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Questions and Answers
What is the value of X-ray in caries assessment?
What is the value of X-ray in caries assessment?
X-ray is valuable in caries assessment because it allows for the detection of caries and the determination of its severity.
Which of the following types of dental caries are only detectable radiographically?
Which of the following types of dental caries are only detectable radiographically?
Explain how to classify proximal caries based on severity
Explain how to classify proximal caries based on severity
Proximal caries are classified into four categories based on severity: Incipient (D1), Moderate (D2), Advanced (D3), and Severe (D4).
What type of X-ray technique is considered the most accurate for detecting interproximal caries?
What type of X-ray technique is considered the most accurate for detecting interproximal caries?
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List the different radiographic techniques used to detect caries.
List the different radiographic techniques used to detect caries.
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Bitewing radiographs are primarily used to assess the crown of upper and lower teeth.
Bitewing radiographs are primarily used to assess the crown of upper and lower teeth.
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What are the criteria for a good bitewing?
What are the criteria for a good bitewing?
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What are the limitations of using X-ray in caries assessment?
What are the limitations of using X-ray in caries assessment?
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What is the value of X-ray in periodontal disease assessment?
What is the value of X-ray in periodontal disease assessment?
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Bitewing radiographs are the most suitable technique for detecting periodontal disease.
Bitewing radiographs are the most suitable technique for detecting periodontal disease.
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What are 2 common procedures for detecting bone loss in periodontal disease assessment?
What are 2 common procedures for detecting bone loss in periodontal disease assessment?
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Which of the following radiographic techniques is typically NOT used for assessing periodontal disease?
Which of the following radiographic techniques is typically NOT used for assessing periodontal disease?
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CBCT is the gold standard for assessing periodontal disease?
CBCT is the gold standard for assessing periodontal disease?
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What are the limitations of X-ray in periodontal diseases assessment?
What are the limitations of X-ray in periodontal diseases assessment?
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X-ray is a member of the ionizing radiation category. Therefore, it has biological damaging effects.
X-ray is a member of the ionizing radiation category. Therefore, it has biological damaging effects.
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Which of the following effects of X-ray damage is NOT applicable in dentistry?
Which of the following effects of X-ray damage is NOT applicable in dentistry?
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Which of the following categorizes the effects of ionizing radiation on the body?
Which of the following categorizes the effects of ionizing radiation on the body?
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What are the 3 main categories of radiation protection guidelines?
What are the 3 main categories of radiation protection guidelines?
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What are 3 key concepts within the ALARA principle for patient radiation protection?
What are 3 key concepts within the ALARA principle for patient radiation protection?
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Which of the following is a synonym for justification in the dental x-ray context?
Which of the following is a synonym for justification in the dental x-ray context?
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What is the primary goal of the optimization principle in dental radiography?
What is the primary goal of the optimization principle in dental radiography?
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What is meant by "general public" in the context of dental radiography?
What is meant by "general public" in the context of dental radiography?
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What is the role of a radiograph in planning for implant placement?
What is the role of a radiograph in planning for implant placement?
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Which of the following is NOT a major advantage of digital radiography over conventional radiography?
Which of the following is NOT a major advantage of digital radiography over conventional radiography?
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The objective of bone quality is a key determinant in the implant treatment planning
The objective of bone quality is a key determinant in the implant treatment planning
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Which of the following is NOT included in the pre-operative planning phase of dental implant imaging?
Which of the following is NOT included in the pre-operative planning phase of dental implant imaging?
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Study Notes
Dental Caries
- Dental caries, if there is a distal caries in lower 5, there are two problems in implant placement: food stagnation due to distal caries; caries progression which may affect the implant.
- Periodontal diseases and severe periodontal conditions with bad oral hygiene have a bad prognosis for implant placement.
- Radiolucent area due to demineralization or decalcification of hard dental tissues. Destruction to dental hard tissue (organic or inorganic).
- X-ray detection of caries relies on being aware of the limitations of the radiograph.
- Determination of severity depends mainly on occlusal and proximal caries.
- Types of dental caries: occlusal, proximal, facial/lingual, & cervical, recurrent, and rampant.
Occlusal & Proximal Caries
- Determination of caries severity: incipient, moderate, and severe.
- Occlusal caries: occurs in occlusal surfaces, including pits and fissures. Detection is better clinically than radiographically if demineralization is below 30-40%.
- Proximal caries: in mesial and distal surfaces from the cervical line to contact point. Detection is better radiographically.
Facial-Lingual & Cervical Caries
- Facial/Lingual caries by radiograph can't be differentiated because buccal and lingual are superimposed. Detection is better clinically.
- Cervical caries (Senile caries / root caries) below cemento-enamel junction, occurs in old age due to xerostomia and bad oral hygiene and gingival recession. It is difficult to detect it posterially so detection is better radiographically.
Recurrent & Rampant Caries
- Recurrent caries: restoration in the radiograph was not done properly and margins were left.
- Rampant caries: quickly spread in the oral cavity, due to bad dietary habits in primary dentition.
Radiographic Techniques for Detecting Caries
- Periapical: best for assessing bone around the implant.
- Bitewing: useful for detecting interproximal caries
Pulp Exposure
- A clinical term, not a radiographic term.
- Key questions to ask: which tooth, surface, type, and severity?
- Radiographic techniques in caries detection: periapical, bitewing, panoramic, CBCT.
Detection of Caries
- Bitewing: best for detecting proximal caries
- Panoramic: gives a better overall view, useful for detecting caries.
CBCT & Radiation Dose in Dental Implantology
- CBCT is useful for cross-sectional imaging prior to implant placement (particularly when mobility, altered sensation).
- It is not used for periodic review of clinically asymptomatic implants.
- CBCT is ideal for implant retrieval, and it is more useful for cases that involve bone augmentation (sinus augmentation).
Radiographic Techniques and Limitations
- Limitations of X-ray in assessment of dental caries: superimposition (30-40% of minerals need to be lost before detection), detection of early lesions (difficult), size approximation (difficult), and pulp approximation (difficult).
Radiographic Evaluation of Dental Implants
- Various factors should be checked during radiological assessment of implants: proper healing, complications (bone loss), and follow-up.
- Bitewing: not used in implantology
- Occlusal: provides maximum bucco-lingual dimension but has no role in implantology.
- Periapical radiography is best for assessing bone around the implant.
Radiologic Follow-up of Dental Implants
- Time criteria for follow-up: monthly, 3 months, 6 months, and yearly.
Radiographic Findings
- Assess bone height
- Assess bone loss
- Assess proximity of the maxillary sinus floor
- Assess proximity of the neurovascular structures
Successful vs. Failed Implants
- Criteria for a successful implant: no mobility, no peri-implant radiolucency, bone loss less than 0.2 mm per year after the first year of loading.
Complications of Dental Implants
- Failure of osseointegration
- Implant fracture
- Screw fracture
- Loose cover screw
- Loose abutment screw
- Displaced implant
- Bone fenestration
- Injury of vital structures (nerve, sinus)
- Malposition of implant
- Injury of adjacent teeth
Planning Using CBCT
- Implant or not
- Sinus lift or not
- Time of implantation
- Fixed or removable
- Implant length, diameter
- Number of implants
- Distribution of implants
- Cervico-apical position of implant
- Angulation of the implant
- Imaging modalities for multiplanar reconstruction
Surgical Guide
- Teeth supported: for partially edentulous patients using teeth as support for the guide.
- Mucosa supported: for completely or partially edentulous patients. Interarch records are created for determining vertical dimension, and fixation screws are used in surgery.
- Bone supported: for patients with atrophied mucosa. A full thickness flap is raised to expose the bone.
Implant levels
- Level 1: CBCT information extraction
- Level 2: Implant simulation (nerve tracing, implant simulation, implant library, implant verification)
- Level 3: Surgical guide usage (designing, fabrication, scanning protocols, scanning appliance)
- Level 4: Implant navigation
Definition of Panoramic Radiography
- Extra-oral radiographic technique to capture a single image of both maxillary and mandibular dental arches and supporting structures.
- Includes principles of: scanography, tomography, and focal trough
Panoramic Errors
- Failure to remove metallic objects
- Improper placement of lead apron, with thyroid collar
- Radiopaque cone shaped artifact over the midline
- Patient position is not straight or erect. Improper Chin support
- Patient bites too far forward on the bite block
- Patient bites too far backward on the bite block
- Incorrect Frankfort plane positioning
- Patient movement during exposure
- Metallic object not removed
- Improper tongue position
Digital Radiography Types
- PSP (photostimulable phosphor)
- CCD (Charge Coupled Device)
- CMOS (Complementary Metal-Oxide Semiconductor)
Dental Radiography
- Principles and techniques: Joen lannucci, Laura Jensen Howerton
- Textbook of Dental & Maxillofacial Radiology: Freny Karjodkar
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