use of intra oral radio graph
TRANSCRIPT
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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