Posterior_Direct_Restorations Salvatore_compressed

FIG 3-20 (a) The wedge direction indicates the correct radiographic axis. (b) Because the ideal axes are often not parallel, a decision must be taken as to whether to carry out multiple exposures or use alternative tests (eg, separation).

A bitewing examination can often be used to determine:

Presence of deep interproximal and occlusal radiolucencies (Figs 3-21 and 3-22)

FIG 3-21 Numerous interproximal lesions and one buccal lesion on the mandibular left first molar.

FIG 3-22 Deep occlusal lesion affecting the mandibular right second molar.

Extent of residual tooth structure (Fig 3-23)

FIG 3-23 The maxillary right second premolar is decidedly lacking in crown structure.

Dimensions of pulp chamber and presence of pulp calcification (Fig 3- 24)

FIG 3-24 Multiple foci of pulp calcification in pulp chambers of the maxillary right second molar and mandibular right first and second molars. The maxillary right first molar shows narrowing of the pulp chamber.

Distance of the lesion or restoration from the pulp chamber (Fig 3-25)

FIG 3-25 The distal restoration of the maxillary right second premolar is very close to the pulp chamber.

Fit and consistency of existing restorations (Fig 3-26)

FIG 3-26 Numerous poorly fitting restorations.

Bone levels, periodontal defects, and furcations (Fig 3-27)

FIG 3-27 Various areas of reduced periodontal attachment can be identified, albeit peripherally.

Presence of interproximal calculus (Fig 3-28)

FIG 3-28 Numerous calculus deposits can be identified interproximally. It is difficult to see the buccal and palatal/lingual calculus on a radiograph.

Presence of anatomical anomalies and/or residual roots (Fig 3-29)

FIG 3-29 Residual root between the roots of the maxillary left second premolar and first molar.

A pediatric dental evaluation can also be carried out if a young patient’s risk level justifies the examination (Fig 3-30). This examination is fundamental but has limitations, namely: