© l.m.brocklebank the clinical value of x-ray images of the teeth and jaws laetitia brocklebank...
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The clinical value of X-ray images of the teeth and jaws
Laetitia BROCKLEBANK University of Glasgow, Scotland
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Wilhelm Roentgen
27.03.1845Lennep
8.11.1895Wurzburg
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von Kölliker’s hand
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why X-ray the teeth and jaws
?
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Abnormalities affecting the teeth and jaws• developmental
• traumatic
• inflammatory
• cystic
• neoplastic
• osteodystrophies
• metabolic/systemic
• idiopathic
• foreign bodies
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Presentation plan• what is a radiographic image?
• radiographic views for teeth and jaws
• critical production factors
• types of abnormalities
• normal dental development
• examples
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Image - radiographic image
• a pictorial representation of a part of the body
• a record of the pattern of attenuation of the X-ray beam after it has passed through matter
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Dental radiographic viewsIntra-oral
• bitewings
• periapicals
• occlusals
Extra-oral
• panoramic
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Bitewings
• side teeth (premolars and molars)
• symmetry of upper and lower teeth
• minimal overlap of adjacent teeth
• inter-dental bone
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Periapical
• shows the full length of at least one tooth
• peri = around
• apical - the apex or tip of the tooth
• surrounding anatomical features
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Periapical similar to a zoom image
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Panoramic like a wide-angle view
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Occlusal radiography
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Critical production factors• adequate kV: 60-70 for intra-orals
• fastest image receptor available – F, E or digital
• correct positioning: use of film holders
• correct horizontal and vertical angulation
• appropriate collimation
• correct exposure time
• proper processing facilities
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Abnormalities affecting the teeth and jaws - examples• developmental
• traumatic
• inflammatory
• cystic
• neoplastic
• osteodystrophies
• metabolic/systemic
• idiopathic
• foreign bodies
• artefacts
• iatrogenic
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Normal dental development
• permanent - 32:– incisors - 8
–canines - 4
–premolars - 8
–molars - <12
• deciduous - 20: – incisors - 8
–canines - 4
–premolars - 0
–molars - 8
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Dental development and abnormalities• number
– increase or decrease
• position
• form– individual or multiple
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Inflammatory lesions• tooth - dental caries (decay)
• supporting structures–periodontal disease - bone level
–around the root tip
• bone - inflammation and infection
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Cystic lesions of the jaws• odontogenic
– radicular
–dentigerous
–keratocyst
• non-odontogenic–nasopalatine
–solitary bone cyst
–Stafne cavity
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Neoplastic, odontogenic• benign
–cementomas
–cementifying fibroma
–myxoma
• ameloblastoma *
• adenomatoid odontogenic tumour
• calcifying epithelial odontogenic tumour
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Neoplastic, odontogenic• ameloblastoma *
• male, 15, clinical expansion
• definite root resorption
• thinning of cortex lingually
• no cortex evident buccally
• findings suggest a locally aggressive lesion
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What do you see?
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family group
Bart van der LeckThe family, 1921
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Hidden pathology
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