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Questions and Answers

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?

  • Occlusal
  • Proximal (correct)
  • Recurrent
  • Cervical (correct)

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?

<p>Bitewing (C)</p> Signup and view all the answers

List the different radiographic techniques used to detect caries.

<p>The radiographic techniques used to detect caries are Periapical, Bitewing, Panoramic, and CBCT.</p> Signup and view all the answers

Bitewing radiographs are primarily used to assess the crown of upper and lower teeth.

<p>False (B)</p> Signup and view all the answers

What are the criteria for a good bitewing?

<p>A good bitewing radiograph should have a free overlap, a good bite, and the occlusal plane parallel to the borders of the film.</p> Signup and view all the answers

What are the limitations of using X-ray in caries assessment?

<p>X-ray has limitations in caries assessment. It cannot detect early lesions, is limited in assessing the size and extent of lesions, and struggles to accurately assess pulp approximation.</p> Signup and view all the answers

What is the value of X-ray in periodontal disease assessment?

<p>X-ray plays a significant role in assessing periodontal disease by detecting bone loss, evaluating its severity, determining the extension and pattern of bone loss, identifying furcation involvement, measuring PDL space width, identifying local predisposing factors, and assessing activity.</p> Signup and view all the answers

Bitewing radiographs are the most suitable technique for detecting periodontal disease.

<p>False (B)</p> Signup and view all the answers

What are 2 common procedures for detecting bone loss in periodontal disease assessment?

<p>Two common procedures for assessing bone loss in periodontal disease are bitewing radiographs and periapical radiographs.</p> Signup and view all the answers

Which of the following radiographic techniques is typically NOT used for assessing periodontal disease?

<p>Occclusal (B)</p> Signup and view all the answers

CBCT is the gold standard for assessing periodontal disease?

<p>False (B)</p> Signup and view all the answers

What are the limitations of X-ray in periodontal diseases assessment?

<p>X-ray has limitations in periodontal disease assessment, including superimposition, its focus on remaining bone rather than bone loss, the inability to detect early bone loss, its limitation in assessing soft tissues, and its susceptibility to errors in vertical and horizontal angulations.</p> Signup and view all the answers

X-ray is a member of the ionizing radiation category. Therefore, it has biological damaging effects.

<p>True (A)</p> Signup and view all the answers

Which of the following effects of X-ray damage is NOT applicable in dentistry?

<p>Acute (B)</p> Signup and view all the answers

Which of the following categorizes the effects of ionizing radiation on the body?

<p>Direct or indirect (A), Stochastic or deterministic (B), Somatic or genetic (C), Acute or chronic (D)</p> Signup and view all the answers

What are the 3 main categories of radiation protection guidelines?

<p>Radiation protection guidelines focus on protecting the patient, the radiographer, and the general public.</p> Signup and view all the answers

What are 3 key concepts within the ALARA principle for patient radiation protection?

<p>The three key concepts within the ALARA principle are justification, optimization, and limitation.</p> Signup and view all the answers

Which of the following is a synonym for justification in the dental x-ray context?

<p>No examination unless there is a reasonable benefit (C)</p> Signup and view all the answers

What is the primary goal of the optimization principle in dental radiography?

<p>The optimization principle aims to minimize radiation exposure to patients while still acquiring the necessary diagnostic information.</p> Signup and view all the answers

What is meant by "general public" in the context of dental radiography?

<p>The &quot;general public&quot; refers to individuals who are present in the dental facility but are not directly involved in the dental procedures, including those waiting in the reception area or working in other rooms.</p> Signup and view all the answers

What is the role of a radiograph in planning for implant placement?

<p>Radiographs are essential for planning implant placement, providing information about bone quantity and quality, the location of vital structures, and the presence of any pathologies that may affect the success of the procedure.</p> Signup and view all the answers

Which of the following is NOT a major advantage of digital radiography over conventional radiography?

<p>Better professional communication (C)</p> Signup and view all the answers

The objective of bone quality is a key determinant in the implant treatment planning

<p>True (A)</p> Signup and view all the answers

Which of the following is NOT included in the pre-operative planning phase of dental implant imaging?

<p>The evaluation of osseointegration (B)</p> Signup and view all the answers

Flashcards

Radiographic Follow Up

The use of imaging techniques to monitor the status of dental implants over time.

Periapical Radiography

A type of intraoral radiograph used to assess the peri-implant bone level around individual implants.

Panoramic Radiography

A type of radiograph that captures a wide view of the jaws, suitable for assessing multiple implants.

Cone Beam Computed Tomography (CBCT)

A three-dimensional imaging technique that provides detailed anatomical information about the implant site, bone structure, and surrounding tissues. Often used for pre-surgical planning and assessing complex cases.

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Bitewing Radiography

A type of intraoral radiograph used to assess the interproximal areas of teeth. Not typically used for implant follow-up but can be helpful in assessing adjacent teeth.

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Occlusal Radiography

A type of intraoral radiograph that captures a broad view of the maxilla or mandible. Not commonly used for implant follow-up, but can be valuable for assessing larger areas.

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Paralleling Technique

A radiographic technique used to assess dental implants that involves positioning the X-ray beam parallel to the long axis of the implant and the film.

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Long Cone Technique

The radiographic technique using a long cone to minimize magnification and distortion.

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Film Holders

The use of specialized devices to hold the X-ray film in a specific position to ensure proper image quality during radiographic assessment

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The Bisecting Angle Technique

The process of making sure that the X-ray beam is directed perpendicular to the bisector of the angle formed by the tooth and the film.

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Paralleling Technique for Periapical Radiography

The ideal technique for radiographic assessment of dental implants due to its ability to minimize distortion and provide a high-resolution image. However, it can be challenging to use in areas with limited space.

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Use Panoramic Radiography for Initial Assessment

The standard recommendation for initial assessment of dental implant patients.

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Use Periapical Radiography to Supplement Panoramic Images

Supplementing panoramic radiographs with intraoral periapical radiographs to provide a more comprehensive understanding of the implant site.

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Use Cross-Sectional Imaging for Detailed Evaluation

Using cross-sectional imaging, such as CBCT, to evaluate the implant site in three dimensions.

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CBCT is the Preferred Imaging Modality for Pre-Surgical Planning

CBCT is the preferred method for pre-surgical cross-sectional imaging of dental implant sites.

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Consider CBCT for Augmentation Procedures

CBCT should be considered in specific situations, such as when augmentation procedures are needed.

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Consider CBCT After Bone Grafting

CBCT should be considered after bone reconstruction or grafting procedures to assess the healing process and bone density.

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Routine Periapical for Post-Operative Assessment

Routine periapical radiography is recommended for post-operative assessment of implants without complications.

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Panoramic for Multiple Implants

Panoramic radiographs may be used for cases with multiple implants.

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Use CBCT Post-Operatively if Needed

CBCT is used postoperatively only if the patient exhibits implant mobility or altered sensation, especially if the implant is in the posterior mandible.

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Don't Use CBCT for Routine Check-Ups

CBCT should not be used for routine periodic review of implants that are asymptomatic.

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Consider CBCT for Implant Retrieval

CBCT should be considered if implant retrieval is anticipated.

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Assess the Peri-implant Bone Level

Assess the peri-implant bone level to identify bone loss.

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Look for Radiolucencies

Assess the presence of radiolucencies indicative of bone loss or infection.

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Assess Implant Stability

Assess the stability of the implant. A loose implant may appear more radiolucent or show signs of movement.

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Assess for Peri-implantitis

Assess the presence of any signs of peri-implantitis, such as bone loss around the implant, soft tissue inflammation, or radiolucency.

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Monitor Position

Monitor the position of the implant and surrounding structures for any changes.

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Assess Prosthetic Component

Assess the prosthetic component for any signs of wear or failure.

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Follow a Standard Protocol

Follow a standard protocol for implant follow-up. This includes taking radiographs at specific intervals (e.g., 6 months, 1 year, then annually) and reviewing the images.

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Communicate with the Patient

Communicate with the patient about the results of the follow-up examination and discuss any necessary treatment or adjustments.

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Document Findings

Document the findings of the examination in the patient's chart.

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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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