There is no doubt that OPT is not the methodology of choice for the evaluation and checking of odontoiatric therapy results.

Indeed, this function is generally performed during the treatment through endoral radiograms and in case of sequela and/or major complications, through computed tomography.

However, it is true that the radiologist, while analysing an OPT radiogram, often has to face different treatment results and can have difficulty in making the report, especially if a precise query and/or a clinical recall are absent.

It must be said that the evaluation, based only on radiological findings, turns out to be very limited and sometimes misleading, if considered separately from the clinical context.

The aim of this chapter is to illustrate the main iconographic patterns related to the results of the different odontoiatric treatments as well as precising their issues and related terminology.

Radiological aspects related to extractive therapy and conservative endodontic treatments along with some of the issues related to implantology will be discussed.

Radiological findings related to the results of a previous dental avulsion mainly refer to the morphological analysis of the so-called extraction site.

It seems to be evident that radiological evaluation must always be supported by a minimum of clinical integration because the exclusive morphological interpretation can be misleading.

Propaedeutical to the evaluation of the pathological extractive site is the knowledge of its normal morphology and its modifications occurring over time. The latter parameter is subjected to significant and very heterogeneous individual variations.

The main characteristic of a recent extraction site, in absence of pathological conditions, is the clear observation of all the anatomical components of the empty alveolus, which can be detectable for a variable time (30–40 days) from one subject to another.

Successively, the empty alveolus starts losing the sharpness of its outlines and assumes a blurred aspect. This is due to the proliferation and organisation of the granulation tissue, followed by mineralisation phenomena, which will lead in about 6–8 months to the complete bone obliteration of the alveolar cavity (Fig. 8.1a–c).

In some cases the blood clot, which is normally expected to occupy the extraction site, can be lost and the healing process interrupted or delayed.

The blood clot is, in fact, an important factor for the protection of the alveolar bone, and its loss can determine a painful complication called alveolar osteitis or dry socket.

In its early stage, obviously, such complication cannot be demonstrated through OPT.

The persistence of such pathological condition, generally linked to infection, determines the subacute and chronic post–extractive alveolitis.

As consequence the site can assume altered connotations which modify its characteristics. The main pathological modification comprises the reduction in sharpness of the alveolar cavity’s outlines.

This finding (typical also of the site’s normal evolution) has pathological meaning only if associated to the loss of the normal alveolar morphology.

Another significant element is represented by the diffuse osteosclerosis of the perialveolar cancellous bone, indicative of sclerosing alveolitis or sclerosing osteitis (Figs. 8.2a–c and 8.3).

Other factors concerning the radiological evaluation of an extraction site are related to a possible detection of residual tooth fragments or of fracture lesions of the alveolar walls.

Residual tooth fragments are found, most of the time, through endoral examinations during an extraction procedure, when the dentist suspects their presence. However, such a finding can occasionally be detected during OPT. In such cases, the clinical-anamnestic evaluation of the patient is obviously crucial for a correct interpretation of this radiological finding, which can often have little pathological significance (Fig. 8.4a, b).

Alveolar fractures are a consequence of extraction manoeuvres. When these lesions occur in the alveolar walls, on the vestibular or lingual-palatal sides, they cannot be detected by OPT for well-known projective reasons.

Conversely, it will be possible to give evidence of the possible lesions affecting the interradicular crest, whose fragment can sometimes contribute to phenomena of post-extractive alveolitis. The fragment can assume the aspect of a small osteosclerotic sequestration inside the alveolus (Fig. 8.5a, b).

Moreover, the radiological analysis of the extraction site must consider possible damages in the mandibular canal, or in the floor of the maxillary sinus, with the consequent formation of oroantral fistula (Figs. 8.6a, b and 8.7).

One must consider that during its evolution, the extraction site may not have its normal bone obliteration. This is most likely to happen for reasons related to chronic inflammatory phenomena, which are often oligosymptomatic.

In this eventuality, the extraction site will develop into an irreversible residual cavity, characterised by little clinical relevance.

In order to prevent this unfavourable situation, some dentists accumulate radiopaque and resorbable material in the post-extraction cavity (Fig. 8.8a, b).

Finally, the possibility for the extraction site to be in continuity with the small residual cavity due to the apical granuloma must be taken in account (Fig. 8.9).

This conservative therapy, aiming at saving the dental element, is fundamentally based on the techniques of endodontic treatment which consider penetrating caries, with infection of the dental pulp (pulpitis), to be the main indication.

The treatment consists of eliminating the carious lesion as well as the removal of the altered pulp from the pulp chamber and canals (devitalisation), followed by obliteration of pulp chamber and canals, through radiopaque resin-based material (gutta–percha), in order to seal the aforementioned cavities. This last procedure avoids persistence and/or diffusion of the infection (canalar therapy).

It is clear that all the aforesaid procedure can be evaluated by the dentist while operating, through the use of endoral radiograms.

In the evaluation of a panoramic radiogram, the morphological results of these procedures are often evident. Moreover, their analysis cannot be prescinded from a clinical-anamnestic evaluation.

Indeed, also in the presence of extremely insufficient results on the morphological aspect, it is not rare to notice clinical conditions which are totally normal and vice versa.

The main problems that must be considered in the presence of the canalar therapy results are irregular and incomplete canal filling, endocanalar overfilling and false routes.

The aforementioned evaluations obviously presume familiarity with a perfect realised treatment. In particular the filling must reproduce the morphology of the pulp chamber and of one or more canals (endodontic cone) in complete manner, without any irregularities or discontinuities (Fig. 8.10a–c).