Uses of Radiographs
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USES OF RADIOGRAPHS IN ORAL SURGERY
Dept of Oral and Maxillofacial SurgeryIIDC, Islamabad
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ROLE OF RADIOGRAPHS
Clinical examination phase Diagnosis (confirm/exclude) Treatment planning During treatment Follow up after various treatment procedures
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BIOLOGICAL EFFECTS OF RADIOGRAPHS
EFFECTS ON THE UNBORN CHILD: Developing fetus is particularly sensitive to the
effects of radiation, especially during the period of organogenesis (2-9 weeks after conception). The major problems are:
1. Congenital abnormalities or death due to large doses of radiation
2. Mental retardation associated with low doses of radiation
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TYPES OF ORAL RADIOGRAPHS
Intraoral
Extraoral
Other technologies/imaging modalities
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TYPES OF INTRAORAL RADIOGRAPHS
Intraoral radiographs can be divided into 3 categories:
1. Periapical radiographs2. Bitewing radiographs3. Occlusal radiographs
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PERIAPICAL PROJECTIONS
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PERIAPICAL PROJECTIONS
These radiographs show all of a tooth, including the surrounding bone
INDICATIONS: Detection of apical infection/inflammation Dental trauma (to the tooth and associated alveolar bone) Assessment of the presence and position of unerupted teeth Assessment of root morphology before extractions Endodontic diagnosis, planning, treatment and monitoring Detailed evaluation of apical cysts and other lesions within the
alveolar bone Evaluation of implants postoperatively
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Radiographic techniques
Two techniques for periapical radiography have been developed:
1. The paralleling technique: the film is positioned in the mouth parallel to the long axis of the tooth and x-ray tube aimed at right angles
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Radiographic techniques
2. The bisected angle technique:film is placed as close to thetooth as possible without bending, angle between film and tooth bisected, x-ray tube positioned at right angles to this bisected line
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BITEWING PROJECTIONS
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BITEWING PROJECTIONS
These radiographs show only the crowns of maxillary and mandibular teeth and adjacent alveolar crests
Film has a flap opposite its center upon which the patient bites to occlude upper and lower teeth
INDICATIONS: Baseline examination Detection of:
Dental caries Non carious tooth loss Monitoring the progress of any loss of tooth structure Assessing existing restorations (defects, contacts) Assessment of periodontal status
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OCCLUSAL PROJECTIONS
These radiographs show an area of teeth and bone larger than periapical radiographs
Occlusal film is held in position by letting the patient bite lightly on the film to support it between the occlusal surface of each jaw
Divided into: Upper occlusals Lower occlusals
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OCCLUSAL PROJECTIONSUPPER OCCLUSALS
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OCCLUSAL PROJECTIONS
INDICATIONS: Presence/absence of developing teeth, supernumerary teeth,
impacted teeth Evaluation of the size and extent of lesions (cysts or tumors) in
maxilla For determining bucco/palatal position of unerupted canines Assessment of the condition of antral floor As an aid to determine position of roots displaced into the antrum
during attempted extraction of upper posterior teeth Assessment of fractures of teeth and alveloar bone including
tuberosity Localization technique (used with another film) When unable to take intraoral radiographs
Limited mouth opening Uncooperative child
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OCCLUSAL PROJECTIONSLOWER OCCLUSALS
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OCCLUSAL RADIOGRAPHY
INDICATIONS: Detection of the presence and position of radiopaque calculi
in the submandibular salivary ducts Assessment of the bucco-lingual position of unerupted
mandibular teeth Evaluation of the bucco-lingual expansion of the mandible by
cysts, tumors or dystrophies Assessment of displacement fractures of mandible in the
horizontal and vertical plane Periapical assessment of lower incisor teeth, especially useful
in adults and children unable to tolerate periapical films
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EXTRAORAL RADIOGRAPHY
Radiographic film/detector positioned outside the patient’s mouth
Can take images of larger areas of mandible, maxilla, face and skull
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TYPES OF EXTRAORAL RADIOGRAPHY
Extraoral radiography includes:1. Skull radiography:
Lateral cephalometric projection (of sagittal or median plane)
True Lateral skull Submentovertex projection (of transverse or horizontal
plane) The Water’s projection (coronal or frontal plane) Posteroanterior cephalometric projection (coronal or frontal
plane) Posteroanterior projections of the jaws Reverse-Towne projections (coronal or frontal plane)
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TYPES OF EXTRAORAL RADIOGRAPHY
2. Oblique lateral projections of the mandibular body and ramus
3. Tomography4. Panoramic radiograph
Orthopantomograph (OPG) TMJ PNS
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Lateral cephalometric projection
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Lateral cephalometric projection
INDICATIONS: Orthodontics Orthognathic surgery:
1. Preoperative evaluation of skeletal and soft tissue patterns
2. To assist in treatment planning3. Postoperative appraisal of the results of surgery and long
term follow up studies
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True lateral skull view
INDICATIONS: Fractures of the cranium and the cranial base Middle third facial fractures to show possible downward and
backward displacement of the maxillae Investigation of the frontal, sphenoidal and maxillary sinuses Conditions affecting the skull vault, particularly
Paget’s disease Multiple myeloma Hyperparathyroidism
Conditions affecting the sella turcica such as, Tumors of the pituitary gland and acromegaly
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Submentovertex projection (Jug handle view)
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Submentovertex projection (Jug handle view)
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Submentovertex (SMV)
INDICATIONS: Destructive/expansive lesions affecting the palate,
pterygoid region or base of skull Investigation of the sphenoidal sinus Assessment of the thickness of the posterior part of
the mandible before osteotomy Fracture of the zygomatic arches – to show these thin
bones the SMV is taken with reduced exposure factors
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Occipitomental (Water’s) view
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Occipitomental (Water’s) view
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Occipitomental (Water’s) view
INDICATIONS: Investigation of the maxillary antra Investigation of the frontal and ethmoidal sinuses Investigation of the sphenoidal sinus Detecting the following middle-third facial fractures:
Le-Fort I Le Fort II Le Fort III Zygomatic Complex Naso-ethmoidal complex Orbital blow-out
Coronoid process fractures
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Postero-anterior Skull (Caldwell) view
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Postero-anterior Skull (Caldwell) view
INDICATIONS: Fractures of the skull vault Investigation of the frontal sinuses Conditions affecting the cranium, particularly,
Paget’s disease Multiple myeloma Hyperparathyroidism
Intracranial calcifications
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Postero-anterior jaws view
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Postero-anterior jaws view
INDICATIONS: Fractures of the mandible involving:
Posterior third of the body Angles Rami Low condylar necks
Lesions such as cysts or tumors in the posterior third of the body or rami
Mandibular hypoplasia or hyperplasia Maxillofacial deformities
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Reverse Towne’s projections
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Reverse Towne’s projections
INDICATIONS: High fractures of the condylar necks Intracapsular fractures of the TMJ Investigations of the quality of the articular surfaces
of the condylar heads in TMJ disorders Condylar hypoplasia or hyperplasia
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Oblique lateral projections
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Oblique lateral projections
INDICATIONS: Assessment of the presence and/or position of
unerupted teeth Detection of fractures of the mandible Evaluation of lesions or conditions affecting the jaws
including cysts, tumors, giant cell lesions, and osteodystrophies
As an alternative when intraoral views are unobtainable because of severe gagging or if the patient is unable to open mouth or is unconscious
As specific views of salivary glands or TMJ
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PANORAMIC RADIOGRAPHSORTHOPANTOMOGRAM (OPG)
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PANORAMIC RADIOGRAPHS ORTHOPANTOMOGRAM (OPG)
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PANORAMIC RADIOGRAPHS ORTHOPANTOMOGRAM (OPG)
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PANORAMIC RADIOGRAPHS
INDICATIONS: As part of orthodontic assessment where there is
clinical need to know the state of the dentition and presence/absence of teeth
To assess bony lesions or an unerupted tooth Prior to dental surgery under general anesthesia As part of an assessment of periodontal bone support
where there is pocketing greater than 5mm Assessment of third molars, at a time when
consideration needs to be given to whether they should be removed or not
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PANORAMIC RADIOGRAPHS TMJ PANORAMIC
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PANORAMIC RADIOGRAPHS
INDICATIONS: In addition dental panoramic radiographs are
also used to assess: Fractures of all parts of the mandible except the
anterior region Antral disease – particularly to the floor, posterior
and medial walls of the antra Destructive diseases of the articular surfaces of the
TMJ Vertical alveolar bone height as part of pre-implant
planning
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INDICATIONS OF TRADITIONAL OPG
Assessment of Wisdom teeth TMJ pathology Maxillary sinus Jaw bone pathologies Orthodontic diagnosis Jaw bone fractures
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OTHER TECHNOLOGIES AND IMAGING MODALITIES
Contrast studies Radioisotope imaging Computerised tomography (CT) Magnetic resonance imaging (MRI) Ultrasound CT Angiography
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REFERENCES
Oral radiology – principles and interpretation; 5th edition; White, Pharoah
Essentials of dental radiography and radiology; 3rd edition; Eric Whaites
Textbook of Dental and maxillofacial radiology; 2nd edition; Freny R Karjodkar
Principles of Dental Imaging; 2nd edition; Olaf E Langland, Robert P Langlais, John W Preece
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