Root tips, tooth wear, resorption, missing teeth, extraction planning, and periapical disease all require a diagnostic view before action.
For apical questions, include the root tip plus surrounding bone; in the lecture example, Dr. Mulherin wanted about 2 mm beyond the apex.
Underexposure, elongation, foreshortening, cone cut, or artifact can make pathology appear or disappear.
Name the question first. Are you evaluating a retained root, apex, tooth wear, resorption, clinically missing tooth, or extraction risk?
Check projection quality. Proper angulation means no “squishy” foreshortening and no “taffy” elongation.
Confirm the field includes the answer. If the apex, lesion margin, or root remnant is cut off, the image cannot answer the question.
Use comparison deliberately. Compare sides, adjacent roots, pulp chamber size, and periodontal ligament space before calling disease.
| Read step | What to check | Why it changes the plan | Ev. |
|---|---|---|---|
| Diagnostic view | Exposure, angulation, apex visible, no decisive cone cut/artifact. | Prevents acting on a view that cannot show the structure at risk. | C |
| Compare anatomy | Tooth/root ID, root count, PDL space, pulp chamber, adjacent teeth and opposite side. | Separates artifact/positioning error from true endodontic, traumatic, or periodontal disease. | C |
| Plan from pathology | Irregular apical lucency, vertical bone loss, retained root, fracture, dilaceration, resorption. | Drives monitor vs treat/extract/referral and procedural risk planning. | C |
If an elevator cannot reach it, improve access/visualization: remove appropriate buccal bone, create a moat, use root-tip instruments.
Leave only when radiographs do not show a large pulp chamber or periapical lucency; wear can still produce pulpitis/non-vitality.
Radiographs must define the resorption pattern and periodontal/endodontic status before deciding what is possible.
If cone cut, exposure, or positioning hides the exact place you need to assess, additional views are better than forced interpretation.
