Nine Rules for Determining Clinical Acceptability of a CRS
- Adequate periapical bone must be shown around the teeth, which are included in any given image so that the periapical conditions can be evaluated. Usually there should be at least 1/8th of an inch (3 mm) beyond the apex of the teeth of interest.
- Sufficient surrounding structure should be seen so that the lamina dura and periodontal ligament space can be evaluated.
- A maxillary molar periapical image must show the third molar area, even if the 3rd molar is missing in the jaw.
- All maxillary and mandibular alveolar bone must be shown at least once. This is true whether there are teeth or simply edentulous bone in the area.
- The first molar generally, should appear on the premolar radiograph.
- Interproximal contact areas must be shown for each interproximal area at least once. Contact areas between adjacent teeth should appear to touch, but have no overlap.
- Cone cuts and other artifacts should not interfere with the diagnostic quality of the radiographic image.
- The premolar bite wing must show the:
- Distal aspect of the most anterior canine
- Contacts between canine and premolars of each arch
- Alveolar interproximal crestal bone of each jaw
- The molar bite wing must show:
- Contacts between molars
- Contacts between first molar and second premolar of each arch
- Alveolar interproximal crestal bone of each jaw
A panoramic radiograph should not routinely substitute for a periapical radiographic image. Most patients should have either a CRS or a panoramic image and not both; particularly during the same appointment.