SHAISTA ZAFAR

BASIC INTRODUCTION TO

RADIOGRAPHS & DIGITAL RADIOGRAPHY

RADIATIONRadiation is energy that comes from a source and travels through space and may be able to

penetrate various materials

DENTAL RADIOGRAPHS

Type Of An Image Of The Oral Cavity Which Results From Penetration Of A High Energy Electromagnetic Radiation Through Dense Body Structures To Form

An Image On A Dental Film

MEASURING UNITThe

scientific unit of measurement for radiation dose, commonly referred to as effective dose, is the

microsievert per hour (mSv/hour)

Intraoral x-ray= 0.005 mSv

GOAL

-Diagnostic informationwith minimal exposure

ARE DENTAL RADIOGRAPHS SAFE?

INDICATIONS!!!• Loss of tooth structure• Caries(occlusal/proximal)• Non-carious(attrition,fracture)• Periodontal disease;• Endodontic disease• Developmental abnormalities;• Tumors• Trauma• Impacted teeth• Unerupted teeth• Other bone pathologies• Implants

ATTRITION

PROXIMAL CARIES

BONE LOSS

IMPLANT

DENTIGEROUS CYSTC

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DENTINOGENESIS IMPERFECTA

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ENDODONTICS

RECOMMENDATIONS FOR

PRESCRIBING DENTAL

RADIOGRAPHS

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TYPE OF ENCOUNTER

CHILD (PRIMARY DENTITION)

CHILD (TRANSITIONAL DENTITION)

ADOLESCENT (PERM. DENTITION)

ADULT, DENTATE OR PARTIALLY EDENTULOUS

ADULT EDENTULOUS

NEW PATIENT Periapical/ occlusal or post. bitewing

Post. Bitewing with either OPG or periapical

Post. Bitewing with OPG

(same) Based on clinical signs & symptoms

RECALLED PATIENT (with clinical caries or inc.caries risk)

Post. Bitewing at 6-12mons interval

(same) (same) Post. Bitewing at 6-18mons interval

_

RECALLED PATIENT (with no clinical caries or inc. caries risk

Post. Bitewing at 12-24mon interval

(same) Post. Bitewing at 18-36mon interval

Post. Bitewing at 24-36mon interval

_

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RECALL ED PATIENT (periodontal disease)

Clinical judgement/ periapical/ bitewing

(same) (same) (same) _

Patient for monitoring dentofacial growth/ dento skeletal relationship

Clinical judgement

(same) Clinical judgement/ panoramic/ periapical

Usually not indicated

(same)

Pt. with implants, other dentofacial pathoses, restorative/endodonticneeds, treated periodontal disease.

Clinical judgement

(same) (same) (same) (same)

RADIATION PROTECTION

• Use of proper exposure and processing techniques

• Patients should be shielded with lead aprons and thyroid shields.

• These shields should have at least 0.5 mm of lead equivalent.

• Film badges

IMAGE RECEPTORS• RADIOGRAPHIC FILM• DIGITAL RECEPTORS

FILM PACKET CONTENTS

SIZES• Various sizes available, although only three are

usually used routinely:• For periapical & bitewings 31 X 41 mm 22 X 35 mm

• For occlusal 57 X 76 mm

TYPES

INTRA ORAL RADIOGRAPHSEXTRA ORAL RADIOGRAPHS

TYPES

INTRA ORAL RADIOGRAPHS

• Bitewing• Occlusal• Peri apical

BITEWING• So called because patient closes the teeth

together biting on a wing of card projecting from the tube side of the film

• Demonstrates occlusal surfaces,inter proximal surfaces of enamel,enamel-dentine junction & the bone levels surrounding the tooth

• Used for pre-molars,molars• indications:DC,assessment of fillings &

crown,periodontology

OCCLUSAL• Utilize the largest intra oral film (6 X 8cm)• Various projections• Maxillary occlusal projections-Upper standard-Upper oblique standard• Mandibular occlusal projections-lower 90 degree occlusal-lower 45 degree occlusal-lower oblique occlusal

PERIAPICAL• Shows usually 2-4 teeth,individual teeth &

tissues around apices

INDICATIONS

• Detection of apical infection• Assessment of periodontal status• After trauma to teeth & associated alveolar

bone• Assessment of root morphology before extraction• During endodontics• Detailed evaluation of apical cyst & other

lesion within the bone• Evaluation of implants postoperatively

PARALLELING TECHNIQUE

BISECTED ANGLE TECHNIQUE

PROBLEMS OF GAGGING

EXTRA ORAL RADIOGRAPHS

• Oblique lateral Radiography• Cephalometrics• Tomography• Panoramic radiography

ORTHOPANTOGRAM

ALTERNATIVE AND SPECIALIZED IMAGING MODALITIES

• Contrast studies• Radioisotope imaging(nuclear

medicine)• Computed tomography• Cone beam CT (CBCT)• Ultrasoud• Magnetic Resonance

• SIALOGRAPHY

SIALOGRAPHY

COMPUTED TOMOGRAPHY(CT)

• INDICATIONS• Intracranial disease e.g:

tumors,haemorrhage,infarcts• Assessment of fracture involving cranial

base,orbits,naso-ethmoidal complex• Assessment of size & extent of cyst• Tumor staging• Investigation of TMJ,osteomyelitis• Pre-operative assessment of maxillary and

mandibular alveolar height

CBCT

DIGITAL RADIOGRAPHY

• Dental radiographs produced with a special computer create digital images (computerized dental radiographs) that can be displayed and enhanced on the computer monitor.

• It involves the use of a radiography machine like that used for conventional xrays. But instead of using films, the clinician makes digital images using a small electronic sensor or an image receptor placed in mouth to capture the image.

• Accepted?• Radiation Source?• Ordering Dental radiographs?• Operator Location?• Advantages?• Disadvantages?

ADVANTAGES• requires 50-80% dose reduction• No films,no dark room,no chemical are needed• No lead foil waste generated• Digital images can be magnified• Friendly

DISADVANTAGES• Cost• Infection control

CORRECT TERMINOLOGY• One examines a radiograph and not an x-ray,

bear in mind that xray cannot be seen• One does not see infection at the apex of a

tooth—radiolucency/opacity• Periodontal bone loss is not periodontitis• In radiologic terminology PA is a postero-

anterior view

COMMON QUESTIONS ASKED BY A PT

• Are regular scans and xrays necessary?• If the period of time between them

could be lengthened?• Are dental x-rays safe for a pregnant

women?• Estimated risk for cancer?

REFERENCES• Essentials of Dental Radiography &

Radiology ERIC WHAITES (by Roderick Cawson)• Images from GOOGLE

THANKYOU

I'm always amazed to hear of air crash victims so badly mutilated that they have to be identified by their dental records. What I can't understand is, if they don't know who you are, how do they know

who your dentist is? -Paul Merton