Intra-oral Radiographs (Bitewing and Periapical)

What it does

Intra-oral Radiographs reads the most frequent images in dentistry: bitewings, the reference view for interproximal caries and crestal bone, and periapicals, the reference for endodontic status and apical lesions. Upload all the intra-oral X-rays of one visit together; the run identifies each image type, corrects sensor rotation and flipping, numbers the teeth and merges every image into one FDI odontogram.

On that chart each surface carries its caries depth, each tooth its alveolar bone level and restorations, and each root seen on a periapical its PAI score. When the same tooth appears on several images the findings are combined, so a full-mouth series gives one consistent chart instead of a pile of separate reads.

Intended use

Decision support for the dentist or hygienist at a recall or new-patient visit: a surface-level caries map to compare with the clinical examination, bone-loss values that feed periodontitis staging, and apical status for endodontic planning. Every finding is linked to a tooth and surface.

Who it is for

General dentists, dental hygienists, periodontists, endodontists and dental students. Developers send the merged odontogram to practice-management software or a patient-communication tool.

Accepted input

• DICOM: Digital Intra-Oral X-Ray Image Storage (modality IO), For Presentation or For Processing.
• Image exports: JPEG or PNG exported from practice software, accepted with a calibration warning.
• Several images per request: bitewings and periapicals from the same visit, in any mix, including a full-mouth series.

Requirements

Requirement	Why
Images from one visit	They are merged into a single odontogram
Sensor orientation	Intra-oral sensors are often rotated or flipped; orientation is normalised before teeth are numbered
Anatomic Region Sequence with tooth designation, when present	Helps place a periapical on the right tooth
Bitewings for interproximal caries and crestal bone	The bitewing projection shows contact areas and the crest with the least distortion
Periapicals that include the root apex	Apical status and the root length used for bone loss need the whole root

Bone loss is expressed as a percentage of root length, which stays valid when an exported image has no calibration. Cervical burn-out, Mach bands and overlapping contacts can mimic caries and are flagged on the surfaces they affect.

Optional context

Age and the reason for the visit (recall, new patient, pain, periodontal assessment) go in clinical_context. Age is needed with bone loss to derive the bone-loss-to-age ratio used for periodontitis grading.

The result

A JSON result with a merged FDI odontogram; findings reference both the tooth and the image they were seen on.

Section	Content
Teeth and restorations	Tooth numbering and restorations: fillings, crowns, root-canal treatment, implants
Caries by surface	Caries per surface (mesial, occlusal, distal, buccal, lingual) with radiographic depth: enamel outer or inner half, dentine outer, middle or inner third
Bone loss	Cemento-enamel junction, alveolar crest and apex points per tooth, percentage bone loss and vertical defects
Periapical status	Apical radiolucency and PAI score per root
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Standards

• Tooth numbering: FDI two-digit notation (ISO 3950), convertible to Universal and Palmer; DICOM CID 4018/4019 and CID 4026 tooth codes.
• Caries: ICDAS/ICCMS radiographic depth scoring.
• Periodontitis: AAP/EFP 2017 classification, radiographic bone loss as a percentage of root length and the bone-loss-to-age ratio as staging and grading inputs.
• Apical status: Periapical Index (PAI, Ørstavik) per root.
• DICOM and exchange: GSPS or Segmentation overlays on each image, SR TID 1500 measurements, Encapsulated PDF, and FHIR R4 Observations with a bodySite per tooth.