Caries
While clinical evaluation plays a fundamental role in the diagnosis and the evaluation of the extension of the dental caries, it is clear that radiological examination, in a considerable percentage of cases, mainly plays a complementary role. Nevertheless
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Caries
Caries, or dental decay is a pathological destructive process which can affect all the components of the dental elements (enamel, dentine, cement), always in an irreversible way. It is caused by a disturbance in the homeostasis existing between the floral bacteria (streptococcus, lactobacillus, etc.) and the local and systemic immune defences. An increase in bacterial load or a reduction of the immune defences breaks this balance and determines the onset of caries. Caries is also furthered by the sugar fermentation activity performed by bacteria, with a consequent production of local hyperacidity. The latter has the effect of destroying the hydroxyapatite crystals and therefore the enamel integrity. In the relevant literature, numerous studies show that radiological evaluation significantly (about 30–50 %) increases detection of caries lesions, with respect to the clinical examination. While clinical evaluation plays a fundamental role in the diagnosis and in the evaluation of the extension of the caries lesion, it is clear that radiological examination, in a considerable percentage of cases, mainly plays a complementary role. All of the literature concerning this topic shows different classification systems of caries, both on clinical and radiological basis. Radiological categorisation of caries evaluates the effects on the enamel (whether in partial or full thickness), the dentine and eventually the pulp chamber. With regard to this, it must be noted that such classifications derive from the evaluations of the endoral radiological examination which, as is known, is characterised by a resolution power which is superior to the OPT one. As a consequence, the evaluation of caries through OPT suffers from some limitations, especially related to the quantification of damage. From a practical point of view however, in orthopantomographic examination it is sufficient to distinguish between the damage of the enamel and the dentine’s one and between the latter and a possible involvement of the pulp chamber. This last eventuality gives rise to ‘penetrating caries’ which, because of this contamination of the chamber, along with the pulp canal and its content, will result in a series of complications. I. Pandolfo, S. Mazziotti, Orthopantomography, DOI 10.1007/978-88-470-5289-5_4, © Springer-Verlag Italia 2013
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Caries
A further progression of the damage, followed by a much wider affection of the crown, will give rise to so-called destructive caries, obviously easily detectable on the clinical point of view. From the radiological point of view, caries, regardless of its evolutionary stage, presents itself as a radiolucent lesion which affects both the crown and the cementoenamel junction. Its morphology varies in relation to the projective conditions with which it is represented. Indeed, it seems evident that carious lesions captured in profile will be characterised by sharply defined outlines and by a semilunar morphology. Conversely, frontally hit lesions, though maintaining the sharpness of their outline
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