Radiographic Surveys and Localization Techniques PDF

Radiographic Surveys and Localization Techniques Dr Saad Al Bayatti B.D.S., M.Sc. Oral Radiology College of Dentistry University of Sharjah [email protected] 1 Dr Saad Wahby Al Bayatti Reference Textbook • Eric Whaites, Nicholas Drage: Essentials of Dental Radiography and Radiology, 5th Ed...

Radiographic Surveys and Localization Techniques Dr Saad Al Bayatti B.D.S., M.Sc. Oral Radiology College of Dentistry University of Sharjah [email protected] 1 Dr Saad Wahby Al Bayatti Reference Textbook • Eric Whaites, Nicholas Drage: Essentials of Dental Radiography and Radiology, 5th Edition, 2013, Churchill Livingstone ISBN: 978-0-7020-4599-8 2 Dr Saad Wahby Al Bayatti Objectives • This presentation discusses the following: mouth intraoral inside the • Types of intra oral surveys surveys e tinted Rent to see issues • Guidelines for prescribing dental progress radiographs • Localization techniques or 3 Dr Saad Wahby Al Bayatti Radiographic Surveys completeview Survey: • General scanning of all teeth and their supporting structures means a survey complete view • Done to detect hidden pathologies and /or of all teeth abnormalities itsdone s • Done on 5 year basis every yrs • Individual radiographs are done on need • Done for adults and children 4 Dr Saad Wahby Al Bayatti 4 incisors are taken together it Italian.dk itffn Radiographic survey for adults periapical films lpiste i.tl im r no caninealwaysalone post horizontal 54 876 876 54 together Entitlals 3 2 1 1 2 21 12 3 3 3 3 meakingyou more 5 or less can have 3 3 12 + periapical films depends onjawsize Dr Saad Wahby Al Bayatti 45 45 depends on jawsize g horizontal 678 678 Radiographic survey for adults are flowers Bitewing films upper together 876 U 54 U 45 U 678 U 876 L 54 L 45 678 L for edentelous pt be wants to see the crown of thePt 6 4 bite-wing films Dr Saad Wahby Al Bayatti Film size 1 L alwaysalone centre lateral seriapical always centrals Kg initiationor mens missingdi Xdepth mediorate 12 buccalbma muting bitewing 4 apical per EE areas nous eden biparowgy ceased be not can or room to centrals kg PM all in sepfilms PAare taken w teeth Edent Full mouth intra oral survey film sizes in bon 7 why pathology Dr Saad Wahby Al Bayatti BW arenot taken foredent For trismusgagging take 45W Or OPG why BW for crowns Radiographic survey for adults • Composed of: • 12 (+ ) size 2 periapical films according to patients mouth size • 4 bite- wing films ( size 2) done for cases on demand • 1 upper occlusal film Problem in the floor of the mouth • 1 lower occlusal film or palate Y 8 Dr Saad Wahby Al Bayatti Radiographic survey for adults Alternatives for cases musclespasm • Severe gagging, trismus, • 4 bite- wing films ( size 2) • OPG but resolution but in.in scan all structures 9 at topenthemouth the teeth Dr Saad Wahby Al Bayatti their supporting Radiographic surveys for children 10 Dr Saad Wahby Al Bayatti Radiographic survey for children size • Done according to age of child • Could be the 1st manipulative dental procedure • Explain the procedure to the child 1 • Let him/her touch the ((camera)) and the film • Demonstrate on parent Read 11 Dr Saad Wahby Al Bayatti l Radiographic surveys for children fullcourage ofteeth dependingon X • 6 (+) size 2 or 1(pedo size) periapical films • 2 or less size 2 or 1 (pedo size) bite- wing II films • 1 upper occlusal film ( can be replaced by b size 2 periapical film) • 1 lower occlusal film ( can be replaced by b size 2 periapical film) 12 Dr Saad Wahby Al Bayatti Radiographic survey for children periapical films 6 E D 6 E D C B A AB CBA ABC be small teeth 13 Dr Saad Wahby Al Bayatti 3 C DE 6 DE 6 Radiographic survey for children Bitewing films 6ED DE6 6ED DE6 be teethare small needonly cover all 14 2 films to postteeth right I Dr Saad Wahby Al Bayatti left periapical upper occlusalfilm p R z b lower occlusal 15 film Dr Saad Wahby Al Bayatti Radiographic survey for children Alternatives • Severe gagging, trismus, • 2 or less size 2 or 1 (pedo size) bite- wing films child Syrs • OPG ya kidsbelow 5yrs OPG L ifyoure reduce but time exposure 16 usually xdo sty Dr Saad Wahby Al Bayatti Rules for Radiography for children The same basic imaging principals are followed with few exceptions: • Size 1 films are used in intra oral views • Number of films is less due to size limitation • Exposure time is reduced because of smaller teeth and lesser bony calcification compared to adults • General rule: Child Exposure = ¼ Adult Exposure not thick to stop enough ray 17 calcified bone exposure Dr Saad Wahby Al Bayatti time Guidelines for Ordering Radiographs 18 Dr Saad Wahby Al Bayatti READ 19 Dr Saad Wahby Al Bayatti Main idea exposure is kept to a minimum ALARA whats thispain called 20 Dr Saad Wahby Al Bayatti 0 how rreasonally ALA R A achievable as at Clinical Situations for the Indications of Radiographs A. Positive Historical Findings • Previous periodontal or endodontic therapy • History of pain or trauma • Familial history of dental anomalies • Postoperative evaluation of healing • Presence of implants B. Positive Clinical Signs/Symptoms • Clinical evidence of periodontal disease • Large or deep restorations • Deep carious lesions • Malposed or clinically impacted teeth • Swelling • Evidence of facial trauma • Mobility of teeth • Fistula or sinus tract infection 21 • • • • • • • • • • • • • Clinically suspected sinus pathology Growth abnormalities Oral involvement in known or suspected systemic disease Positive neurologic findings in the head and neck Evidence of foreign objects Pain and/or dysfunction of the temporomandibular joint Facial asymmetry Abutment teeth for fixed or removable partial prosthesis Unexplained bleeding Unexplained sensitivity of teeth Unusual eruption, spacing or migration of teeth Unusual tooth morphology, calcification or color Missing teeth with unknown reason Dr Saad Wahby Al Bayatti I g 2 ray I 2 ray ray fixedvertical horizon fixedv1diffhorizontal fixed vent angul diff vent angel 1 SLOB Parallelix 2 The known Object Rule head 5 Vertical x movement ray 4 Right Angle Technique Localization Techniques wecansagitseithrdistelof6 at CE decided loration woid 0 I same.gg It.su I1IdI youbut 22 coming height BILyoucantitffg.tt aegat III L.IE sYoward7whenutouhmesially fromthe 5 me Dr Saad Wahby Al Bayatti d used in endo D Localization Techniques 3D witty widthel length depths • Conventional radiography (plain radiography) shows a m two-dimensional image of a three- dimensional object • To visualize the missing 3rd dimension (depth), certain dimers procedures are followed known as the localization techniques • There are three “rules” for the localization of objects toward the buccal or lingual within the jaws using two periapical radiographs taken at different angles g all ray are 20 lookatthis BWTPA show Anteroposterior spiff lateral sideto side mediu dont show BUT xrays shows it BUT not superininterim BUTwhentakingocclusal rays 23 Dr Saad Wahby Al Bayatti ffÉ p Q How's the Localization Method Proceded • Done with two intra oral periapical films • The 1st is taken with normal vertical & horizontal angulations • The 2nd is taken with the X-ray head shifted horizontally in either mesial or distal direction same w mymovement same lingual ilb3eed is buccal shloun noabga opposite tothe 24 Dr Saad Wahby Al Bayatti Same Lingual Opposite Buccal (Parallax) (Clark in 1910) • This rule requires a fixed vertical angulation and a different horizontal anglulation for the two radiographs • If the object in question moves in the same direction as the horizontal shift of the tube head, it is toward the lingual • If the object moves in the opposite direction, it is on the buccal • If it does not move, it is in the middle of the jaw in question opp toyon indegebuccal root middle palatalroot 25 Dr Saad Wahby Al Bayatti finger a gu Parallax lingual • The image of the object FAR from the x-ray tube moves in the SAME direction of the tube movement buccal • The image of the object CLOSE to the x-ray tube moves in the OPPOSITE direction of the tube movement • S = same L =lingual O =opposite B =buccal • SLOB • If object does not move, then it is on the same of the reference point a 26 Dr Saad Wahby Al Bayatti The Known Object Rule Langlais in the early 1980s • Two radiographs are taken at different vertical or horizontal angles • A known object (buccal or lingual) is identified • The known object will have moved either up or down or mesially or distally in the two comparison radiographs 27 edenturous Saad Wahby fromAl Bayatti hehas tip ofDrroot pt do Refer tomental F F located tothe 9 extraction w y buccal HLIfig.int tipis tomesial bmedm93ameFitgd team rotated wyataraktilya3 gayrilrotqt.fr The Known Object Rule Langlais in the early 1980s isial ifmthhgyehedniitgf.fi nEmII • Some known objects are the buccal cusps, malar process of the maxilla, incisive foramen, mental foramen, external oblique ridge, genial tubercles , internal oblique ridge, etc. • Look at the unknown object and compare its movement to the movement of the known object • If the unknown object moves in the same way as the known object, it is located in the same place (either buccal or lingual) • If it moves in the opposite direction as the known object, it is opposite in location 28 Dr Saad Wahby Al Bayatti verlapping so onlyblack shown 29 c Dr Saad Wahby Al Bayatti close opp MB 1M Distal horizontal if it went tothe opp direction distally then it'slocated angulation 30 Dr Saad Wahby Al Bayatti buccaly Ex tipof root presentfedent Pt with metal foramen to locate compare it P foundbuccaly if i tookthebeam mesialy I 7 same direction as me then tipis lingual be same retained tip wentmesialy SLOB y lingered towardlingual cause movedin the same direction h premolar shown comes from mesially 31 Dr Saad Wahby Al Bayatti as me miggger lingual indexbuccal pic yo samelingual e samew movement oppbuccal at CET Piel gemmy I coronoid process 32 enamelpearl Objeit in question between located 617 Pic 2 change of horizontalangulation is is distal the objecting image also moved distally Dr Saad Wahby Al Bayatti 2 rays 1 Normal vertical Angual Vertical X-ray head movement 2 • The 2nd radiograph may be done with vertical X-ray tube movement in an upward or downward direction same principle SLOB if X ray upward me 33 structure moved in the same direction as then lingual it opp then buccal Dr Saad Wahby Al Bayatti beam downward 34 Dr Saad Wahby Al Bayatti Easy way to localize! Radiographic Definition: Objects closer to film appear sharper lingual 35 move radiopaque Dr Saad Wahby Al Bayatti lingual palatal1 be radiopaque sharper 36 Radiographic definition Dr Saad Wahby Al Bayatti Right Angle Technique 90 • It involves taking 2 radiographs one perpendicular on the other • The 1st shows two dimensions, superior- inferior and mesial – distal • The 2nd shows the mesial – distal and the buccal – lingual • Combination of the two radiographs shows the buccal – ligual and superio- inferior dimensions 37 Dr Saad Wahby Al Bayatti OPG Right angle technique OPG+Occlusal samedimensions as periapical 38 Dr Saad Wahby Al Bayatti Right angle technique Occlusal+periapical 39 Dr Saad Wahby Al Bayatti Right angle technique OPG+Occlusal 40 Dr Saad Wahby Al Bayatti I medial 41 Right Angle (Occlusal) technique Dr Saad Wahby Al Bayatti Right Angle Technique Views Taken • • • • 42 Perapical + occlusal OPG + occlusal PA skull + OPG PA skull + occlusal Dr Saad Wahby Al Bayatti soft tissues dont show x rays sothey inject on radiopaquemat mainly done for softtissues in gland Contrast Media radiopaquemedia step • The use of a radio D opaque contrast medium to visualize the soft tissues that can not be 9and in seen radio graphically e.g. inject BV since ftp.fagrenfyinjectonafc Sgt • Sialography; studying the salivary glands iodinebas material • Angiography; studying the blood vessels • Arthrography; studying the joints • Barium swallow; studying the GIT radiopaquematerial e demonstrating drinkbariumsalt 43 takeseries atpics whered Dr Saad Wahby Al Bayatti tissue 1 the bank on Submandibular Sialography 44 Dr Saad Wahby Al Bayatti treelike in winter Barium swallow 45 Dr Saad Wahby Al Bayatti 46 Dr Saad Wahby Al Bayatti it ompam ftp.t ofdisc are injected cause sensitivity Arthrography 47 Dr Saad Wahby Al Bayatti open close Arthrography 48 Dr Saad Wahby Al Bayatti fully dosed fullyopened an bossa Arthrography Aniovisum 49 Dr Saad Wahby Al Bayatti Angiography 50 Dr Saad Wahby Al Bayatti distally away 51 went away buccal mesially Dr Saad Wahby Al Bayatti so buccal mene 52 Dr Saad Wahby Al Bayatti palatal G radiopaque 53 Dr Saad Wahby Al Bayatti a lingual goeswithsame direction 54 Dr Saad Wahby Al Bayatti 55 Dr Saad Wahby Al Bayatti 15 premolar film incisor film 56 canine film Dr Saad Wahby Al Bayatti