Radiographic Assessment in Paediatric Dentistry

Presented By:

Sayfaldeen Muhannad Ali Kashmoola

Nur Alia Bt. Che Mohd Din

Supervised By:

Dr. Nur Asilah Bt. Harun

Histroy of X-rays

Wilhelm Röntgen Dec. 1895

Radiography in Medicine

Radiography in Dentistry

3

12

4

5

Digital Radiography Device:1- The Patient2- X-Ray Generator3- Sensor4- Wireless connector between sensor and PC5- PC to view the Radiograph

Dental X-Ray Film

clear cellulose acetate film base is coated on both sides with silver bromide, silver halide, and silver iodide.

Processing the Film

Rationale in taking X-Ray Should not be performed in a routine manner using the same practice for all individuals. Should only be performed when the patient

history and/or objective findings and symptomslead to the conclusion that further usefulinformation might be obtained.

If a radiograph is not expected to change diagnosis or treatment or add other useful information, it should not be taken.

Criteria to take a radiograph

Based on objective findings/symptoms. Based on anamnestic information.

EAPD guidelines for use of radiographs in children 2003

Based on objective findings/symptoms

1. Caries2. Pulpal and periapical pathology3. Traumatic injuries4. Problems of eruption5. Developmental anomalies6. Unexplained discolouration of teeth7. Orthodontic treatment planning and evaluation8. Evidence of swelling9. Unexplained tooth mobility10. Unexplained bleeding

Based on objective findings/symptoms11. Deep periodontal pocketing12. Fistula formation13. Unexplained sensitivity of teeth14. Unusual spacing or migration of teeth15. Lack of response to conventional dental

treatment16. Unusual tooth morphology,17. Evaluation of growth abnormalities18. Altered occlusal relationship19. Aid in diagnosis of systemic disease

Based on anamnestic information History of pain History of trauma to teeth Postoperative evaluation Familial history of dental anomalies

General Indications for Radiographs

Detection of caries; Dental injuries; Disturbances in tooth development, Examination of pathological conditions other

than caries. Orthodontic treatment planning.

Techniques of Dental radiographic views in Paediatric Dentistry

Dental Radiographs

Extraoral Intraoral

•Panoramic View•Lateral oblique/bi-molar View•CBCT

•Bitewing view•Periapical view•Occlusal view

Bite-Wing Radiograph

horizontal Bitewing and vertical bitewing

Indication for Bite-Wing Radiograph Detect proximal caries that cannot be

detected clinically, Estimate the extent of lesions, Monitor lesion progression, Determine pulp chamber configuration, Suspected secondary caries under old

restorations.

Baseline bitewing

These factors should be considered for base line of radiograph for caries

relevant epidemiological data on the caries prevalence and rate of progression in the population;

caries experience; oral hygiene and dietary habits; exposure to fluorides; socioeconomic status.

Based on this knowledge, an individual risk assessment is carried out.

The baseline examinations and intervals to the next bitewing examination in children.

Baseline bitewing examination

Interval to next bitewing examination

At age: Low caries risk High caries risk

5 years 3 years 1 year

8 or 9 years 3-4 years 1 year

12 to 16 years 2 years 1 year

16 years 3 years 1 year

Limitation of BW

Active vs non-active lesions; Cavitated vs non-cavitated surfaces; Radiographic depth vs clinical depth.

Periapical Radiograph

Periapical techniques

Paralleling technique Bisecting technique

Based on Cieszynski’s rule of isometry.

Indications for Periapical Radiograph Detection of pathologic changes associated with primary

teeth (such as apical infection/inflammation or internal resorption)

After trauma to the teeth and associated alveolar bone, Detect developmental abnormalities, Assessment of the presence and position of unerupted

teeth, Assessment of the periodontal status, Assessment of root morphology before extractions, Detailed evaluation of apical cysts and other lesions within

the alveolar bone, In endodontic/pulp treatment (Preoperative, Working length

estimation, Post condensation, Review).

Occlusal Radiograph

The occlusal view is indicated when there is a desire to reveal the skeletal or pathologic anatomy of either the floor of the mouth or the palate.

The occlusal view taken with a large film (3X2.3 inches) and the patient is asked to bite on it.

It has two types which are: maxillary occlusal view ( Standard, oblique, and

Vertex) mandibular occlusal view (90°, 45°, oblique)

Maxillary standard occlusal - clinical indications

Periapical assessment of the upper anterior teeth in patients unable to tolerate periapical films

Detecting the presence of unerupted canines, supernumeraries and odontomes

As the midline view, when using the parallax method for determining the bucco/palatal position of unerupted canines

Evaluation of the size and extent of lesions such as cysts or tumors in the anterior maxilla

Assessment of fractures of the anterior teeth and alveolar bone, especially useful for children

Mandibular – true occlusal indication

Detection of the presence and position of calculi in the submandibular salivary ducts

Assessment of the bucco/lingual position of unerupted mandibular teeth by parallax technique

Evaluation of the bucco/lingual expansion of lesions in the body of the mandible like cysts, tumours or osteodystrophies

Assessment of displacement fractures of the anterior body of the mandible in the horizontal plane

Upper standard occlusal view

Diagram showing the position of the film packet in relation to the lower arch. B Positioning from the front; note the use of the protective thyroid shield. C Positioning from the side. D Diagram showing the positioning from the side

Upper oblique occlusal

Diagram showing the position of the film packet in relation to the lower arch for a left upper oblique occlusal. B Positioning for the left upper oblique occlusal from the front; note the use of the protective thyroid shield. C Diagram showing the positioning from the front.

Vertex occlusal

Diagram showing the position of the cassette in relation to the lower arch. B Positioning for the vertex occlusal from the front; note the use of the protective thyroid shield. C Positioning from the side. D Diagram showing the positioningfrom the side.

Lower 90° (true) occlusal

Lower 45° (standard) occlusal

Lower oblique occlusal

Lateral oblique/bimolar radiograph

Radiograph of molars and premolars using film/sensor positioned beside the face

Useful in difficult and uncooperative patient small children, mentally/physically disable patient Can tolerate with extraoral radiograph better than intraoral

radiographs Beneficial in having a short exposure time Limitation – distortion of teeth Indication : 1. To Examine the posterior region of the mandible.2. Patients who have fractures or swelling.3. It evaluate the condition of the bone and to locate impacted

teeth or large lesions.

LATERAL OBLIQUE

Cassette positioned against cheek and centered over the mandibular first molar area.

•The patient presses the tube side of the cassette firmly against the cheek with the palm of one hand and the thumb is placed under the lower edge of the cassette.

•Head position tilted 10 to 20 toward the side to be examined and the chin is protruded.

•The central ray directed toward the first molar region of the mandible from a point slight underneath the opposite side of the mandible and directed as perpendicular to the horizontal plane as possible

LATERAL OBLIQUE

Panoramic Radiograph (OPG)

What can we gain from OPG

Presence or absence of permanent teeth and their Positions in relation to the primary teeth.

Evaluation of bony lesions and the TMJ Bone loss Estimate the age of the patient

Indications for Panoramic Radiograph Diagnose missing and supernumerary teeth, Detect gross pathoses, Asses development of the dentition, Estimate the dental age of the patient, Detect bone fractures, traumatic cysts, Detect anomalies, In some patients with disabilities (if the

patient can sit in a chair and hold head in position).

Parallax Technique

Two types:1. Horizontal parallax involves taking either: Two periapicals with different angulations and follow the (SLOB)rule1-4 or An upper occlusal and a periapical views.

2. Vertical parallax involves taking either: An upper occlusal (Standard) view and an orthopantomogram (OPG) A periapical view and an orthopantomogram (OPG).

http://www.midemos.com/demos/elsevier/haring/SlobRule.html

Indication for Parallax technique Over-retention of the primary canine. Delayed eruption of the permanent canine. Absence of a upper labial canine bulge in a

10- or 11- year-old patient. Presence of a palatal bulge. Distal crown tipping of the lateral incisor.

Adverse effects of X-ray  X rays are carcinogenic. Chest x-ray vs background radiation Dental x-ray vs background radiation. Patient’s age and radiation The x-rays can cause damage by two mechanisms:1. Direct damage.

Somatic: It happens when X-ray photon or a high-energy ejected electron cause breakage of weak bonds between nucleic acids in RNA or DNA. This can cause inability to pass information, abnormal replication, or cell death. Or it might be resolved and the damage is repaired.

Genetic : Radiation-induced congenital abnormalities.

2. Indirect damage. Indirect damage occurs due to formation of free radicals inside the

cells.

Radiation protection

Protection of staff a.Position b.Workload c.Local rules d.Good practice guidelines

Radiation protection

Protection of patient - a. justification b.dose limitation c.quality assurance

Justification Don’t take x-rays for fun

Dose limitation

Quality assurance DON’T BY X-RAY MACHINE BECAUSE IT IS

CHEAP. A yearly maintenance and periodic check up

with the manufacturer. Request for extended warranty. Quality assurance certification every two

years.

A Good quality x-rayArea Improving methods

Radiographic technique Use film-holding/beam aiming device Careful positioning for OPG Careful selection and instruction of patients

X-rays set Regular maintenance and service

Film and cassettes Use film before expiry date

After care Mount, name and date radiograph

Radiographic assessment

Errors in radiographs

http://www.dentalcare.com/en-US/dental-education/continuing-education/ce137/ce137.aspx?ModuleName=testpreview&PartID=-1&SectionID=-1

Thanks for listening and participating