Radiographic Examination

Radiographs provide essential information to supplement the clinical examination. Detailed knowledge of the extent of bone support and the root morphology of each standing tooth is essential to establishing a comprehensive fixed prosthodontic treatment plan. Although radiation exposure guide lines recommend limiting the number of radiographs to only those that will result in potential changes in treatment decisions, a full periapical series (Fig. 1-23) is normally required for new patients so that a comprehensive fixed prosthodontic treatment plan can be developed. Patient exposure can be minimized by using a technique that provides the most information with a minimal need for repeat films and by using appropriate protection. The use of digital radiography can further help reduce radiation exposure.

Panoramic films (Fig. 1-24) provide useful information about the presence or absence of teeth. They are especially helpful in assessing third molars and impactions, evaluating the bone before implant placement (see Chapter 13), and screening edentulous arches for buried root tips. However, they do not provide a sufficiently detailed view for assessing bone support, root morphology, caries, or peri-apical pathology.

Special radiographs may be needed for the assessment of TMJ disorders. A transcranial exposure (Fig. 1-25), with the help of a positioning device, will reveal the lateral third of the mandibular condyle and can be used to detect structural and positional changes. However, interpretation may be difficult.21 More information can be obtained from serial tomography, arthrography, 22 CT scanning, 23

Radiographic Positioning Teeth
Fig. 1-24. A panoramic film cannot be substituted for a full-mouth series because the image is distorted. Nevertheless, it is very useful for assessing unerupted teeth, screening edentulous areas for buried root tips, and evaluating the bone before implant placement.
Transcranial Radiograph
Fig. 1-25. A transcranial radiograph shows the lateral pole of the mandibular condyle (arrow).

magnetic resonance imaging (Fig. 1-26), or digital subtraction radiography of the joints.

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