Interpreting Dental Radiograph PDF

In partnership with Interpreting Dental Radiograph Jiann Khaw Tutor Dentist  To introduce a framework for The interpreting Aim dental radiograph 2 Learning Outcomes: At the end of this session, you should be able to: 1. Explain the principles of int...

In partnership with Interpreting Dental Radiograph Jiann Khaw Tutor Dentist  To introduce a framework for The interpreting Aim dental radiograph 2 Learning Outcomes: At the end of this session, you should be able to: 1. Explain the principles of interpreting dental radiograph 2. Differentiate various types of dental radiograph 3. Identify radiographic anatomy and assess changes in common disease GDC Learning Outcome: 1.1.2; 1.2.5; 1.2.7. C1.15, C1.17, C2.1.4, C2.1.8, C2.3.1 3 Beyond scope of Ionising Radiation Medical Exposure this lecture to cover Regulation 2017 all aspects of dental Dental Radiography Techniques radiology but Physics of X-rays important Guidance notes for Dental considerations: Practitioners on safe use of X-ray equipment Justification for X-ray exposure: patient safety vs benefits 4 Radiographic film Source: White & Pharoah's Oral Radiology. ✘ Analog or ✓ Photo ✓ Solid chemical Stimulable state processed Phosphor detectors films plate 5 Diagnosis History Clinical Examination Special Test Radiological Examination Gopikrishna et al. (2009) Assessment of pulp vitality: a review, Int J Paed Dent, 19:pp. 3-15. 6  Interpreting Dental Radiograph Principles 7 Source: Getty Images, BBC News What is a radiograph? A captured shadow of an object with X-ray beam (‘light’) shone through it A 2D image of a 3D object Visualisation and Perception (Depth, Overlap) Source: White & Pharoah's Oral Radiology. 8  Terminology Radiolucent / Radiolucency denotes dark areas on radiograph allows more X-ray beam to pass through object Radiopaque / Radiopacity denotes light areas on radiograph blocks or does not allow X-ray beam to pass through object 9 Source: White & Pharoah's Oral Radiology. Viewing radiographs 1. Environment – room with minimal glare or light reflection 2. Viewing device with good contrast 3. Digital pixels with minimal distortion 10 Image Quality 11 Establish a viewing routine or systematic approach ✓ Wide view before narrow or focused ✓ Edge of Film ✓ Left to Right ✓ Top to Bottom ✓ Teeth ✓ Bone Source: White & Pharoah's Oral Radiology. ✓ Other – Sinus, Soft tissues, artifact? 12 Identify Anatomy ✓ ‘normal’ anatomy Enamel Dentine Pulp Lamina Dura Root Restorations Skull anatomy ✓ Variant of ‘normal’ ✓ Anomalies Source: White & Pharoah's Oral Radiology. ✓ Lesions 13 Describe lesion 1. Location 2. Lesion 3. Shape 4. Size 5. Symmetry 6. Borders 7. Relationship to other structure 14  Describe lesion 1. Location 25 (or UL5) Distal 2. Lesion Radiolucent enamel / dentine 3. Shape 4. Size Into Inner 1/3 of dentine 5. Symmetry 6. Borders 7. Relationship Close proximity to pulp to other structure 15  Interpreting Dental Radiograph Identify view types & anatomy 16 Source: Getty Images, BBC News Bitewing (BW): Horizontal View of upper and lower posterior teeth View includes posterior of canine to first molar View taken to assess: Proximal carious lesion Depth of carious lesion Pulp horn / chamber Alveolar bone crest Source: J.Khaw 17 Bitewing (BW): Vertical View of upper and lower posterior teeth View includes posterior of canine to first molar View taken to assess: Same reasons for horizontal BW Root morphology Furcation region (arrow) esp. maxillary Unerupted permanent successor Source: White & Pharoah's Oral Radiology. 18 Periapical (PA) View of whole tooth to include root and underlaying supporting alveolar bone structure View taken to assess: Root morphology Apical pathology Position of underlying structure S.L.O.B. Rule (Same Lingual Opposite Buccal) Source: Google images 19 Periapical (PA) – SLOB Rule Same Lingual Opposite Buccal Source: White & Pharoah's Oral Radiology. 20 DentoPanTomograph (DPT) [or OrthoPantomoGraph (OPG)] View of lower half of skull to include structure of maxilla and mandible View taken to assess: Position of object in relation to other structure Broad overview of maxilla and mandible View to condyles "Dental X-ray" by icethim is licensed under CC BY 2.0 21 DentoPanTomograph (DPT) Source: White & Pharoah's Oral Radiology. 22 Occlusal: Upper Anterior Occlusal View of anterior teeth including root morphology and apex View taken: To assess underlaying developing permanent successor in paediatric cases – usually following trauma Alternative to multiple PA view, if appropriate – challenging procedure, behaviour, poor compliance etc. Source: Google images 23 Cephalometric Lateral view of skull View taken: To assess position of teeth in relation to jaw and other fixed landmark of skull prior to orthodontic treatment Lateral Cephalometric Radiograph. Source: Wikimedia Commons 24 Lateral Oblique (Bimolars) View of posterior teeth View taken: where patient is not able to cooperate for BW or DPT Lateral oblique radiograph. Source: Wikiradiography 25 Cone Beam Computed Tomograph (CBCT) View of a selected section in 3 orthogonal plane (axial, sagittal, coronal) View taken to assess: Multiple view and orientation of a selected section Endo – accessory canals Oral surgery position of nerves and vessels Thickness of bone + position for implant placement care plan 26 Source: White & Pharoah's Oral Radiology.  Interpreting Dental Radiograph Identify & assess changes 27 Source: Getty Images, BBC News Alveolar bone loss Horizontal bone loss Radiolucency at furcation area of 46 and 48 denoting loss of alveolar bone 28 Carious lesion 46 mesial and distal surface has radiolucency into dentine denoting change to structure of dentine (loss of minerals) Source: Abesi et al. (2012) 29  Root Fracture Black arrow indicating radiolucency at mid-third of root; widening of periodontal ligament space. Pathology? 30 Principles of Terminology interpreting Interpreting Dental Radiograph Types of Summary Recognise Radiographic anatomy Link to: Views Clinical evaluation Record Keeping Visual aid during treatment Adaptation of diagram by S.Balian (2021) 31 Bibliography for this presentation: 1. Butt, A., Mahoney, M. & Savage, N.W. (2012) The impact of computer display performance on the quality of digital radiographs: a review. Aust Dent J, 57 Suppl 1: pp.16-23. DOI: 10.1111/j.1834- 7819.2011.01660.x 2. Gopikrishna, V., Pradeep, G. & Venkateshbabu, N. (2009) Assessment of pulp vitality: a review. Int J Paed Dent, 19: pp. 3-15. DOI: 10.1111/j.1365-263X.2008.00955.x 3. Mally, S.M. & Lam, E.W.N. (2019) White and Pharoah’s Oral Radiology: Principles and Interpretation. 8 th Edition. Missouri: Elsevier. 4. Pasler, F.A. (1993) Color Atlas of Dental Medicine: Radiology. Thieme. 5. Public Health England (PHE) & Faculty of General Dental Practice (UK) [FGDP(UK)] (2020) Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment. 2nd Edition. London: PHE & FGDP (UK). Available at: https://www.rqia.org.uk/RQIA/files/44/449bdd1c-ccb0-4322-b0df-616a0de88fe4.pdf (Accessed: 2 October 2024). 32