Ideal Class II radiograph

[ShawnOne]

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Hello everybody,

I am preparing to take the WREB exam this June. I have screened some patients and found class II lesions. However, the ones I found all seem to be a little bit shy of the DEJ. Others are obviously way too big.

Can anybody post a radiograph of an IDEAL board lesion? I would really appreciate it.

 

[ShawnOne]

Found this photo on the internet. Would you consider the mesial lesion ideal?

 

[ShawnOne]

How about this one?

 

[ItsGavinC]

Found this photo on the internet. Would you consider the mesial lesion ideal?

100% no! That distal decay is huge and there would be pulpal involvement with that lesion. The ideal lesion, as you described, is the one that just kisses the DEJ. For patients I had last year I was fairly certain that my patients would get rejected, but neither of them did. Both of the lesions were barely to the DEJ (some said they weren't quite to the DEJ).

The key, which may seem like overstating the obvious, is that the enamel should be broken through. It doesn't have to be a wide break into dentin (think of the triangle pattern of proximal decay, just the tip may be the only area completely broken through into dentin), but it has to be there.

 

[ItsGavinC]

How about this one?

Much better than the first one. The first one was leaning towards pulpal involvement. Remember that the lesion is progressed past where you view it on the radiograph. In my opinion the decay on this one is still not ideal due to the proximal pattern of decay. It has progressed beyond the typical "triangle" and looks more like a rectangle. You might have difficulties with that, but wouldn't be terrible.

 

[ItsGavinC]

Here is one I'm probably going to use this year (distal #12):



The other thing to be aware of is patient behavior. This person is a good friend of mine, I know they'll be on time for the exam, so in my mind that can compensate for a lesion being less-than-ideal.

 

[ShawnOne]

100% no! That decay is huge and there would be pulpal involvement with that lesion. The ideal lesion, as you described, is the one that just kisses the DEJ. For patients I had last year I was fairly certain that my patients would get rejected, but neither of them did. Both of the lesions were barely to the DEJ (some said they weren't quite to the DEJ).

The key, which may seem like overstating the obvious, is that the enamel should be broken through. It doesn't have to be a wide break into dentin (think of the triangle pattern of proximal decay, just the tip may be the only area completely broken through into dentin), but it has to be there.

Are you looking at the right lesion? On the first photo I was reffering to the smaller lesion (mesial). The distal lesion is obviously huge, but the mesial lesion, while in dentin, doesnt look like its pulpally involved.

 

[ItsGavinC]

Are you looking at the right lesion? On the first photo I was reffering to the smaller lesion (mesial). The distal lesion is obviously huge, but the mesial lesion, while in dentin, doesnt look like its pulpally involved.

My bad. Mesial lesion is still bigger than ideal. If it was ideal it wouldn't have any evidence of caries in the dentin, just the broken proximal enamel. Not a bad lesion though.

 

[USCSD]

Hello everybody,

I am preparing to take the WREB exam this June. I have screened some patients and found class II lesions. However, the ones I found all seem to be a little bit shy of the DEJ. Others are obviously way too big.

Can anybody post a radiograph of an IDEAL board lesion? I would really appreciate it.

the second x-ray is very good specially premolar.don't even think about somthing like the first lesion. it is too big.I already took my WREB last month and my lesions were very similar to your second x-ray.since u are an SC student,make sure to show the x-rays to Dr.sunders.
Good luck 😉

 

[ShawnOne]

the second x-ray is very good specially premolar.don't even think about somthing like the first lesion. it is too big.I already took my WREB last month and my lesions were very similar to your second x-ray.since u are an SC student,make sure to show the x-rays to Dr.sunders.
Good luck 😉

The lesion on the premolar doesn't look like it touches the DEJ. Dont you think? I have screened patients who have lesions like mesial of 19 / distal of 20, but I think they are likely to be rejected.

 

[ShawnOne]

Here is one I'm probably going to use this year (distal #12):



The other thing to be aware of is patient behavior. This person is a good friend of mine, I know they'll be on time for the exam, so in my mind that can compensate for a lesion being less-than-ideal.

Gavin, thanks for sharing. That lesion looks money! What is the age of this patient?

 

[tinker bell]

Gavin, u have a very good premolar there. It's important to get patient at least older than 25 with a bit recession, easier when dropping the gingival box.

 

[ItsGavinC]

Gavin, thanks for sharing. That lesion looks money! What is the age of this patient?

She is 26, I believe. Her lesion is bigger radiographically than the ones I submitted last year, and they were all accepted. This same patient has a mandibular premolar that I'll probably end up doing, along with a class III on another patient.