Volume 6 • 2019 • Issue 8

37 Issue 8 | 2019 | S upporting Y our P ractice a distal-shoe space maintainer was fabricated chairside and placed immediately ( Image 5b ).  Detecting eruption anomalies. Eruption anomalies could also be detected by the posterior periapicals, such as this case ( Image 6a ), which shows an ectopically erupting tooth 16 and distal root resorption on tooth 55. About 70% of the time, permanent molars that ectopically erupt go through self-correction due to the posterior growth of the jaw, so they don’t necessarily need treatment. But sometimes, after months of observation, they do not self-correct. In this case, intervention by means of a distalizing appliance allowed for proper eruption of tooth 16 ( Image 6b ). A few years after the correction of 16 ( Image 6c ), the permanent tooth is close to eruption and there was no need to extract tooth 55. Bitewing Radiographs A posterior bitewing exam should be performed 6 months to a year after the posterior contacts are closed in primary molars. When posterior contacts are closed, you cannot rely on your clinical assessment alone to diagnose early interproximal lesions. Radiographs or other forms of visualization are necessary because by the time you can see an interproximal lesion clinically, the lesion is already quite deep ( Image 7 ).  Diagnosing interproximal lesions. In this radiograph ( Image 7 ), you can see tooth 64 has a very deep lesion that has penetrated into the pulp and the distal marginal ridge has broken down. Usually when you see the marginal ridge of a primary molar fracturing as a result of caries, there’s about an 80% chance that the caries has already entered the pulp.  Detecting occult caries. Another thing to consider is detecting occult caries, or hidden cavities, which commonly occur in primary teeth. Tooth 84 in this radiograph could clinically appear fine; you might see a bit of staining but underneath the radiograph shows a deep carious lesion ( Image 8 ).  Diagnosing periradicular lesions, pathology or dental anomalies. The quality of these bitewing radiographs ( Images 7 and 8 ) demonstrate the amount of diagnostic information one can gather when such radiographs are properly positioned and exposed in cooperative patients. Even the follicles of developing succedaneous teeth are visible on these bitewing radiographs. Ideally these films should’ve been placed more anteriorly in order to capture the contact area between the primary canines and the first primary molars. Panoramic Radiographs Panoramic radiographs are used in cases of severe trauma to ensure there are no bone fractures or severe fractures of the dentition in posterior regions, and to detect pathology or anomalies. If there is no such indication to take a panoramic radiograph early on, the best timing for a panoramic radiograph is in the early mixed dentition.  Early intervention to remove mesiodens. This patient had the first panoramic radiograph taken in the early mixed dentition ( Image 9 ). You can see the two permanent central incisors in the lower jaw, and the first permanent molars have erupted partially. You can also see the inverted mesiodens, which is resulting in the delayed eruption of tooth 21. If you look at the incisal edges of these teeth you can see that eruption of tooth 21 is delayed. One should give consideration to removing that mesiodens in order to allow for proper eruption of tooth 21. 9 7 8 6c 6a 6b