Periapical Pathological Feature Pulp and Periapical Diseases Notes

Milestone In Periapical Pathological Feature Pulp and Periapical Diseases

Dental caries: The carious process results in demineralization which is radiolucent because the carious lesion allows the beams to pass through more easily than healthy tooth structure resulting in more remnant beams reaching the film to produce more interaction in the emulsion layer, thus producing more black metallic silver.

Occlusal caries: Large carious lesions in the dentin give a diffuse appearance as they expand toward the pulp. The diffuse periphery of occlusal caries differentiates it from facial and lingual caries.

Root Caries:

• On a radiograph, root caries produce a saucer-shaped (scooped-out) appearance. The carious lesion has a diffuse periphery.
• Frequently, root caries may be incorrectly interpreted as cervical burnout, especially when the radiolucency occurs under the proximal step of a metallic restoration.
• For root caries to occur there must be loss of crystal bone and exposure of the cementum.

Facial and Lingual (Palatal) Caries:

• Facial and lingual (palatal) caries originate in pits and grooves on the facial and lingual surfaces.
• The radiolucency is well-demarcated from the surrounding sound tooth structure. Its shape may be round, oval or semilunar, and depends on its location and degree of extension.
• Even after the carious lesion has penetrated the dentin enamel junction and has spread along the junction, the undermined enamel tends to retain its integrity and provides a definite periphery to the lesion. This sharp demarcation differentiates facial and lingual caries from occlusal caries.
• Pulpal pathosis: A pulpal condition usually caused by dental caries or deep restoration or exposed dentin due to cuspal fracture, severe attrition or cervical abrasion that causes pain precipitated by thermal or chemical stimulus and pain lasts for several seconds to minutes. Radiographic changes involve dentin and expanding towards pulp in. Radiographically, a radiolucent lesion extending into the pulp chamber will be evident without periapical changes.

Secondary caries (or) recurrent caries: Radiographic diagnosis of secondary or recurrent caries:

• Caries is immediately next to restoration.
• Inadequate margins and excavation.
• On a radiograph, calcium hydroxide produces a thin radiolucent line whereas recur-rent caries produces a diffuse radiolucency

Hidden Caries:

• Hidden caries is a term used to describe occlusal dentin caries that is missed on a visual examination, but is large and demineralized enough to be detected by radiographs.
• They are found in pit or fissure lesions that develop through tiny enamel defects, progressing under seemingly intact tooth structures.
• The etiology of hidden caries is still unknown, although some authors believed to be related to the massive use of fluorides, which act in the remineralization of occlusal enamel lesions masking their evolution.
• It has been postulated that the incidence of hidden caries is increasing due to the use of fluoride which reduces or makes absent the demineralization characteristic of the carious lesion of enamel, hiding the caries progression into dentin.

Periapical Diseases:

• Radiographically present as a periapical radiolucent lesion as a result of localized inflammatory reaction, infection in the root canal system, and reducing the mineral density of the affected periapical bone.
• Advancing pulpal inflammation when exits, the apical foramen will exhibit radiographic signs, such as widened PDL and poorly demarcated periapical low-density area due to demineralization.
  These changes are typically located at the apex of the tooth. Sometimes these lesions extend along the lateral surface of the root due to the presence of the accessory canals. Widening of PDL is an early sign of periapical inflammation.
• Periapical lesions are confined to the cancellous bone only. This is a result of periapical mineral loss in bone masked by denser, more mineralized cortical plates. Periapical lesions are seen immediately below the mesial root of the first mandibular molar tooth, as it is surrounded by more cancellous bone than the normal counterpart, hence periapical radiolucent lesions are usually developed in mesial roots of the mandibular 1st molar.
• Periapical radiolucent lesions are diagnosed only when there is a perforation of the overlying cortical plate.
• Radiolucent or low-density presentations at the periapical region are categorized as periapical rarefying osteitis including periapical periodontitis, periapical abscess, granuloma, and cyst/tumor while the radiopaque presentations are categorized as periapical sclerosing osteitis and idiopathic osteosclerosis.
• Definitive diagnosis of periapical lesions is possible only with microscopic findings of the lesion. Radiographic findings are helpful in considering a provisional diagnosis.
• The radiographic appearance of periapical lesions is not the exact replica when compared with the actual periapical lesion.

Reason:

• Anatomical note—Less contrast in the periapical lesion in cancellous bone and increased thickness of cortical bone.
• Bisecting angle technique causes geo¬metric distortion that may increase or decrease the resolution or even inability to visualize.

Periapical Periodontitis:

• The pulpal disease extends into surrounding periradicular tissues and causes inflammation.
• PDL space appears widened with distinct radiolucency.
• Discontinuity of lamina dura is also seen at the apical region.

Periapical Granuloma: Circumscribed circular to ovoid radiolucent area at the periapical region that encloses the root end. The lesion shows a grayish appearance. It is the most common periapical radiolucent.

Periapical Abscess:

• An inflammatory reaction to pulpal infec¬tion and necrosis characterized by slow ingress into periapical tissue and resultant inflammatory process cause periradicular bone resorption that manifests as a peri-radicular radiolucency on a radiograph.
• This periapical condition may occur with a necrotic pulp of partially or definitely endodontically treated tooth with an unfilled lateral or accessory canal in which continued bacterial contamination and leakage occurs.

Periapical Cyst:

• Well-defined area of bone destruction seen as dark radiolucent lesion attached with root apex.
• It is the second most common periapical radiolucency.
• To differentiate cyst and granuloma radio-graphically, the size of the lesion is usually considered. Periapical granuloma is usually less than 1 cm in size whereas cyst is more than 1cm in diameter.

Periapical Index:

• PAI 1: Normal periapical structure.
• PAI 2: Small changes in bone structure not pathognomic for apical periodontitis.
• PAI 3: Changes in bone structure with some mineral loss characteristic of apical periodontitis.
• PAI 4: Periodontitis with well-defined radiolucent area.
• PAI 5: Severe periodontitis with exacerbating features and bone expansion.

Periapical Rarefying Osteitis:

• It occurs as a result of bone resorption in the periapical areas surrounded by a sclerotic periphery.
• Early lesions present as a widening of the PDL space followed by a gradual loss of apical lamina dura.
• As the lesion grows with resorption, thinning of associated buccal and lingual cortices with possible expansion of the region.

Periapical Sclerosing Osteitis:

• Also known as condensing osteitis or focal sclerosing osteitis occurs as a result of a chronic low-grade periapical infection in a tooth.
• Individual thickening of the trabeculae is noted within the marrow spaces surrounding the roots of the affected tooth with sclerosis of the periapical bone. This is a result of surrounding bone attempting to wall off the inflammation or repair the bone affected by the inflammatory process.

Idiopathic Osteosclerosis:

• A dense bone island or enostosis are localized area of increased radiopacities that occur due to unknown etiology. They occur in the periapical areas, extend beyond the apices of associated teeth, and can also be found in the edentulous areas.
• Radiographically, these present as well-defined, densely homogeneous, non-expansile radiopacity with normal PDL space and lamina dura when in close proximity to the apex of a tooth.

Condensing Osteitis (Focal Sclerosing Osteomyelitis):

The involved teeth will have an etiologic factor of low-grade, chronic inflammation, such as necrotic pulp or extensive restorative material. Radiographically, the tooth shows increased radiopacity around one or more of the roots. This periradicular radiolucency resolves after endodontic therapy.

Root Resorption:

• Root resorption is the loss of hard tissue of roots, i.e. dentin and cementum.
• Chronic infection or pressure will stimulate odontoclasts and then causes resorption.

Root Internal Resorption:

• The pulp of only the crown or both crown and root may be involved in the resorptive defect.
• Radiographically internal root resorption shows an enlargement of the pulp chamber or pulp canal or both. But the normal outline of the canal is maintained with a thin layer of radiopaque dentin bordering the pulp chamber and canal.
• The enlargement of the pulp canal characteristically appears as a ballooning out of the root canal.
• The resorption appears as radiolucent with smooth well-defined margins and in oval or round shape, the outline of the root canal is usually distorted and the root canal and the radiolucent resorptive defect appear to be contiguous.
• More common in permanent dentition with a high prevalence for maxillary incisors.

External Root Resorption:

• Loss of root structure from the outer surface and localized at apical, middle or cervical third of roots.
• The radiographic appearance depends on the severity of the process.
• External inflammatory root resorption is always accompanied by the resorption of the bone seen as a loss of lamina dura around the apex in addition to that of the root apex.
• The early lesion appears cloudy radiolucent in the cervical region.
• The teeth and borders appear poorly defined.
• The root canal outline appears normal and can usually be seen
• “Running through” the radiolucent defect indicating lamina or external structure.
• Superficial resorption appears as a shallow lesion with a rounded contour, beginning at the apex and progressing towards the coronal direction, and is seen as a slightly shortened root with blunt and square apex, whereas deep resorption begins at the cervical part of the root and appears as small narrow canals with scalloped margins.

Apical Scar:

• An apical scar results from endodontic treatment of periapical lesions which generally tends to resolve the lesion, but sometimes the granulation tissue produces excessive collagen fibers that result in a dense tissue scar.
• This remains as a permanent, asympto¬matic periapical lesion and appears as a well-circumscribed radiolucency on the radio¬graph of an endodontically treated tooth.

Calcific Metamorphosis: A pulpal response to trauma by rapid deposition of hard tissue on the canal space. The entire space may appear obliterated radiographically due to extreme deposition. Most common in anterior teeth.

Benign Fibro-Osseous Lesions:

Noninflammatory periapical lesions are collectively called as “Benign fibro-osseous lesions” Normal bone is replaced by fibrous connective tissue containing abnormal cementum or bone. Cemento-osseous dysplasia (COD) is an example of a fibro-osseous disease that occurs in the jaws.

• Radiographically, these lesions exhibit early osteolytic, intermediate, and mature stages.
• The osteolytic stage appears as well-defined radiolucencies at the apices of associated teeth. These can be easily confused as pulpal disease; however, the affected teeth are vital and typically are asymptomatic.
• Intermediate-stage lesions appear partly radiolucent and partly radiopaque with the initiation of hard tissue (bone or cementum) formation at the center of the lesion.
• Mature stage lesions appear completely radiopaque.

Endodontic/Periodontic Lesion (Pulpo-period-dental lesion): A process involving diseases of the pulp and periodontium.

Classification of the Lesion Based on Etiology Diagnosis and Prognosis:

• A primary pulpal lesion with extension into periradicular tissue.
• A primary pulpal lesion with extension to the periradicular tissue with secondary infection and inflammation of periodontal tissue.
• Primary periodontal lesion.
• A primary periodontal lesion with extension into pulpal tissue.
• Combined pulpal and periodontal lesions with independent disease processes in both tissues are joined or coalesced in peri-radicular tissue.
• The concomitant pulpal-periodontal lesion in which the disease process exists independently in each tissue but are apparently not interlaced.

Milestone In Periapical Pathological Feature Periodontitis

A progressive destructive change in the supporting tissues that attaches the root of the teeth to the alveolar bone leads to loss of bone.

• In periodontal disease interpretation, we need to look for changes in the:
  • Crestal bone
  • Height and contour of alveolar bone
  • Lamina dura
  • Alteration in the medullary bone pattern.

Horizontal Bone Loss:

• When the remaining crest of the bone is parallel with a line between the cementoenamel junctions of two adjacent teeth, it is called horizontal bone loss.
• It is usually caused by inflammation.
• When the amount of remaining bone is fairly evenly distributed throughout the dentition, it is described as generalized horizontal bone loss. If confined to a specific area, localized horizontal bone loss is used.

Vertical Bone Loss (Angular Bone Loss):

• Irregular reduction in the height of crystal bone occurring in a plane that is at an angle to a line that is drawn from the CEJ of a tooth to an adjacent tooth. These defects develop when bone loss progresses down the root of the tooth.
• With vertical bone loss, there will be greater bone loss on the mesial surface on one tooth in comparison to the adjacent tooth.
• Usually, inflammation and trauma from occlusion are combined in causing the destruction and irregular shape of the bone.

Radiographic Assessment of Periodontal Status:

• Receding bone height related to CEJ.
• Loss of bone at interproximal space or at furcation.
• Widening of periodontal space.
• Loss of integrity of lamina dura.

Stages of Periodontal Disease: Periodontal disease is also classified from stages 1 to 4 based on the severity of radiographic and clinical signs.

Stage 1: Gingivitis

• Clinically, the gingiva appears swollen and inflamed.
• In stage 1 disease, no bone loss has occurred, and dental radiographs appear normal.

Stage 2: Early periodontitis

• Signifies the first appearance of radio¬graphic abnormalities. The earliest radio¬graphic signs of periodontitis are the loss of definition of the crystal bone. The alveolar crest loses its distinct sharp appearance and becomes blunted.
• The bony margin becomes diffuse and irregular and may show areas of localized erosion.
• In the incisor regions, there will be a blunting of the alveolar crests. In the premolar- and molar regions, there may also be a loss of the normally sharp angle between the lamina dura and the alveolar crest.

Stage 3: Established periodontitis

• Clinically seen as pocket formation.
• Radiographically, the bony destruction usually extends to the buccal or lingual alveolar bony plate or both.
• There may also be horizontal or vertical defects.
• Horizontal bone loss is used to describe the radiographic appearance of the loss of bone height in the region of several adjacent teeth.
• Horizontal bone loss may be classified as mild (less than 10% bone loss), moderate (10-30%), or severe (>30%) depending on the extent of bone loss.
• In the horizontal bone loss, both the buccal and lingual plates of bone, as well as the interdental bone, have been resorbed.
• Vertical bone defects are also called as proximal intrabony defects. Radiographically, the vertical bone defect is generally “V-shaped” and sharply outlined.
• An inconsistent bony margin is the result of uneven resorption of the alveolar cortical plate on lingual or facial surfaces, a feature of established periodontitis.

Stage 4: Advanced periodontal lesions

• Its a periodontal disease, and bone loss is extensive.
• Furcation exposure (radiolucent area at the region of the furcation) starts from bone loss at the furcation of multirooted teeth.
• Furcation involvement is indicated by triangular radiolucency in the bifurcation area of mandibular first and second molars.

Periodontal Abscess: It appears as distinct radiolucency along the lateral aspect of the root. However, radiographs alone should not be considered for diagnosing periodontal abscess because the findings are often atypical due to:

• In the early stage, it does not reveal any change.
• Abscess in the soft tissue wall of the periodontal pocket are less likely to demonstrate changes.
• Abscesses on the facial and lingual aspects of the root are often obscured by the density of the roots. Only interproximal location can be appreciated.
• The morphological changes on the bone may also give a false positive result.
• If a sinus orifice is seen in the associated tooth a gutta percha point is placed through the sinus might locate the source of abscess in the radiograph.

Trauma from Occlusion:

• Evidence of loss of lamina dura in the apices, furcations, and marginal areas with thickening of PDL space.
• Angular bone loss is a characteristic feature.
• Cervical V-shaped (angular bone loss), thickening of lamina dura, increase in density or apical bone sclerosis signs reflect an attempt by the periodontal tissues to adapt by the new functional demand.

Alveolar Dehiscence:

• Alveolar dehiscence exists when the alveolar cortical bone is resorbed along the entire length of the root.
• Radiographically, there will be a radio-lucency surrounding the affected root.

Furcation Involvement: Extension of bone loss between the roots of multi rooted teeth and eliminating the bone covering the root in that region. It is visible as radiolucency at the point of division.

Milestone In Periapical Pathological Feature Restorative Materials

• According to Radiographic Density (Beginning with Most Radiopaque):
  • Group 1: Gold alloys, amalgam, silver.
  • Group 2: Gutta percha, zinc phosphate, or other base materials, composite with opacifier, rubber base impression material, calcium hydroxide group with opacifier.
  • Group 3: Porcelain.
  • Group 4: Radiolucent—Calcium hydroxide, composite, resin.

Base Materials: Zinc phosphate cement and zinc oxide-eugenol paste, are used as cavity liners to protect the pulp of the tooth and appear as radiopaque. (If compared with amalgam, base material appears less radiodense).

Gutta Percha Cone: A radiopaque cone used for restoring the pulp canal.

RC Filling: Radiopaque material is placed into the root canal for obturation and sealing of the canal space.

Post and Core Restoration: Seen in endodontically treated teeth. Cast metal appears radiopaque as amalgam or gold. The core portion of the restoration resembles the prepped portion of a tooth crown, and the post portion extends into the pulp canal.

Acrylic Restoration: Often used as an interim or temporary crown or filling. Of all nonmetallic restorations, acrylic is the least dense and appears radiolucent or barely visible on a dental radiograph.

Splint: A stainless steel wire used for immobilization to support weak teeth which appear to the radiopaque.

Pontic: Artificial tooth suspended from the retainer casting, occupies the space formerly filled by the crown of a natural tooth.

Implant: A flat screw-shaped device that pierces in the alveolar process (that supports prosthesis).

Overfilling: Radiopaque root canal filling extends beyond the apical foramen. Inference: The root canal space is completely obturated.

Overextension: Root canal filling extending beyond the apical foramen often results in failure to create an apical stop during instrumentation indicating that the root canal space is not completely obturated.

Milestone In Periapical Pathological Feature Developmental Defects and Anomalies

• Supernumerary teeth: These can cause crowding problems and are often associated with unerupted permanent teeth or malposed permanent teeth.
• Dilaceration: It is defined as a deviation or bend in the linear relationship of a crown of a tooth to its root.
  • The direction of root dilacerations should be considered in 2 planes, and they can be categorized as mesial, distal, labial/buccal, or palatal/lingual.
  • If the roots bend mesially or distally, the dilaceration is clearly apparent on a periapical radiograph. However, when the dilaceration is toward the labial/buccal or palatal/lingual, the X-ray beam passes through the deflected portion of the root in an approximately parallel direction.
  • The dilacerated portion then appears at the apical end of the unaltered root as a rounded opaque area with a dark “spot” in its center that is caused by the apical foramen of the root canal (this appearance is similar to a bull’s eye or a target).
  • The periodontal ligament space around the dilacerated portion of the root might be seen as a radiolucent halo, and the radiopacity of this segment of the root is usually greater than the rest of the root as a result of the increased thickness of tooth structure that the X-rays have to pass through. In some cases, especially in the maxilla, the geometry of the projections may stop the recognition of a dilaceration.

Ankylosis:

• Ankylosis of teeth is the fusion of the tooth to the bone, preventing the tooth from erupting. Radiographically, there is obliteration of periodontal ligament space suggestive of fusion between root, cementum, and alveolar bone.
• Conventional radiographic diagnosis is however limited when ankylosis occurs in the lingual, labial, and interradicular areas.

Enamel Hypoplasia: It appears as a radiolucent area with radiopaque margins.

Amelogenesis Impefecta

• Hypoplastic form: The crowns of the teeth either have very thin enamel or lack enamel completely.
• Hypocalcified form: Enamel is less radio¬paque than dentin on radiographs.
• Hypomaturative form: The radiodensity of enamel is approximately the same as that of dentin.
• Dentinogenesis Imperfecta: Radiographically, the teeth have bulbous crowns with constricted short roots. Initially, pulp chambers may be abnormally wide and resemble “shell teeth,” but they will progressively obliterate.
• Odontome: Radiological features manifest as a dense radioopaque lesion surrounded by a thin radiolucent halo corresponding to the connective tissue capsule.

Three developmental stages can be identified based on the radiological features and degree of calcification of the lesion at the time of diagnosis.

1. The first stage is characterized by radio transparency due to the absence of dental tissue calcification.
2. The second or intermediate stage presents partial calcification.
3. The third or classically radiopaque stage exhibits significant calcification surrounded by a radiolucent halo.

Compound odontomas: Show an irregular radiopaque image with variations in contour and size, composed of multiple radiopacities corresponding to the so-called denticles (mini teeth).

Complex odontoma: Shows radiopacity which is not specific for tooth structure but resembles a disorganized, irregular single or multiple mass.

Milestone In Periapical Pathological Feature Fracture

Radiographic Features: Sharp radiolucent line within the anatomic boundaries. Deviation from a normal anatomic outline.

• Discontinuity in the cortical border or step formation.
• In a few situations increased density.
• A crown fracture that exposes the pulp chamber will result in endodontic disease.
• When this occurs the extent of pathology should be evaluated with a dental radio-graph, blunt trauma may result in damage to the pulp without fracturing the tooth.
• A dental radiograph should be made of any tooth that is discolored from pulp hemorrhage.

Root Fracture:

• Vertical root fractures (VRF) are longitudinal fractures that begin at the roots of teeth; these fractures occur primarily in the buccolingual plane.
• VRFs in teeth without endodontic treatment are relatively common; they are more common in the posterior teeth of people over 40 years of age and may be caused by excessive forces from mastication or occlusion.
• Symptoms are usually minimal or absent in the early stages. With time, dull pain on mastication may develop as a result of the separation of the fractured root segments. Hence, careful radiographic evaluation is necessary when a patient reports symptoms of pain in a clinically sound tooth.
• One limitation of intraoral radiographs is the absence of radiographic signs when the X-ray beam is not parallel to the plane of the fracture.
• The images taken from three different angulations could increase detection ability in the intraoral images as vertical translucent lines.

Luxation: Total displacement of a tooth from its original position in the alveolus as a result of trauma.

Extrusive Luxation: A partial axial displacement of the tooth out of its socket.

Impaction: The partially or completely unerupted tooth is known as an impacted tooth.

Complete impaction: Crown and root struc¬tures of 3rd molar are entirely below the level of the alveolar crest.

Partial impaction: A portion of 3rd molar crown is above the alveolar crest.

An impacted tooth should be radiographically evaluated for the position:

• Angulation
• Relation with adjacent vital structures like mandibular canal
• Root curvature
• Pathological changes

Pell and Gregory classification for mandi¬bular third molar position in relation to ramus:

1. Class 1: Sufficient amount of space between the distal aspect of the second molar crown and the ramus of the mandible to accommodate the mesiodistal diameter of the third molar crown.
2. Class 2: The space between the distal aspect of the second molar crown and the ramus of the mandible is insufficient to accommodate the mesiodistal diameter of the third molar crown.
3. Class 3: All or most root of the third molar is on the ramus.

Angulation of impacted teeth may be:

• Mesioangular: Long axis of the crown 3rd molar is tilted mesially to the long axis of the 2nd molar and b below the level of the occlusal plane.
• Distoangular: Long axis of the crown’s 3rd molar is tilted distally to the long axis of the 2nd molar and below the level of the occlusal plane.
• Vertical: Long axis of the crown 3rd molar is parallel to the long axis of the 2nd molar and below the level of the occlusal plane
• Horizontal: Long axis of the crown 3rd molar is perpendicular to the long axis of the 2nd molar and below the level of the occlusal plane.

Pell and Gregory classification for impacted maxillary third molar (Based on the relative depth of the impacted maxillary third molar in bone)

1. Class 1: The lowest portion of the crown of the impacted maxillary third molar is on a line with the occlusal plane of the second molar.
2. Class 2: The lowest portion of the crown of the impacted maxillary third molar is between the occlusal plane of the second molar and the cervical line.
3. Class 3: The lowest portion of the crown of the impacted maxillary third molar is at or above the cervical line of the second molar.

Classification for maxillary canine impac¬tion

• Horizontal
• Vertical
• Semi vertical

Milestone In Periapical Pathological Feature Imagined Caries

Misinterpretation of Cervical Burnout:

• A sharply defined radiolucent wedge at the alveolar bone crest may resemble interproximal or cemental caries burnout due to excessive exposure is called peri¬pheral or cervical burnout.
• Cervical burnout should not be mistaken for root caries or with caries under the proximal step of a Class 2 restoration.
• The final confirmation must be done clinically with the use of an explorer.
• A second radiograph made with a slightly different X-ray beam angulation and a change in exposure factors will enable the clinician to differentiate cervical burnout from root caries.

Mach Band Effect: An optical illusion which produces artificial radiolucent areas in dentinal peaks bounded by occlusal and proximal enamel seen especially in premolar but also in molar teeth.

• Radiolucent restorations and linings may be mistaken for caries but these usually have clearly demarcated outlines and can be confirmed clinically.
• Developmental defects in enamel hypo¬plasia may appear as radiolucent dots outline of all visible changes on a radiograph should be carefully visualized to mark it as either.
  • Anatomical landmark
  • Pathological finding
  • Superimposed or overlapped structures
  • Artifact due to processing or technical error.

Aunty Minnie:

• The term “Aunt Minnie” describes an imaging finding that is both perfectly obvious and pathognomonic of a disease. In other words, if it looks like your aunt Minnie then it is your aunt, Minnie, for example, recurrent pericoronitis. Uncle Fred: Represents a dull and unexciting abnormality that is frequently seen in a radiograph, for example, attrition.
• Cousin Harry represents a rare abnormality which is uncommon to be noticed by a physician but I like to see it, for example,, a dentigerous cyst.

Why cannot you depend on radiographs alone to determine pulpal exposure to caries?

• Overregulation can create the appearance of pulpal exposure.
• “Burnout” of dentin between pulp and the carious lesion enlarges the lesion.
• The superimposition of caries over the pulp gives the illusion of pulpal invasion.

What are some developmental-acquired defects that might appear as caries?

• Defects in tooth structure often appear radiolucent.
• Hypoplastic defects in the enamel will mimic caries.
• Abrasion, especially toothbrush abrasion will mimic cervical caries.
• Severe attrition may mimic occlusal caries.