpretation:

14. Interpretation :
• Step by step analytical process that provides
an exact idea of the clinical problem and helps
to achieve the final diagnosis of any particular
lesion.

15. The importance of interpretation:
• Radiographic interpretation is an essential
part of the diagnostic process. The ability to
evaluate & recognize what is revealed by a
radiograph enable us to detect diseases,
lesions & conditions which can’t be identified
clinically.

16. Steps of interpretation
• Localization.
• Observation.
• General consideration.
• Interpretation.
• Correlation.

17. Localization:
• Localized or generalized
• Position in the jaw
• Single or multiple
• Size

18. Observation:
• All shadows, other than the localized shadows
of the normal landmarks must be observed.
• For example: shadows in crowns, cervical
area, roots, restorations, size of root canals,
periodontal membrane space, periapical area,
alveolar crest, foreign bodies, integrity of
bone

19. General consideration:
• A radiograph shows only 2 dimensions of a 3
dimensional object (width and height but not
the depth)
• Cervical burnout: usually appears as cervical
Radiolucency and misinterpreted by caries;
this occurs due to less density and more
penetration of rays.
• Pulp exposure: never to be determined from
radiograph but only the proximity to the pulp.

20. Interpretation:
• Studying the features of teeth and bone:
Teeth
Study the whole tooth,(crown, root, enamel,
pulp), number of teeth and finally supporting
structures, (Periodontal membrane space,
lamina dura , alveolar crest)

21. Bone:
Changes in bone may include:
1- Changes in density.
2- Changes in the margin
3- Changes inside the lesion.
4- Effect on surrounding tissues.
5- Changes in structure

22. Correlation:
• The final step is to correlate all of the
radiographic features to reach a radiographic
differential diagnosis.
• Then to draw a final diagnosis, we have to
correlate other data as case history, clinical
examination, and other diagnostic aids with
the radiographic differential diagnosis

23. Dentine
Pulp chamber
Root canal
enamel
Metallic restoration
P/d ligament
Lamina duraalveolar bone

24. Periapical radiograph
interpretation:

25. Enamel
• Caries of the enamel : appears as radiolucent
area

26. • Enamel hypoplasia: appears as radiolucent
area surrounded with radiopaque margins

27. • Amelogenesis imperfecta: all the enamel
appear as radiolucent area

28. Dentin:
• Caries of the dentin: appears as radiolucent
area

29. • Dentinogenesis imperfecta: dentin appear as
radiolucent area surrounded by faint
radiopaque margins

30. • Dense in dente: appears as radiopaque
structure within the tooth surrounded by
radiolucent margin

31. • Internal resorption: radiolucent lines on the
apex or lateral side of the root dentin

32. Pulp:
• Calcification of the pulp: appears as a localized
area of radiopacity, if the calcification is
generalized it appears as a generalized area of
radiopacity

33. • Shell tooth: appear as wide pulp chamber

34. Cementum:
• Hypercementosis: appear as radiopaque area
covers the cementum line

35. • Cementoma: appears at the apex of the tooth
as a radiolucent area in its early stages and
converted into radiopaque at the terminal
stages

36. PDL space:
• Normally appear as radiolucent line surround
the root surface
• Widening of the space as a result of osteolytic
process e.g, osteolytic osteoma
• Narrowing of the space as a result of
osteoblastic process e.g, scleroderma

37. Pdl space
Widened pdl space Narrow PDL space

38. Lamina dura:
• Normally appear as radiopaque clear
continuous band covers the alveolar bone i.e,
lining the socket and covers the crest of the
alveolar bone
• Discontinuity of the lamina dura indicate
pathological changes

39. Lamina dura pathology
Normal lamina dura Loss of lamina dura

40. Alveolar bone:
• Bone resorption either horizontal or vertical
• Bone loss:
Alveolar bone height
Alveolar bone health
Generalized v/s localized alveolar bone loss

41. Horizontal bone loss Vertical bone loss

42. Metallic restoration :
• Restoration done on tooth showing radio-
opacity.

43. Status of root filling (RCT) :
• Radio-opacity on the whole pulp chamber can
be seen.

44. Dental Implant :
• Dental implant shows obvious shape and
radio-opacity on radiographs

45. Follow up:

46. OPG radiographs :

47. • OPG radiographs:
An Extra-oral technique which produces a
radiograph with wide view of the maxilla and
mandible.
It's also known “pantomography” “Rotational
panoramic radiography”

48. Indications for OPG radiographs:
• Gross caries
• Pain related to a whole quadrant
• Orthodontic assessment
• Pre-operative assessment
• Mandibular fractures

49. • Cysts, tumors , developmental anomalies
• Assessment of TMJ
• Periodontal disease
• Impacted tooth
• Implants

50. Normal Radiographic Anatomy
(OPG)

54. OPG Radiographic interpretation :

55. Describing the Lesion
• 1. Size
• 2. Shape
• 3. Location
• 4. Density
• 5. Borders
• 6. Internal Architecture
• 7. Effect on adjacent structures

56. Nolla stages (dentitional status) :
• Panoramic radiographs shows unerupted
tooth and help to diagnose nolla stage and
dentitional status.

57. Impacted tooth :
• Impacted tooth are identified on OPG
radiographs easily as the teeth are
displacement and tilted.

58. Fractures :
• Bone displacement, broken mandible gives
the diagnosis of fracture.

59. Tumors/lesions:
• Ill-defined borders with sclerosis and ground
glass appearance gives the diagnosis of lesion.

60. Cyst:
• Presence of radiolucency , corticated borders ,
locularity and displacement of tooth shows
the diagnosis of a cyst.

61. Restoration material :
• Restoration can be diagnosed by radiopacity
on tooth structures.

62. Thank you!