1
Diagnostics of
the dental
caries
x-ray diagnostics
Aim
To introduce students to X-ray diagnostics and interpretation of
X-ray pictures in the area of Preventive Dentistry, Cariology and
Paediatric Dentistry.
Outcomes
Students will be competent to diagnose the dental caries, its
forms and severity, topographical relationship between primary
and permanent teeth as well as to indicate appropriate
endodontic treatment both in primary and permanent dentition
including teeth with open apices and primary teeth under root
resorption.
Target group
ZLPZ041c, ZLDL0922c, ZLDL0821p
Prerequisites
Knowledge of following subjects is necessary to understand the
topics: Anatomy of teeth, Imaging techniques in dentistry,
Preventive dentistry, Cariology, Pediatric dentistry.
Contents
Enamel caries - Caries incipiens ..2
Caries in dentine 7
Caries in dentine - Caries pulpae
proxima ..................................... 9
Caries in dentine - Caries ad
pulpam penetrans.....................12
Primary dentition ......................14
Early childhood caries (ECC)......16
Premature loss of primary molars
...................................................20
Course of primary molars
resorption..................................25
Age of the child 8 years......31
Age of the child 9 years......32
Age of the child 10 years....33
Age of the child 12 years....34
Assessment of the root
developmental stage.................35
2
Commentary
Dg: caries in dentine, D3.
Commentary
Dg: enamel caries D2
Study motivation
Identify caries incipiens in other
localizations (16,15,46, 47).
Enamel caries - Caries incipiens
Periapical projection. 85, low conical radiolucency mesially ( ),
reaching into the outer half of the enamel. Higher magnification
demonstrates the radiolucency penetrating slightly into the dentine
( ).
B-W projection. 45 distal surface, caries incipiens ( ). Higher
magnification demonstrates radiolucency also in the inner half of the
enamel - D2.
3
Commentary
Dg: D2.
15 distally – the lesion on the
boundary between D1 a D2.
Study motivation
Assess remaining approximal
surfaces and determine the
diagnosis.
Study motivation
Assess the remaining surfaces.
Enamel caries - Caries incipiens
B-W projection. 14 caries incipiens on the distal surface ( ) DG:
D1, 15 caries superficialis distally ( ) and mesially.
B-W projection. 17, 16 caries incipiens D1 ( ),
however, D2 is suspicious on 16,
47 caries incipiens D1 mesially ( ),
46 caries superficialis D2 distally.
4
Study motivation
Localize the lesions.
Commentary
Dg: D3, chronic caries.
Enamel caries - Caries incipiens
B-W projection. 35 Caries superficialis D2 on the distal surface ( ).
D1 lesion on several approximal surfaces of molars and premolars.
B-W projection. Dentine caries D4 on the distal surface of 35.
Another diagnosis: caries pulpae proxima.
Radiolucency in dentine along the entire dentine-enamel junction
mesially ( ), mild surface radiolucency in enamel (D1) missing the
typical conical character.
5
Study motivation
Identify another lesions and
compare morphology of
primary and permanent molars.
Study motivation
Identify another lesions and
compare morphology of
primary and permanent molars.
Enamel caries - Caries incipiens
B-W projection. 74 caries in dentine D3 distally ( ),
75 radiolucency - burn out effect distally. ( ).
B-W projection. 64 distally, 65 mesially caries in dentine D4 ( ),
26 caries in dentine D3( ).
6
Study motivation
Identify another lesions and
compare morphology of
primary and permanent
molars.
Enamel caries - Caries incipiens
B-W. projection. 16 caries in dentine D4, caries pulpae proxima, burnout
effect 55 ( ).
Caries superficialis affecting 85 distally ( ).
7
Commentary
Caries pulpae proxima.
Study motivation
Evaluate the thickness of
dentine wall and the size of
the dental pulp cavity in all 4
incisors.
Study motivation
Evaluate the state of other
teeth in the dentition and
calculate the dmft, DMFT
indices.
Caries in dentine
Periapical projection, primary dentition, 5-year child. caries
superficialis 51,61, mesially ( ).
Caries in dentine 52, 62 ( ).
OPG, 10-year-old child, mixed dentition. Caries in dentine:
55-caries sec., 16-caries sec.
65, 75, 85- caries in dentine,
74 caries ad pulp. penetrants.
8
Commentary
Caries pulpae proxima.
Study motivation
For students of the 4. year:
Describe developmental root
stages in permanent
erupted/erupting permanent
teeth.
Caries in dentine
OPG, child, 11 years. Susceptible caries in dentine 16 mesially, 15
distally,
26 mesially and distally,
37 secondary caries,
36 caries in dentine mesially, 35 distally.
BW projection – left. The x-ray demonstrates substantially smaller
extent of radiolucency than that visible on OPG projection. 26
( ), 36 ( )
B-W projection is more precise.
26 mesially corresponds to D3, distally to D0,
35 corresponds to D0,
36 corresponds to D1,
37, caries extent corresponds approximately to the depth between
D3 to D4.
9
Commentary
Caries pulpae proxima.
Study motivation
Describe carious lesions on
remaining teeth.
Commentary
Dg. Early childhood caries.
Study motivation
Assess the state of remaining
teeth of the primary dentition.
Mention the age, in which
marked root resorption of the
first primary molars can be
detected.
Caries in dentine - Caries pulpae proxima
Periapical projection, extensive radiolucency localized on the distal
surface of 22 and mesial surface of 23 extending to the dental pulp
vicinity.
OPG of primary dentition. Caries pulpae proxima in teeth 85, 74.
Distinct radiolucency in the root area of 74, the roots are almost
resorbed.
10
Study motivation
Repeat: types of the dental
caries.
Study motivation
Repeat: types of the dental
caries, mention the ways of
microbs penetration into teeth.
Carious lesion D0 on approximal
surfaces of 36.
Caries in dentine - Caries pulpae proxima
Periapical projection. 26 caries pulpae proxima, secondary caries.
B-W projection. 36, caries pulpae proxima, primary caries.
Carious lesion D0 on approximal surfaces of 36.
11
Caries in dentine - Caries pulpae proxima
B-W projection. 75 caries pulpae proxima, caries sec.
74, 64 destructed by caries, persisting roots of the teeth surrounded
by expressed radiolucency visible also in the interradicular space,
susp. ostitis.
12
Commentary
The case can be diagnosed as
early childhood caries, so
called ECC.
Notice the beginning of root
resorption of lower primary
molars.
Caries in dentine - Caries ad pulpam penetrants
OPG, primary dentition. Child, 5 years. Marked teeth destruction in
the lower jaw. Caries ad pulpam penetrants in: 85, 84, 74, 75.
Dental caries penetrating into the dental pulp. Extensive carious
defects also in the upper jaw, because of teeth overlapping the
distinct diagnosis in individual teeth is not possible.
B-W projection, child, 9 years. 85, Caries ad pulpam penetrants
mesially, mild radiolucency of bone in bifurcation, signalizing
beginning of periodontitis ( ).
Total destruction of teeth 54, 84.
13
Commentary
Assess condition of
remaining teeth both in
upper and lower jaws.
Determine the
developmental stage of 46,
36.
Commentary
Describe morphology of 34.
Caries in dentine - Caries ad pulpam penetrants
OPG, mixed dentition, child, 5 years. Caries ad pulpam penetrants 85,
75 – distinct radiolucency extending from mesial dental pulp horns to
the dental pulp cavity. ( ).
74 – interradicular radiolucency suggesting ostitis.
BW projection, child, 11 years, 36. Extensive radiolucency in the
dental pulp cavity, neither its ceiling nor the floor can be defined
distinctly. Caries penetrates inside, till to the root canal orifice.
Distinct manifestation of defensive dental pulp reaction, radioopacity
in the mesial root canal – dental pulp obliteration ( ).
14
Commentary
Buds of 45,44 a 34, 35 are
not visible yet,
mineralization of their
crowns will start later. Buds
of all first permanent molars
are present, their crowns are
formed, they mineralize
gradually.
Study stimulation
Detect all radiolucent areas
in the present teeth.
Compare dentine thickness
and size of dental pulp cavity
Repeat: development and
eruption of primary and
permanent teeth.
Commentary
Cause of the interradicular
radiolucency in the 64 area is
a disease of the dental pulp
(necrosis/gangrene) because
of untreated dental caries
(64).
Study stimulation
Assess the root development
of 64 (M root), evaluate the
thickness of the dentinal wall
in all the present teeth and
evaluate radiolucency in the
crown of 62. Compare with
the image in OPG.
Primary dentition
OPG. Child, 2 and half a year. Primary carious dentition. Second
primary molars are numbered. (FDI system). All primary molars
display areas with mild radiolucency, susp. caries. Changes in the
crown shape of 61 indicate presence of caries. Remaining upper
incisors have irregular radiolucency in the crown, susp. caries.
Periapical projection, the same case as on the previous OPG.
64-distinct radiolucency in the interradicular space. Mesiobuccal
root-M, distobuccal root-D, palatal root-P. Presence of the fourth
root cannot be excluded. ( ) Radiolucency in the occlusal part of
the crown ( ), caries does not penetrate inside the dental pulp
cavity.
55 65
75
85
M
D
P
15
Commentary
Considering the caries
severity there is a danger of
loss of points of contact in
molar region and as a result
mesial shift of primary
molars. The result of the
situation may be premature
loss of space for permanent
successors and the crowding
(ectopic eruption).
Study stimulation
Calculate dmft and dmfs
index. Observe the
arrangement of buds of
permanent teeth in the
frontal region – repeat
development and eruption
of permanent teeth.
Primary dentition
OPG. Child, 6 years. Primary, carious dentition, example of ECC. Buds
of permanent teeth are present, including the second molars.
Presence of the third molars cannot be at that age confirmed.
Permanent molars are in a different stage of crown/root
development (36, 46). Primary incisors in the upper and lower jaws
exhibit signs of root resorption, which is in lower central incisors
advanced. First signs of root resorption can be observed in lower
primary molars, in the upper jaw the situation is not well distinct
(overlapping teeth).
16
Commentary
Caries pulpae proxima/ad
pulpam penetrans affecting
all primary molars. Mild
interradicular radiolucency
suggesting penetration
infection into that region is
visible (). Root resorption
of lower primary molars has
already started. Exact
diagnosis in individual upper
primary teeth cannot be
determined.
Study motivation
Describe possible way of
infection penetration from
the dental pulp cavity into
the interradicular space.
Repeat morphology of
molars. Can we use root
canal therapy (root canal
filling) in the case presented
on the OPG?
Early childhood caries (ECC)
OPG. Age of the child: 5 years. Destruction of primary dentition.
Radiolucency of different extent can be detected in all teeth except
for frontal lower teeth. Owing to the radioopacity (summation
effect) in the midline exact caries detection in this area is not
possible. ( -interradicular radiolucency 85)
17
Commentary
Surgical-conservative
treatment followed by space
maintainers will be
recommended. In favourable
situation prefabricated
crowns on second primary
molars with corresponding
space maintainers can be
used (teeth are vital or
treated by coronal
pulpotomy).
Study stimulation
Assess dmft and dmfs.
Early childhood caries (ECC)
OPG. Age of the child: 3 and a half a year. Destruction of primary
dentition. Radiolucency od different extent affecting all the teeth
except for lower frontal teeth. Radix of 54 and loss of space for 15 can
be detected in the 54 area. Tooth 84 is separated by caries into two
parts ( ), distinct radiolucency in the interradicular area, susp.
ostitis. The same picture can be observed in 74 area ( ).
Buds of molars 17,16,26,27, 36, 37, 46, 47 can be detected.
18
Commentary
Surgical and conservative
treatment followed by
prosthetic rehabilitation is
suggested (suitable space
maintainers - removable).
Study stimulation
Suggest suitable prophylactic
measures considering
erupting permanent teeth
above all the molars.
Early childhood caries (ECC)
OPG. Age of the child: six and half a year. Mixed dentition,
permanent upper central incisors, and lateral lower incisors before
eruption. Lower permanent central incisors erupting, permanent first
molars before eruption.
Primary dentition is destructed by dental caries.
54 extracted
75, 74 only radices.
85, 84 caries ad pulpam penetrans, interradicular radiolucency ( ),
susp. ostitis.
19
Commentary
ECC is a dangerous state
because of easy transfer of
cariogenic microflora from
primary to permanent
dentition.
Study motivation
Assess the caries risk for
permanent dentition
(transfer of microbes) and
suggest appropriate
measures to stop transfer of
microbes and to prevent
caries spreading. Suggest the
suitable therapy of affected
teeth.
Early childhood caries (ECC)
OPG. Age of the child: 7 years. Erupted both lower first permanent
molars, upper first permanent molars erupting, central permanent
incisors erupted both in the upper and lower jaw.
Carious destruction of primary molars, their roots display different
stages of resorption
Interradicular radiolucency in teeth 54, 75, 74 ( ),
85 extracted, 46 inclined mesially.
20
Commentary
Lack of space for premolars
can develop not only
because of premature
extraction of primary molars
but also because of loss of
points of contact in molar
region in case of approximal
caries.
Study motivation
Repeat time of permanent
teeth eruption.
Premature loss of primary molars
OPG. Age of the child: 9 years. Mixed dentition. Carious destruction
of all upper primary molars which are before elimination, 53 is
destructed by caries.
Lack of space for 23.
Fragment of 63, shift of 64 into the gap mesially.
Permanent incisors 12,11, 21, 22 are affected by caries circularly.
22 caries reaching into the pulp proximity ( ).
Primary molars in the lower jaw are extracted (missing).
Teeth 73 and 83 are caries affected (D4).
Lower primary molars were prematurely extracted, mesial shift of 46,
36 into the gap followed the extraction. Consequence of the situation
will be lack of space for premolars in future. Crowding can be
expected.
21
Study motivation
Repeat time of permanent
teeth eruption.
Premature loss of primary molars
OPG. Age of the child: 8 years and 9 months. Mixed dentition,
persisting primary molars severely destructed,
55, 85, 84, 74, 75 extracted prematurely. Loss of space for premolars
and mesial shift of molars is obvious.
22
Commentary
All first permanent molars
incline mesially.
Study stimulation
Assess the state of dentition
and suggest the possibilities
of treatment.
Premature loss of primary molars
OPG. Age of the child: 9 years. Mixed dentition. Remaining primary
teeth are caries affected as well as all first permanent molars.
16 car. sec.
26 car. media (D3),
36 car. pulpae prox. (D4)
46 car. ad pulpam penetrants. Crowding in permanent dentition can
be expected.
23
Commentary
Lack of space for 15, 25, 35,
45, ectopic eruption or tooth
retention can be expected.
Premature loss of primary molars
OPG. Age of the child: 10 years. Permanent dentition with premature
loss of primary molars, consequence of ECC.
Fragment of 85 in 45 area.
Caries in upper incisors ( ).
Crowding in premolar area in all quadrants.
Carious destruction of 46 crown.
Root separation by caries process in 46.
Interradicular and periapical radiolucency in 46, susp. apical
periodontitis/ostitis.
24
Commentary
Removable space
maintainers in the upper and
lower jaws are indicated.
Study motivation
Assess state of development
of individual permanent
teeth (7 stages). Describe
step by step procedures
which are performed both in
surgery and laboratory when
making the removable space
maintainer
Premature loss of primary molars
OPG. Age of the child: 5 years. Extreme situation, no primary tooth is
preserved (all teeth are missing) all primary teeth had to be
extracted because of extreme carious destruction. Buds of all
permanent teeth can be seen on OPG, except for the third molars,
which cannot be, at this age, visible yet.
25
Commentary
Assessment of root
resorption in primary teeth is
important for treatment
planning and suitable
therapy. Evaluate the
relationship between roots
of primary teeth and crowns
(peri coronal sac) of
permanent teeth.
Study motivation
Determine the suitable
therapy in the following
diagnosis: 85, 84 chronic
periodontitis, 74 ostitis, 75
chronic ulcerous pulpitis.
Course of root resorption in primary molars
OPG. Age of the child: 5 and half a year. Caries affected primary
dentition (ECC). Stage of root resorption in primary frontal teeth in
upper and lower jaw cannot be distinctly determined because of
teeth overlapping and radioopacity in frontal region (summation
effect in OPG technique).
Stage of root resorption can be determined in upper molars. Cusps
of premolars are in close vicinity to trifurcation of all primary molars
( ). Root resorption of lower molars is also in progress, buds of
premolars resorb not only the apical part of the root but also the
root surface from the interradicular space ( ).
26
Commentary
Primary molars should be
preserved if possible, to
maintain the sufficient space
for premolars. Notice the
relationship between roots
of primary molars and
crowns (pericoronal sac) of
permanent teeth.
Study motivation
Suggest suitable endodontic
treatment in case of
following diagnosis. 85
partial pulpitis, 75 dental
pulp hyperaemia in case of
dental pulp exposure in
decayed dentine area.
Course of root resorption in primary molars
OPG. Age of the child: 10 years. Mixed dentition. Teeth 55, 65
before shedding.
Roots of the 85 ( ) and 75 ( ) display almost intact length
on the x-ray, however, their resorption is very progressed on the
surface turned into the interradicular space. Roots are extremely
thinned, and their resorption is reaching into the dental pulp cavity.
27
Commentary
Would you indicate
extraction of 74? If yes, why?
Study stimulation
Suggest the therapy suitable
for 75 and explain how to
maintain the space after
extraction of 74.
Course of root resorption in primary molars
B-W projection. Age of the child: 9 years. Mixed dentition.
Radiolucency in dentine 75 distally, under the filling, reaching into
the dental pulp vicinity ( ). Bud of 35 in proximity of 75
bifurcation, beginning of root resorption can be seen mesially ( ).
Tooth 74 destructed by caries, pronounced radiolucency in root area,
susp. ostitis.
28
Commentary
Carious, untreated primary
dentition. Assess the relation
between roots of primary
molars and crowns of
premolars (pericoronal sac).
Study stimulation
Suggest suitable filling
therapy, possible endodontic
treatment of 85, 84 in
following diagnosis: partial
pulpitis, total pulpitis, dental
pulp necrosis.
Course of root resorption in primary molars
OPG. Age of the child: 4 years. Primary dentition. Roots of primary
teeth are in the rest stage at this age. The teeth finished their
development and resorption has not started yet. Buds of permanent
teeth are at a distance so that they cannot participate on the
resorption yet. Situation in the upper jaw is, however, indistinct
because of teeth overlapping.
29
Commentary
Diastema between 11, 21,
lack of space for 13, 23 can
be expected.
Study motivation
Suggest suitable therapy in
case of resorptive pulpitis in
84. Can it be expected in this
case?
Course of root resorption in primary molars
OPG. Age of the child: 9 years. Mixed dentition. Primary teeth shortly
before shedding, intact, roots of primary teeth are under progressed
resorption. Notice the relationship between roots of primary teeth
and buds of permanent teeth (pericoronal sac).
30
Commentary
Radiopaque strands
stretching towards 47, 37 are
artefacts due to the wrong xray
technique – earrings
were not removed on taking
x-ray.
Study stimulation
Suggest suitable therapy for
secondary caries – car. pulp.
proxima affecting 75
including possible
complications.
Course of root resorption in primary molars
OPG. Age of the child: 10 years. Mixed, treated dentition.
75 susp.car. sec.
Primary molars in a different stage of root resorption shortly before
shedding, except for 53. Lack of space for the permanent tooth in
the area 23.
Roots of 85 and 75 are long, resorption is in progress from the
interradicular space. Their continuity is almost interrupted by
resorption ( ).
31
Commentary
The presented patient will be
followed during resorption
of roots of 85, 75 and during
eruption of permanent teeth
including classification of
root developmental stages in
developing permanent
dentition.
Study stimulation
Repeat the characteristics of
teeth with developing roots
(open apices).
Assess stage of root
resorption in 85, 65, 74.
Course of root resorption in primary molars
Age of the child: 8 years
OPG.
Mixed dentition.
Root resorption:
Beginning root resorption in the apical part of 85, bud of 45 is
approaching to the interradicular space of 85.
Similar situation in the apical part of 75.
Permanent dentition, root development:
1. stage of root development can be observed on the teeth: 22 and
44,
2. stage of root development: 46, 36,
3. stage of root development: beginning 21, more advanced 32, 42,
31, root is slowly closed 41.
32
Commentary
Developmental stages are
mentioned only in quite
distinct and representative
cases.
Course of root resorption in primary molars
Age of the child: 9 years
OPG.
Root resorption in primary teeth:
All primary teeth in the upper jaw have already been replaced by
permanent teeth.
In the lower jaw the root resorption of 85, 75 is in progress, crowns
of premolars occupy the whole interradicular space, their cusps are
approaching to bifurcation. Marked resorption of root walls turned
towards to buds of premolars ( ), noticeable attenuation of the
root wall, resorption is opening the dental pulp cavity. The length of
roots seems to remain unchanged.
Permanent teeth:
2. developmental stage: 15, 23, 34.
3. developmental stage: 36, 44, 46.
33
Commentary
Bilaterally well-developed
recessus of maxillary sinus
(R).
Study stimulation
Assess the relation between
maxillary sinus and roots of
permanent teeth. Determine
to which of them.
Course of root resorption in primary molars
Age of the child: 10 years
OPG.
Root resorption: 85 in comparison with the previous x-ray the
situation has not progressed and remains unchanged. Penetration
into the root canal is obvious ( ), the root length remains the
same, roots embrace the crown of the 45.
Resorption of 75 advanced substantially, the tooth is before
elimination, roots, even though practically separated, persist in the
bud neighbourhood ( ).
Permanent teeth:
1. stage of development 37 ( ),
3. stage of development 15 (between 2-3), 23, 25, 34, .
First permanent molars finished the root development.
R
R
34
Commentary
Caries affecting the 46 () radiolucency,
as well as on
the 85.
Study stimulation
Trace at which age the caries
could be diagnosed and
suggest the suitable therapy
at those time. Which
therapy will be suitable at
the present time?
Determine the cause of
caries development on the
mesial surface of 46. Identify
remaining carious lesions
and suggest their therapy.
Find out the anomaly
present in this case.
Course of root resorption in primary molars
Age of the child: 12 years
OPG.
Resorption of roots: 85 in the terminal stage, the tooth before
elimination. Both roots, however, persist in the apical/middle part
( ).
Permanent teeth:
2. stage of development: 37, 35, 47 (between 1. - 2.),
3. stage of development: 15, 25, 34. Remaining permanent teeth
finished the root development.
All 3. molars (buds) are present.
35
Evaluation of root developmental stage
On treatment the teeth with not fully developed roots, mainly in
permanent dentition, the assessment of the stage of root
development is decisive in the choice of the suitable therapy. Seven
developmental stages can be recognised, for the clinical treatment,
however, only last four stages of them are of clinical importance. We
can distinguish stages: 1, 2, 3 and 4.
Stages of root development - characteristics
I. stage of development: the root is shorter than the crown,
maximally of the same length (1:1). Dentine layer is very thin, dental
pulp cavity is large, dentinal walls are divergent apically and the
foramen apical is very large (open apex) – shape of the mesenchymal
papilla..
II. stage of development: the root is longer than the crown, dental
pulp is large, dentinal walls of the root are divergent apically,
foramen apical is large (open), dentine layer is very thin
III. stage of development: the root reached almost its expected
length, dentine is thicker than in previous stages, dentinal walls are
parallel in the apical part, dentine layer is thin, dental pulp cavity is
large, the pulpal horns are high.
IV. stage of development: the root has reached the expected length
(2:1), foramen apical is closed (physiological constriction), dentine is
thicker, but the dental pulp cavity remains large, the horns remain
high.
36
Evaluation of root developmental stage
Tooth 11, end of the 1. developmental stage.
Tooth 21 beginning of the 2. developmental stage.
All four upper incisors are in the 2. developmental stage
Teeth 11 and 12 are in more advanced phase than 21 and 22
37
Evaluation of root developmental stage
Tooth 12 is in the 1. developmental stage.
11 and 22 are in the 2. developmental stage, but they differ slightly in
the length of the root in thickness of dentine and size of the apical
papilla.
Tooth 21 is missing because of avulsion.
Tooth 11 in the 3. developmental stage (crown fracture).
Tooth 12 is in the 2. developmental stage. Periapical radiolucency
and periodontal space enlargement in the region 12 and 11 is a
consequence of vitality loss after the injury and arising apical
periodontitis.
38
Evaluation of root developmental stage
Central incisors (11 a 21) are in the 3. developmental stage, 12 in the
2. stage, 22 inclines palatally, stage of the development cannot be
precisely determined.
All four permanent incisors are in the 4. developmental stage, 11 is
filled to the apex of the root.
39
Commentary
Transverse fracture of the root
with mild fragment dislocation.
Evaluation of root developmental stage
Teeth 11 and 21 are almost in the 4. developmental stage, even
though apical foramen does not display distinct wall convergency.
21 in the 4. developmental stage, 22 almost in the 3. stage.
40
Commentary
Strongly radiopaque strands
are artefacts – shades of
earrings.
Study motivation
Assess dmft index.
Determine type of dental
caries as to its depth in the
dentine and determine the
teeth with inflammatory
changes of periodontium –
radiolucency in the
interradicular space.
Evaluation of root developmental stage
OPG. Age of the child: 8 years.
1. developmental stage: 11, 21, 36, 31, 41, 46
41
Commentary
Determination of
developmental stages in
teeth of the upper jaw is
difficult because of
summation effect.
Study stimulation
Compare radiolucency in the
periapical region and its
character in teeth: 41 versus
31 and versus 47, 37.
Describe the differences and
state the diagnosis in the
case of 41.
Evaluation of root developmental stage
OPG. Age of the child: 10 and half a year.
1. developmental stage: 47, 37
2. developmental stage: 13, 23, 45, 44, 33, 34, 35, may be also: 43,
x-ray is not quite distinct in the area.
3. developmental stage: 22, 42, 32
4. developmental stage: 41, 31
42
Commentary
Determination of
developmental stages in
teeth of the upper jaw is
difficult because of
summation effect.
(subtraction effect).
Study stimulation
Determine pathological
process in the periapical
periodontium and adjacent
bone of the tooth.
Evaluation of root developmental stage
OPG. Age of the child: 10 years.
1.developmental stage: 47, 37
2.developmental stage: 44, 34
3.developmental stage: 33
4.developmental stage: 42, 32
43
Commentary
All buds of third permanent
molars are present.
Study stimulation
Assess the diagnosis of 26
and suggest suitable therapy.
Evaluation of root developmental stage
OPG. Age of the child: 13 years.
Developmental stages in the upper jaw cannot be determined on the
OPG because of summation effect.
1. developmental stage: 37 (on the borderline).
2. developmental stage: 45, 35
3. developmental stage: 44
4. developmental stage: 42, 41, 31, 32
44
Commentary
Duration of the second
developmental stage is quite
long; root is growing into the
length gradually. That is why
the signs of the
developmental stage are
different, especially the
length of the root, but also
the other criteria.
Study stimulation
Compare periapical
radiolucency in teeth 47
versus 46, and 37 versus 36.
Describe differences and
state the diagnosis and
suggest suitable therapy.
Also suggest the therapy in
the molar region in the
upper jaw.
Evaluation of root developmental stage
OPG. Age of the child: 11 years.
Developmental stages in the upper jaw cannot be exactly
determined.
1. developmental stage: 47, 37
2. developmental stage: 45, 44, 43, 33, 34,
3. developmental stage: 46, 36
4. developmental stage: 42, 41, 31, 32