Interpreting Dental Radiograph GN PDF

In partnership with Interpreting Dental Radiograph Jiann Khaw Tutor JUSTIFICATION = Dentist Radiograph only justified if taking the radiograph out weighs the harm caused to patient.  To introduce a framework for...

In partnership with Interpreting Dental Radiograph Jiann Khaw Tutor JUSTIFICATION = Dentist Radiograph only justified if taking the radiograph out weighs the harm caused to patient.  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  2nd year 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 Difficult to use - less flexible 5  If you can see enough clinically will the radiograph show anything different or new? Is Diagnosis it justified? History Medical history Dental history Social history What can you see in the patients Clinical Examination mouth? Special Test Cold test (endo-frost) Severity 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  Multiple sides (Buccal and lingual/palate) in one 2D image 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 DARK - Less dense - X- Radiolucent / Radiolucency ray beam passes through (soft tissues)  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 WHITE - More dense (mineralised) areas - X-ray does not pass through as easily as soft tissues. 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 Reflection will cause distortion 10  Image Quality Grade X-ray after processing - is it diagnostically acceptable, does it show you what you need 11  Consistency helps reduce cognitive stress. Establish a Aids to look at whole radiograph without missing details. viewing routine Sinus - radiolucent with compact bone border or systematic approach  Wide view before narrow or focused  Edge of Film  Left to Right  Top to Bottom  Teeth  Bone  Other – Sinus, Soft Source: White & Pharoah's Oral Radiology. 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  UL5/25 distal radiolucency within enamel into Describe dentine Close to pulp - inner 3rd of dentine lesion 1. Location 2. Lesion 3. Shape 4. Size 5. Symmetry 6. Borders 7. Relationship to other structure Caries is a process started by biofilm causing demineralisation of tooth - outcome is carious lesions A good bitewing should cover distal of 3 to distal of 7. 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  Most common 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 Very rare Specific area U/L with roots 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 S Source: White & Pharoah's Oral Radiology. 18  Whole length of tooth and root along with supporting structures 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  Good overview of anatomical features Incidental findings 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  Usually used for uncooperative children and for trauma 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  Might see for trauma patients Common in ortho - lateral view 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  Not very clear due to overlaps. Lateral Oblique (Bimolars) View of posterior teeth View taken:  where patient is not able to cooperate for BW or DPT Children who cannot cooperate, much more comfortable. Lateral oblique radiograph. Source : Wikiradiography 25  Implant placements Specialised endodontic treatment High radiation!!! 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 Less minerals - radiolucent 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 presenta8on: 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. 2 nd 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