Template Evaluasi Mutu
- Elemen: 13.28
- Objek tercakup dan terletak di tengah: ya
- kontras : radiopak dan radiolusen terlihat jelas/ dapat dibedakan/ tidak terlihat Detail : struktur anatomi terlihat jelas/tidak terlihat jelas Ketajaman : outline objek terlihat jelas/tidak terlihat jelas/
- Distorsi horizontal(Daerah interdental terlihat jelas / tidak terlihat jelas) :minimal/maksimal Distorsi vertikal(Cusp bukal dan palatal / lingual terletak sebidang / tidak sebidang) :minimal/ maksimal
- Kesalahan: tidak ada yellowish brown discoloration (rinsing kurang bersih), black spot (kontaminasi developer sebelum processing), white spot (kontaminasi fixer), developer cut off, fixer cut off, cone cut (round/ rectangular)
- Kualitas: baik(tidak Ada kesalahan sama sekali)/ dapat diterima (Ada kesalahan besar atau kecil tapi tidak mengenai Objek)/ tidak dapat diterima (kesalahan biarpun kecil tetapi mengenai objek
- Radiograf: dapat diinterpretasi (Kualitas baik/dapat diterima) / tidak dapat diinterpretasi ( Kualitas tidak dapat diterima)
Template Lembar Interpretasi PSA
1. Mahkota: Normal / terjadi perubahan
  1. Elemen:
  - perubahan: terdapat radiolusensi pada oklusal mahkota sebelah (distal/mesial), dari enamel sampai (dentin, ruang pulpa, ****tanduk pulpa)
  - bahan tambalan: terdapat radioopak pada oklusal mahkota dari (enamel) sampai (ruang pulpa) yang menyerupai bahan tambal
2. Akar
  - jumlah akar 2(RB)/3(RA), pembengkokan dan kearah mana: lurus (Delacerasi) akar ke (distal)
  - Normal/ perubahan: ~~~~terdapat radiolusensi pada akar sebelah (distal/mesial), dari enamel sampai (dentin, ruang pulpa, tanduk pulpa)
  - bahan tambalan: terdapat radioopak sepanjang saluran akar yang menyerupai bahan pengisi saluran akar
3. Membran Periodontal
  - Normal/ pelebaran/ hilang/ terputus/ menyempit/ tidak terlihat pada membrane periodontal
  - (1/3 apikal) akar bagian (mesial atau distal)
  - Dalam batas normal/ tak ada kelainan : tidak ada bayangan radiousent/pelebaran sepanjang akar
  - Melebar ( membran yang mengalami peradangan) ditunjukkan dengan garis radiolusent sepanjang akar/ sebagian
  - Menghilang: ditunjukkan tiadak adanya membran digantikan lesi yang jauh lebih besar
4. Lamina Dura
  - Normal/ pelebaran/ hilang/ terputus/ menyempit/ tidak terlihat
  - Dalam batas normal: tampak garis radiopak tipis/ tidak tampak garis radiolusent disepanjang tulang alveolar yang mengelingingi gigi
  - Terputus-putus: terdapat bayangan radioopak di sepanjang tulang (keselutuhan / sebagian)
  - Menebal: bayangan radioopak menebal terlihat jelas disepanjang tulang alveolar mesial
  - Menghilang: lamina dura tertutup oleh lesi/ lainnya yang berukuran lebih besar
5. Alveolar Crest
  - Normal/ penurunan tulang alveolar secara (vertikal/ horizontal) sebesar (...)mm
6. Furkasi
  - Normal(tidak terlihat radiolusen)/ terdapat radiolusen pada daerah furkasi
7. Periapikal
Template Lembar Interpretasi Bitewing
- Gigi Geligi (5,6,7
  - Karies: terdapat radiolusensi pada oklusal mahkota sebelah (distal/mesial), dari enamel sampai (dentin, ruang pulpa, tanduk pulpa) gigi (...)
  - Impaksi: tidak ada/ada (gigi didalam ginggiva)
  - Restorasi : terdapat radioopak pada oklusal mahkota dari (enamel) sampai (dentin) yang menyerupai bahan tambal/ overhanging gigi (...)
  - Kelainan gigi: (jumlah/struktur/ukuran/bentuk/posisi)
- Tulang alveolar
  - Penurunan Tulang : Normal/ penurunan tulang alveolar secara (vertikal/ horizontal) sebesar (...)mm di gigi (...)
- Lesi (Lesi/ tidak terdapat Lesi)
  - Lokasi: pulpa gigi coronal/ radicular, gigi (...)
  - Bentuk: bulat sedikit oval, (multilokuler, unilokuler)
  - Ukuran: sekitar 3mm (< 5 mm: Granuloma ) (>5mm: Kista) mm
  - Tepi: diffure irregular (pulp stone), berbatas jelas dan tegas (Resorpsi internal), berbatas tidak jelas dan tidak tegas (Resorpsi external)
  - Efek jaringan sekitar: tidak ada/ mendesak jaringan pulpa
  - Radiodiagnosis degenerasi kalsifikasi (pulp stone), internal resorption, external resorption
- Suspect Radiodiagnosis:
  - (Karies (Sekunder, Oklusal, Proksimal) :restorasi aproksimal overhanging, post perawatan saluran akar, pulp capping
  - Penurunan Tulang
  - Lesi: (Pulp stone, Resorpsi Internal/External)
https://lh6.googleusercontent.com/bLqdVau2BSlFEmO6cpoOSu-ccUE8cR_Pkyo-3vOvYdliMjllE2w87CC5zAwjNPizNcQC88uDKOtsKr6Xe9w-dIdpAc8bYwBMsdip3UzbVDeuHLdXolCGJhDrqgbVvBs3_Ktrl_sS
Template Lembar Interpretasi Oklusal
- Gigi Geligi (5,6,7
  - Karies: terdapat radiolusensi pada oklusal mahkota sebelah (distal/mesial), dari enamel sampai (dentin, ruang pulpa, tanduk pulpa) gigi (...) tidak ada
  - Impaksi: tidak ada/ada (gigi didalam ginggiva)
  - Restorasi : terdapat radioopak pada oklusal mahkota dari (enamel) sampai (dentin) yang menyerupai bahan tambal/ overhanging gigi (...)tidak ada
  - Kelainan gigi: (jumlah/struktur/ukuran/bentuk/posisi)
- Lesi (Lesi/ tidak terdapat Lesi)
  - Lokasi: pulpa gigi coronal/ radicular, gigi (...)/ duktus nasopalatine (RA M). buccolingual, mandibular tori, lingual di area gigi 34,35,36
  - Bentuk: bulat sedikit oval, memanjang (unilokuler→ kista,tumor, granuloma, abses), (multilokuler→ameloblastoma)
  - Ukuran: sekitar 3mm (< 5 mm: Granuloma ) (>5mm: Kista) mm, 5cm Kista Residual radicular (2-3cm), Kista lateral periodontal
  - Tepi: diffure **irregular(**bergelombang) (pulp stone), berbatas jelas(halus) dan tegas (Resorpsi internal, sialolithiasis), berbatas tidak jelas dan tidak tegas (Resorpsi external)
  - Efek jaringan sekitar: tidak ada / mendesak jaringan (pulpa)
  - Radiodiagnosis degenerasi kalsifikasi (pulp stone), internal resorption, external resorption, salivary stone, ameloblastoma, abses,granuloma, kista, abses, sialolithiasis
- Suspect Radiodiagnosis:
  - (Karies (Sekunder, Oklusal, Proksimal) :restorasi overhanging, post perawatan saluran akar, pulp capping
  - Penurunan Tulang
  - (Pulp stone, Resorpsi Internal/External,salivary stone, ameloblastoma, abses,granuloma, kista, abses)sialolithiasis
Kelainan gigi (DBN/N)
- Abnormalities in number
- Abnormalities in structure
- Abnormalities in size
- Abnormalities in shape
- Anomalies affecting whole teeth
- Anomalies affecting the crowns
- Anomalies affecting roots and/or pulp canals
- Odontomes
- Abnormalities in position
Kelainan gigi (DBN/N)
- Abnormalities in number
  - Missing teeth (anodontia)
    
    ● Localized anodontia or hypodontia – usually
    
    third molars, upper lateral incisors or second
    
    premolars
    
    ● Anodontia or hypodontia associated with sys
    
    temic disease – e.g. Down’s syndrome, ectoder
    
    mal dysplasia.
  - Additional teeth (hyperdontia)
    
    ● Localized hyperdontia
    
    – Supernumerary teeth
    
    – Supplemental teeth
    
    ● Hyperdontia
- Abnormalities in structure
  - Genetic defects
    - Amelogenesis imperfecta
      
      – Hypoplastic type
      
      – Hypocalcified type
      
      – Hypomature type
    ● Dentinogenesis imperfecta
    
    ● Shell teeth
    
    ● Regional odontodysplasia (ghost teeth)
    
    ● Dentinal dysplasia (rootless teeth).
  - Acquired defects
    
    ● Turner teeth – enamel defects caused by infec
    
    tion from overlying deciduous predecessor
    
    ● Congenital syphilis – enamel hypoplastic and
    
    altered in shape (see below)
    
    ● Severe childhood fevers, e.g. measles – linear
    
    enamel defects
    
    ● Fluorosis – discoloration or pitting of the
    
    enamel
    
    ● Discoloration – e.g. tetracycline staining.
- Abnormalities in size
  
  ● Macrodontia – large teeth
  
  ● Microdontia – small teeth, including rudimen
  
  tary teeth.
- Abnormalities in shape
- Anomalies affecting whole teeth
  
  ● Fusion – two teeth joined together from the
  
  fusion of adjacent tooth germs
  
  ● Gemination – two teeth joined together but
  
  arising from a single tooth germ
  
  ● Concrescence – two teeth joined together by
  
  cementum
  
  ● Dens-in-dente (invaginated odontome) –
  
  infolding of the outer surface of a tooth into the
  
  interior usually in the cingulum pit region of
  
  maxillary lateral incisors.
- Anomalies affecting the crowns
  
  ● Extra cusps
  
  ● Congenital syphilis
  
  – Hutchinson’s incisors – crowns small, screw
  
  driver or barrel-shaped, and often notched
  
  – Moon’s/mulberry molars – dome-shaped or
  
  modular
  
  ● Tapering pointed incisors – ectodermal
  
  dysplasia.
- Anomalies affecting roots and/or pulp canals
  
  ● Number – additional roots, e.g. two-rooted
  
  incisors, three-rooted premolars or four-rooted
  
  molars
  
  ● Morphology, including:
  
  – Bifid roots
  
  – Excessively curved roots
  
  – Dilaceration – sharp bend in the root
  
  direction
  
  – Taurodontism – short, stumpy roots and longitudinally enlarged pulp chambers
  
  ● Pulp stones – localized or associated with spe
  
  cific syndromes, e.g. Ehlers–Danlos (floppy
  
  joint syndrome)
  
  ● Cementoma (see odontogenic tumours in
  
  Ch. 27).
- Odontomes
  
  ● Compound odontome – made up of one or
  
  more small tooth-like denticles (see Ch. 27)
  
  ● Complex odontome – complex mass of disor
  
  ganized dental tissue (see Ch. 27)
  
  ● Enameloma/enamel pearl.
- Abnormalities in position
  
  Delayed eruption
  
  ● Local causes
  
  – Loss of space
  
  – Abnormal crypt position – especially 8 8/
  
  and 3 3/
  
  – Overcrowding
  
  – Additional teeth
  
  – Retention of deciduous predecessor
  
  – Dentigerous and eruption cysts
  
  ● Systemic causes
  
  – Metabolic diseases, e.g. cretinism and rickets
  
  – Developmental disturbances, e.g. cleidocra
  
  nial dysplasia
  
  – Hereditary conditions, e.g. gingival fibroma
  
  tosis and cherubism
- Mesioden
Template Lembar Interpretasi Oklusal Penjelasan contoh
- Gigi Geligi (5,6,7
  - Karies: terdapat radiolusensi pada oklusal mahkota sebelah (distal/mesial), dari enamel sampai (dentin, ruang pulpa, tanduk pulpa) gigi (...)
  - Impaksi: tidak ada/ada (gigi didalam ginggiva)
  - Restorasi : terdapat radioopak pada oklusal mahkota dari (enamel) sampai (dentin) yang menyerupai bahan tambal/ overhanging gigi (...)
  - Kelainan gigi: (jumlah/struktur/ukuran/bentuk/posisi)
- Tulang alveolar
  - Penurunan Tulang : Normal/ penurunan tulang alveolar secara (vertikal/ horizontal) sebesar (...)mm di gigi (...)
- Lesi (Lesi/ tidak terdapat Lesi)
  - Lokasi: pulpa gigi coronal/ radicular, gigi (...)/ duktus nasopalatine (RA M). buccolingual, mandibular tori
  - Bentuk: bulat sedikit oval (unilokuler→ kista,tumor, granuloma, abses), (multilokuler→ameloblastoma)
  - Ukuran: sekitar 3mm (< 5 mm: Granuloma ) (>5mm: Kista) mm
  - Tepi: diffure irregular (pulp stone), berbatas jelas dan tegas (Resorpsi internal), berbatas tidak jelas dan tidak tegas (Resorpsi external)
  - Efek jaringan sekitar: tidak ada/ mendesak jaringan (ginggiva, pulpa)
  - Radiodiagnosis degenerasi kalsifikasi (pulp stone), internal resorption, external resorption, salivary stone, ameloblastoma, abses,granuloma, kista, abses
- Suspect Radiodiagnosis:
  - (Karies (Sekunder, Oklusal, Proksimal) :restorasi overhanging, post perawatan saluran akar, pulp capping
  - Penurunan Tulang
  - Lesi: (Pulp stone, Resorpsi Internal/External,salivary stone, ameloblastoma, abses,granuloma, kista, abses)
Contoh Soal Bitewing
Contoh Soal Periapikal

Caries

Classification
- Proximal
- Occlusal
- Bukal, Lingual, Palatal
- Others
- Level Of Disease
Diagnosis and Detection
- Method
- Radiographic appearance of caries lesions
Other Radiographic Appearace
- Residual Caries
- Radiodensity of adhesive restoration
- Cervical burn out/ cervical translucency
Limitation of Radiographic Appearace

● Lesions of caries are usually larger clinically than they appear radiographically and very

early lesions are not evident at all.
- Technique variations in image-receptor and X-ray beam positions can affect considerably varying the horizontal tubehead angulation can make a lesion confined to enamel appear to have progressed into dentine
- Exposure factors can have a marked effect on the overall radiographic contrast affect the appearance or size of caries lesions on the film.
- Superimposition and a two-dimensional image (digital or film) mean that the following
Assesment of Restoration
- restoration
  - The type and radiodensity of the restorative material, e.g.
    
    – amalgam
    
    – cast metal
    
    – adhesive materials such as composite or glass ionomer (see earlier and Fig. 20.5)
  ● Overcontouring
  
  ● Overhanging ledges
  
  ● Undercontouring
  
  ● Negative or reverse ledges
  
  ● Presence of contact points
  
  ● Adaptation of the restorative material to the base of the cavity
  
  ● Marginal fit of cast restorations
  
  ● Presence or absence of a lining material
  
  ● Radiodensity of the lining material
- Underlying tooth
  
  ● Caries adjacent to restorations
  
  ● Residual caries (see earlier and Fig. 20.4)
  
  ● Radiopaque shadow of released tin and zinc ions (see earlier and Fig. 20.9)
  
  ● Size of the pulp chamber
  
  ● Internal resorption
  
  ● Presence of root-filling material in the pulp chamber
  
  ● Presence and position of pins or posts
Limitation of Radiographic Image
- Technique variations in X-ray tubehead posi tion may cause recurrent caries lesions to be obscured (see Fig. 20.14)
● Cervical burn-out shadows tend to be more obvious when their upper borders are demarcated by dense white restorations because of the increased contrast differences
- Superimposition and a two-dimensional image
what is the difference between external root resorption and root caries?

resorption occurs on surfaces still covered by bone or gingiva

Periapical Tissue

Normal Feature
- Permanenth Teeth
- Deciduous Teeth
- Developing
Normal
The effects of normal superimposed shadows
- Radiolucent shadows
- Radiopaque shadows
RADIOGRAPHIC APPEARANCES OF PERIAPICAL INFLAMMATORY CHANGES

Following pulpal necrosis, either an acute or chronic inflammatory response is initiated in the

apical tissues. The inflammatory response is identical to that set up elsewhere in the body fromother toxic stimuli, and exhibits the same signs and symptoms.
- Acute
  
  In the apical tissues, inflammatory exudate accumulates in the apical periodontal ligament space(swelling), setting up an acute apical periodontitis.
  
  The affected tooth becomes periostitic ortender to pressure (pain), and the patient avoids biting on the tooth (loss of function). Heat and redness are clinically undetectable. These signs are accompanied by destruction and resorption, often of the tooth root, and of the surrounding bone, as a periapical abscess develops, and radiographically a periapical radiolucent area becomes evident.
  - Cardinal signs of acute inflammation
    
    ● Swelling – tumor
    
    ● Redness – rubor
    
    ● Heat – calor
    
    ● Pain – dolor
    
    ● Loss of function – functio laesa
- Chronic
  
  These include the processes of destruction and healing which are going on simultaneously, as the body’s defence systems respond to, and try to confine, the spread of the infection.
  - In the apical tissues, a periapical granuloma forms at the apex and dense bone is laid down around the area of resorption. Radiographically, the apical radiolucent area becomes circumscribed and surrounded by dense sclerotic bone.
  - Occasionally, under these conditions of chronic inflammation, the epithelialcell rests of Malassez are stimulated to proliferat and form an inflammatory periapical radicular cyst (see Ch. 26) or there is an acute exacerbation producing another abscess (the so-called phoenix abscess).
  - The type and progress of the inflammatory response at the apex and the subsequent spread of apical infection is dependent on several factors relating to:
    
    ● The infecting organism including its virulence
    
    ● The body’s defence systems.
- Summary
Widening and

Periodontal Tissue (Alveolar Crest, Lamina Dura, Membran)

Health Periodontal Alveoalr Crest

The only reliable radiographic feature is the relationship between

the crestal bone margin and the cemento–enamel junction (CEJ). If this distance is within normal limits (2–3 mm) and there are no clinical signs of loss of attachment, then it can be said that there has been no periodontitis
- Radiographic Feature
  
  ● Thin, smooth, evenly corticated margins to the interdental crestal bone in the posterior regions.
  
  ● Thin, even, pointed margins to the interdental crestal bone in the anterior regions.
  
  ● Cortication at the top of the crest is not always evident, owing mainly to the small amount of
  
  bone between the teeth anteriorly.
  
  ● The interdental crestal bone is continuous with the lamina dura of the adjacent teeth. The junc tion of the two forms a sharp angle.
  
  ● Thin even width to the mesial and distal periodontal ligament spaces
- Note
  
  Important points to note
  
  ● Although these are the usual features of a
  
  healthy periodontium, they are not always
  
  evident.
  
  ● Their absence from radiographs does not neces
  
  sarily mean that periodontal disease is present.
  
  ● Failure to see these features may be due to:
  
  – Technique error
  
  – Overexposure
  
  – Normal anatomical variation in alveolar
  
  bone shape and density.
  
  ● Following successful treatment, the periodontal
  
  tissues may appear healthy clinically, but radio
  
  graphs may show evidence of earlier bone loss
  
  when the disease was active. Bone loss observed
  
  on radiographs is therefore not an indicator of
  
  the presence of inflammation.
- Image
Disease
- Classification
- ● Gingival diseases
- ● Periodontitis
- Abscesses of the periodontium
Limitation

● Superimposition and a two-dimensional image bringing about the following problems:

– It is difficult to differentiate between the

buccal and lingual crestal bone levels

– Only part of a complex bony defect is shown

– One wall of a bone defect may obscure the rest of the defect

– Dense tooth or restoration shadows may obscure buccal or lingual bone defects, and

buccal or lingual calculus deposits

– Bone resorption in the furcation area may be obscured by an overlying root or bone shadow.

● Information is provided only on the hard tissues of the periodontium, since the soft tissue gingival defects are not normally detectable.

● Bone loss is detectable only when sufficien calcified tissue has been resorbed to alter the
Pathological
Lamina Dura
- Loss vs Normal
- Menebal
Membran Periodontal Ligament
- normal
- destruction
- widening
match band

Ilusi optik berupa garis radiolusen karena perbedaan densitas/grayscale dari gigi, fulano, dan restore

→ perbedaan radioopaque dan radiolucent beda jauh → ada kesan gambar radiolucent karena retina→ bisa di seluruh perm oklusal gigi, proksimal
cervical burn out

Bentukan seperti pita radiolusen yang muncul pada cervical baik pada sisi mesial maupun distal gigi bagian CEJ

Terjadi karena sudut penyinaran horizontal yang kurang tepat dan adanya perbedaan kepadatan jaringan sehingga menyebabkan kurangnya penyerapan sinar X pada bagian yang tipis

→ perbedaan densitas emg karena radiografi→ pasti di cervical

Cervical burn-out can be explained by considering all the different parts of the tooth and supporting bone tissues that the same X-ray beam has to penetrate:
- explanation
  
  less tissue for the X-ray beam to pass through→no opaque shadow is cast of this area on the radiograph→ appears radiolucent, as if some cervical tooth tissue does not exist or that it has been apparently burnt-out.
- distinguished by
  
  ● It is located at the neck of the teeth, demarcated above by the enamel cap or restoration and below by the alveolar bone level ● It is triangular in shape, gradually becoming less apparent towards the centre of the tooth ● Usually all the teeth on the radiograph are affected, especially the smaller premolars.
- Image