Volume 6 • 2019 • Issue 8

36 | 2019 | Issue 8 S upporting Y our P ractice  Assessment of pathology following trauma or as a result of dental caries. A child (age 4.5) had a mesioincisal fracture on tooth 61 after experiencing a traumatic injury ( Image 2a ). The fracture was not significant, so the parents opted to wait and observe. In cases of trauma, periapical radiographs ( Image 2b ) will allow you to assess any developing pathology. In this case, six months following the traumatic incident, a periapical inflammatory lesion resulted in premature root resorption of tooth 61 and adjacent bone, allowing for premature eruption pattern of the permanent successor, tooth 21. If this lesion is left untreated for a long period of time, it is sure to result in damage to the permanent incisor.  Providing anticipatory guidance. We detected a mesiodens in a child (age 5.5) and wanted to do a close follow-up to make sure it was not interfering with the eruption of permanent teeth. In the radiograph, you can see that the incisal edges of the central incisors are at the same level, an indication that the mesiodens is not interfering with eruption of these teeth ( Image 3a ). About 9 months later, a follow-up radiograph shows that tooth 11 has erupted but tooth 21 is now delayed ( Image 3b ), an indication that the mesiodens is interfering with its eruption. This suggests the timing is right to extract the mesiodens so the permanent tooth can fully erupt into position ( Image 3c ), as long as you feel comfortable about the positioning of the tooth and performing an extraction without damage to tooth 21. In this case, these radiographs helped us provide the parents with anticipatory guidance for their child.  Managing anomalies. This case of a boy (age 8) with an odontoma illustrates the importance of taking radiographs at the right time. A radiograph was taken because there was a concern that tooth 11 was not erupting, despite the eruption of tooth 21 and the partial eruption of tooth 22 ( Image 4a ). An odontoma was detected on the radiograph. If this lesion had been detected earlier, the odontoma could have been extracted earlier, allowing for the proper eruption of 11. By delaying the extraction, tooth 12 has started to tip mesially, blocking 11 from eruption ( Image 4b ). Extraction of the odontoma will likely cause some movement of tooth 11, but it will not reach its ideal position without intervention. Posterior Periapical Radiographs We take posterior periapicals in order to diagnose trauma to teeth, including any fractures; deep caries and pulpal involvement; and eruption anomalies. Keep in mind that the first place you are likely to see signs of pulpal inflammation and pathology in primary teeth is the furcation area. For this reason, posterior periapicals in primary molars should be taken at a bitewing angle to visualize the furcation area without having the follicle of the permanent successor overlapping it.  Detecting pathology in primary molars . This posterior periapical radiograph shows tooth 85 had a very deep restoration placed, which may have been through the pulp horn ( Image 5a ). As a result, necrosis and pathology of the tooth developed, which was first noticed in the furcation area. When this tooth was extracted, 4a 4b 5a 5b 3a 2a 3b 2b 3c