PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

The bitewing radiograph is the view of choice for interproximal caries detection, but it
does require a reasonable degree of patient co-operation. For patients unable to
tolerate intraoral films, the lateral oblique radiograph provides a useful alternative
(Fig. 3.24). This view has the added advantage of including the developing permanent
dentition.


Following the initial radiographic investigation of caries, a decision should be made
regarding the frequency of any future assessment. The interval will depend on the
patient's individual caries risk (see Section 3.6) as follows:



  • high caries risk⎯repeat bitewings in 12 months (Fig. 3.25)

  • low caries risk⎯repeat bitewings in 24-36 months


Trauma assessment


Radiographs may be indicated for patients who have sustained facial or dental
trauma. This topic will be discussed in more detail in Chapter 12.


Orthodontic treatment planning


A discussion of radiographic views for orthodontic treatment planning is not within
the remit of this chapter. However, a panoral radiograph is usually mandatory prior to
any orthodontic treatment. The need for other views, such as an upper standard
occlusal or lateral cephalometric radiograph, is dependent on the individual clinical
situation (Chapter 14).


Dental development


The need for radiographic assessment of the developing dentition may be prompted
by any of the following clinical features:


(1) delayed/premature dental development;
(2) suspected missing/extra teeth (Fig. 3.26);
(3) potential ectopic tooth position (especially upper maxillary canines);
(4) first permanent molars of poor prognosis⎯in cases where first permanent molars
are to be extracted it is mandatory to check for the radiographic presence of all other
permanent teeth, including third molars, and to assess the stage of dental
development of the lower second permanent molars in order to determine the
optimum time for any first permanent molar extractions (see Chapter 14).


The panoral radiograph provides the optimum view for an overall assessment of
normal or abnormal dental development. Furthermore, accurate determination of
chronological age can be achieved by calculating dental age, using a panoral
radiograph and a technique for dental aging, such as that described by Demirjian
(1973).


A panoral radiograph may be supplemented with an intraoral radiograph, such as an
upper standard occlusal, when an 'abnormality' presents in the anterior maxilla. The
combination of these two views provides the opportunity to confirm the exact position

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