use of intra oral radio graph

8/3/2019 Use of Intra Oral Radio Graph

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DR EROMOSELE OBEHI


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INTRODUCTION/OVER VIEW

METHOD OF RADIOGRAPHICDIAGNOSIS

INTRA- ORAL RADIOLOGY

FACTORS/CONSIDERATIONS WHEN

TAKING INTRA-ORAL RADIOGRAPHS

TYPES OF INTRA-ORAL RADIOGRAPHS

INDICATIONS/ USES

CONCLUSIONS

REFERENCES


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The use of radiographs is an integral part ofclinical dentistry, with some form of

radiographic examination/investigationnecessary on the majority of patients. As a

result, radiographs are often referred to as

the clinician's main diagnostic aid.

The range of knowledge of dental

radiography and radiology thus required canbe divided conveniently into four main

sections:


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1. BASIC PHYSICS AND EQUIPMENT the

production of X-rays, their properties and

interactions which result in the formation of theradiographic image

2.RADIATION PROTECTION the protection of

patients and dental staff from the harmfuleffects of X-rays

3.RADIOGRAPHY the techniques involved inproducing the various radiographic images

4. RADIOLOGY

the interpretation of theseradiographic images.

Understanding the radiographic image is

central to the entire subject


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Aim

One must be able to have interpretation ofnormal anatomical features and so be able toidentify abnormal appearances onradiographs of the teeth, jaws and skull.

1) Identify the radiograph2) Identify the normal radiographic anatomy

3) Describe the radiographic pathology

4) Make your radiologic (differential) diagnosis


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Direct action film:

Radiograph taken with the film

placed inside the oral cavity wherethere is need for fine detail andexcellent image quality.


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4 main factors considered when taking eachview:

Film position

Patients head position

The sagittal plane

The horizontal plane or floor

Tube position

Vertical angle

Horizontal angle

Exposure


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Tooth under investigationand film should be as closeas possible

Tooth and film should beparallel to each other

The X-ray beam shouldmeet both tooth and film atright angles in both verticaland horizontal planes

However the anatomy ofthe oral cavity does notallow these idealpositionings.


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1. PERIAPICAL RADIOGRAPHY

2. BITE WING RADIOGRAPHY

3. OCCLUSAL


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Periapical radiography describesintraoral techniques designed to show

individual teeth and the tissuesaround the apices.

Each film usually shows two to four

teeth and provides detailedinformation about the teeth and thesurrounding alveolar bone.


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Detection of apical infection/inflammation

Assessment of the periodontal status

After trauma to the teeth and associated

alveolar bone Assessment of the presence and position

of unerupted teeth

Assessment of root morphology beforeextractions

During endodontics


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Preoperative assessment and postoperative

appraisal of apical surgeryDetailed evaluation of apical cysts and other

lesions within the alveolar bone

Evaluation of implants postoperatively.

Full-mouth survey

This terminology is used to describe collectionof periapical radiographs showing the full

dentition. Not every tooth is radiographedindividually, but enough films are taken to

include all the teeth.


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Lateral projection of the crowns of teeth inboth upper and lower jaws together upon one

film. This should demonstrate the interdental

spaces

Name taken from the original techniquewhich required patient to bite on a smallwing attached to a periapical film packet.

Tab is now used as the terminology

instead of wing.

An individual film is designed to show the

crowns of the premolar and molar teeth on

one side of the jaws.


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Detection of dental caries and its extent Disclosure of recurrent caries Detection of interproximal caries

Monitoring the progression of dentalcaries Assessment of existing restorations

checking relationship between prepared

cavity and pulp chamber


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Detection of overhanging edge ofrestoration Diagnosis of periodontal

disease/assessment of periodontalstatus Detection of presence or absence of

impacted teeth eg. wisdom teeth


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An intra-oral radiographic techniquetaken using a 5.7x7.6cm film placed at

the occlusal plane.


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Modified British Standards Glossary

Maxillary occlusal projectionsUpper standard occlusal

Upper oblique occlusal (upper

lateral oblique occlusal)Vertex occlusal


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Mandibular occlusal projections

Lower 90o occlusal (cental true

occlusal)Lower 45o occlusal (standard

occlusal, lower midline oblique

occlusal)Lower oblique occlusal


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INDICATIONSPeriapical assessment of the upper

anterior teeth, especially in children

but also in adults unable to tolerateperiapical filmsDetecting the presence of unerupted

canines, supernumeraries and

odontomes


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As the midline view, when usingparallax to determine thebucco/palatal position of uneruptedteeth

Evaluation of the size and extent oflesions, such as cysts or tumours inthe anterior maxillaAssessment of fractures of both

anterior and posterior teeth andalveolar bone.


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CP at the bridge of the nose

CR is 65o-70o to horizontal plane

A-F distance 30cm


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Shows the more posterior part of themaxilla on one side

INDICATIONSPeriapical assessment of the upper

posterior teeth

Evaluation of size and extent oflesions, such as cysts and tumours


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Assessment of antral floor anddetermining position of rootsdisplaced inadvertently into the

antrumAssessment of fractures of the

posterior teeth and associatedalveolar bone, including thetuberosity


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The film is placed tothe side of the mouthunder investigation

and the patient bitestogether gently on it X-ray tube is

positioned to the sideof patients face

CP thru cheek CR angled at 65o-70o to

the horizontal


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Projection shows a plan view of theteeth from above. The beam passes

through considerable amount oftissue, delivering large dose orradiation to patient and especially

pituitary gland. An intra-oral cassettecontaining intensifying screens isused to reduce radiation dose.


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Assessment ofthe bucco-palatal

position ofuneruptedincisors and

canines


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CP is vertex of skullaiming downwards

CR aimed down thelong axis of the rootcanals of the incisorteeth

Anode film distance -45cm.


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Shows a plan view of the tooth-bearing portion of the mandible and

the floor of the mouthA minor variation of the technique is

used to show unilateral lesions.


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Detection of the presence andposition of radiopaque calculi in thesubmandibular salivary ducts

Assessment of the bucco-lingualposition of unerupted mandibularteeth

Evaluation of the bucco-lingualexpansion of the body of themandible by pathology eg. Cysts,tumours or osteodystrophies


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Assessment ofdisplacement offractures of the bodyof the mandible in

the horizontal planeAssessment of buccal

expansion withcharacteristic

deposition of bone inGarres osteomyelitis


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Film is placed central Patient tilts head as far

backwards as is

comfortable X-ray tubehead is

placed below chin

CP in the midline

CR angled at 90o

to filmand so occlusal plane


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Taken to show full length of loweranterior teeth. The resultantradiograph resembles a large

bissected angle technique periapicalof the region


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Periapical assessment of the lowerincisor teeth, especially useful inchildren

Evaluation of the size and extent oflesions affecting the anterior part ofthe mandible

Assessment of fractures of teeth,alveolar bone and body of that part ofmandible


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X-ray tubehead ispositioned in themidline

CP thru the chin point

CR angled at 45o tohorizontal which is also

the occlusal plane(+50o-55o in children)


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Designed to image thesubmandibular gland on side of

interest. Because X-ray beam isoblique, all the anatomical tissuesshown are distorted.


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Detection of radiopaque calculi in asubmandibular salivary glandAssessment of the bucco-lingual

position of unerupted lower wisdomteethEvaluation of the extent of lesions

and their expansion of the mandible

in a bucco-lingual dimensionAssessment of buccal expansion with

characteristic deposition of bone inGarres osteomyelitis


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Film is tilted to side oflesion

The supported patientshead is rotated away from

side of investigation withchin raised

X-ray tubehead is aimedupwards and forwards

CP is from below and

behind the angle of themandible

CR parallel to the lingualsurface of the mandibledirected towards film at an

angle 110

o

-115

o

to film


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Successful diagnosis of oral diseases requiresaccurate interpretation of radiographs by the

clinicians.

This requires deep knowledge and

understanding the type of radiographic image,being able to recognize the range of normal

appearances as well as the salient features of

relevant pathologies.


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Whaits E., Cawson R. A. Essentials of dentalradiography and radiology. 3rd edition

churchill livingstone, 2003 Radiography &

RadiologyPp:69-101Parkins G. Lecture notes on dental radiology

U.G.D.S. 2009

use of intra oral radio graph

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