Overall Classification:
UNCLASSIFIED//REL TO NATO/ISAF
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Early, incipient
Moderate
Advanced and Extensive
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Occlusal, incisal
Proximal
Lingual, palatal
Facial
Cemental
Recurrent
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Caries immediately next to a restoration
Inadequate margins or excavation
Pulpal necrosis
Metallic restorations often hide
Clinical examination
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Therapeutic radiation
Xerostomia
Caries begins at cervical region
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Between CEJ and alveolar crest
Diffuse radiolucency
Ill-defined borders
Presence of the edge of root
Clinical evaluation
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Amount of bone present
Condition of alveolar crest
Bone loss in furcation areas
Width of periodontal ligament
Local factors: calculus, overhanging
restorations
Crown/root ratio
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No indication of morphology of bony defects
No indication of successful management
No indication of hard/soft tissue relationship,
i.e., depth of pockets
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1.0-1.5 mm apical to
cemento-enamel
junction
Parallel to line joining
the CEJ of adjoining
teeth
Smooth
Continuation of
lamina dura, has the
same radiopacity
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Localized erosion of crest of bone
Blunting of crest- anterior teeth
Loss of sharp angle between lamina dura and
crest
Widening of PDL near crest
Periodontitis radiograph
evaluation
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Calculus
Overhanging restorations
Poor restoration contours
Horizontal Bone Loss: Crest of bone
is parallel to CEJ line between
adjoining teeth. The remaining bone is
still horizontal but may be positioned
apically.
Vertical bone loss
Crest of remaining bone is not parallel
to the CEJ line between adjoining teeth
(displays an oblique angulation to the
CEJ line )
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Bone destruction
around apex of tooth,
mostly secondary to
pulp exposure due to
caries or trauma.
Bacterial invasion of
pulp produces toxic
metabolites which
escape to the
periapical bone
through apical foramen
and cause
inflammation.
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Periapical
granuloma:
Localized mass of
chronic granulation
tissue containing
PMN’s,
lymphocytes,
plasma cells.
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Radiographicall
y, widening of
PDL or variable
size of
periapical
radiolucency
may be present
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Periapical abscess:
When pus forms in
the area. It may
develop directly as
an acute process or
develop in a preexisting granuloma.
Radiographically,
appears identical to
granuloma.
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Can one differentiate between the two on the
basis of radiographs alone?
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A cyst is an epithelium lined cavity which is
filled with fluid or semi-solid material.
Radicular cyst is the ONLY cyst related to
non-vital pulp.
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Can you definitively differentiate between a
periapical granuloma, abscess or radicular
cyst on the basis of radiograph alone?
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Sclerosing osteitis (chronic sclerosing
osteomyelitis). Occasionally, the reaction to
periapical inflammation is predominantly
osteoblastic, i.e., more sclerotic bone is
formed (radiopaque mass).
Usually occurs in children or young adults
when the resistance is high.
Most common location is mandibular 1st
molar.
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How do you differentiate between
osteosclerosis and condensing osteitis?
In osteosclerosis, the pulp is vital. There are
no clinical signs or symptoms. No treatment
is necessary.
Sclerosing osteitis is secondary to pulp
exposure. Patient is symptomatic.
Endodontic treatment or extraction is
indicated.
Secondary to Trauma to the Tooth
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Widening of apical PDL or periapical
radiolucency ( associated with indication of
pulp exposure)
Discontinuity of lamina dura
Displacement of lamina dura
Sclerosing osteitis
Calcific degeneration (metamorphosis)
Radiographic indication of pulp exposure
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Also called Cementoma. Localized alteration
in periapical area. Osseous structure is
replaced by fibrous tissue, cementum-like
material, abnormal bone or combination of
these.
Pulp is vital. Patient is asymptomatic. There
are no clinical signs.
No treatment is required.
Mean age is 39 years.
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85% patients are females.
3 times more common in Africanamericans.
Most commonly seen in mandibular anterior
areas.
May be multiple.
May be bilateral.
Well-defined radiolucency, opacity or
mixed.
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Variation in healing process. Normally
surgical site fills with blood clot which
organizes and eventually mineralizes and
remodels like surrounding bone.
Occasionally, normal mineralization and
remodeling fails to occur.
Patient is asymptomatic and no treatment is
required.
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Smaller than
average
Most commonly
involved:
Maxillary 3rd molars
Maxillary laterals
(sometime called “peg”
laterals)
Maxillary premolars
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Tooth size larger than
average
Unknown cause
May involve a single tooth
or group of teeth
Detectable by clinical
examination
During development,
single tooth germ attempts to
divide into two.
 Usually results in
bifurcation of a part of
crown
 Unilateral or bilateral
 Normal complement of
 teeth is present
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During development, union
of two adjoining tooth
germs
Clinically, identical to
gemination, i.e, bifurcated
crown
One tooth is missing
Unilateral or bilateral
Primary or permanent
dentition
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Union of two teeth
either during
development or after
they are completely
formed
Joined with cementum
Radiographic diagnosis
can be difficult
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Unusual angulation of
roots
Cause is either trauma
to a developing tooth
or unknown
Diagnosed
radiographically
Surgical removal of
dilacerated teeth can
be difficult
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Invagination of a layer of
enamel and dentin into
pulp.
Creates a potential space
for entrapment of food
debris and bacteria.
Wide variation in size.
Clinically, either not
discernible or seen as a
prominent pit at the
cingulum.
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Frequently, caries, pulp
exposure and periapical
pathology develops
without any clinical
indication.
Most frequently (95%) in
maxillary lateral incisor.
Bilateral in half the
cases.
Prophylactic restoration
recommended.
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Due to outfolding of an
enamel organ
Usually on the occlusal
surface of a premolar
or a molar
The outgrowth is
covered with enamel,
dentin and contains
pulp
Detectable clinically
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Bifurcation of molar pulp chamber into
root canals displaced apically, resulting
in an extremely large pulp chamber and
short root canals. Usually in permanent
molars.
Most patients asymptomatic; does not
require treatment.
Frequently, bilateral.
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Local or systemic disturbances during
development of permanent teeth.
Examples: nutritional disturbances,
childhood infections, etc.
Usually affect permanent anterior teeth
and first molars bilaterally.
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Affects permanent
incisor or 1st molar
Affected incisor is
named Hutchinson’s
incisor; 1st molar is
named mulberry
molar
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Hypodontia: Few missing teeth
Oligodontia: More than half the
number missing in any dentition
(permanent or primary)
Anodontia: All teeth missing
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Frequency of
congenitally missing
permanent teeth, in
the following order:
3rd molars
Maxillary 2nd
premolars
Mandibular 2nd
premolars
Maxillary laterals
Mandibular canines
Other
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80-85% of all
supernumerary in
maxilla
Mesiodens. Midline of
maxilla. 85-90%
Paramolars. Buccal or
lingual to maxillary
molars
Distomolars (4th
molars, distodens).
Distal to maxillary 3rd
molars
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Attrition
Abrasion
Erosion
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Physiologic wearing
away
Incisal, occlusal and
interproximal
surfaces
Part of aging
process
Bruxism –
pathologic attrition
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Change in normal outline
Flat occlusal plane
Loss of mamelon
Pulp chamber, canal size
diminuish
Hypercementosis
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Non-physiologic
wearing away
Habits
Toothbrush trauma
Dental floss injury
Occupational hazards
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Radiolucent defects at
the cervical region
Well-defined semilunar
defects
Pulp chambers
sclerosed
In case of dental floss
injury, distal surfaces
more involved
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Chemical cause
No bacteria involved
Diet: Labial surfaces are
affected
Regurgitation: Lingual
surfaces are affected
Occupational hazards
 External
 Internal
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Pathological
Inflammation:
Trauma, Chronic
Apical Periodontitis
Infection
Cysts: OKC
Benign and
malignant
neoplasm
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Non pathological
Mechanical force:
orthodontic tooth
movement
Idiopathic
Impacted teeth
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Periapical Path
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Trauma
Trauma
 Idiopathic
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Coronal fracture
 Root fracture
 Alveolar fracture
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Overall Classification:
UNCLASSIFIED//REL TO NATO/ISAF