basics of dentistry

Villa Marketing Division

Villa Sistemi Medicali SpA

Guide lines: Dental radiology


• Stomatognathic System

• General Dentistry

• Dental Specialties

Contents


• Dentistry is involved in the study, diagnosis, prevention and treatment of diseases and conditions of the oral cavity, the maxillofacial area and the adjacent and associated structures (maxillar bones, temporomandibular joints, salivary glands, neuromuscular tissues and oral mucosa) and their impact on the human body. All these components constitute the stomatognathic system (from the greek stoma, stomatos “mouth” and gnatos “maxilla”)

• This complex system consists of:

- The teeth, essential for chewing

- The parodontium, that contains the teeth

- The maxillary bones, that holds the teeth and the related structures

- The temporomandibular joint, allows the jaws to move and to open/close the mouth

- The chewing muscles, that permit the mastication

- The salivary glands, that produce saliva and, finally, the oral mucosa and the gum

Stomatognathic System


Three anatomical parts of teeth may be distinguished:

• The crown is the exposed part of the tooth

• The roots represent the part embedded in jaws: they are responsible for the position of the teeth and contain nerve endings and blood vessels. The shape and the number of the roots differ according to the tooth examined

• The neck, or cementoenamel junction (CEJ), represents the area where the enamel, which covers the anatomical crown of a tooth, and the cementum, which covers the anatomical root of a tooth, meet. Image source: Sam Fentress

Stomatognathic SystemTeeth anatomy


FDI Universal

Stomatognathic SystemDental Numerating Systems


There are various sides and surfaces of the teeth:

• The occlusal is the surface that is used for biting and chewing

• The vestibular (or facial or labial) is the closest to the cheek

• The lingual is next to the tongue

• The mesial and distal surfaces are the sides that come into contact with adjacent teeth. They are also called proximal surfaces. The mesial side faces are in the front of the mouth. The distal side faces are in the back of the mouth.

Stomatognathic System


• The periodontium consists of the bone, the connective tissue and the gum surrounding and supporting a tooth

• It is composed by:

- the alveolar bone (C)

- the periodontal ligament (I, J, K)

- the gum or gingiva (D)

- the cementum, the surface layer of the tooth

root (B)Image source: DRosenbach

Stomatognathic SystemPeriodontium


Every structure in the oral cavity (gum, teeth and muscles) is supported by two bones:

• Upper jaw: the maxillar bone or maxilla

• Lower jaw: the mandibular bone or mandible

Stomatognathic SystemMaxillary bones


• The temporomandibular joints connect the upper jaws to the mandible.

• The part of the mandible which mates to the under-surface of the disc is the condyle and the part of the temporal bone which mates to the upper surface of the disk is the glenoid (or mandibular) fossa.

• The dysfunctions of these joints can provoke serious problems:

- restricted mandibular movement, which can

cause difficulty eating or speaking

- noises during jaw movement

- headache / earache

Stomatognathic SystemTemporomandibular Joints (TMJ)





Contents


• General Dentistry involves all first aid interventions on the stomatognathic system and includes the study, the diagnostics, the prevention and the treatment of diseases, disturbs and pathological conditions of the oral cavity, the maxillofacial area and the adjacent structures and their impact on the organism

• There is a significant difference between the General Practitioner and the Specialized Dentist (Implantologist, Orthodontist, etc.). GP are the primary dental care providers for patients of all ages. They are dental professionals who take responsibility for the diagnosis, treatment and overall coordination of services to meet oral health needs.

General Dentistry


The GP frequently uses the orthopantomography (panoramic) and the intraoral exams, that allow a precise study of a single tooth or a group of teeth. It requires the use of films or digital detectors which are positioned and hold in the mouth through specific centrators.

Radiographic Exams

General Dentistry


It may be distinguished:

• Generic Intraorals: allow to visualize the anatomy of a specific element (crown, roots, gum) when a pathology is suspected. A special centrator helps holding the film (both in a hygienic disposable protection) and positioning it correctly, in order to get a precise X-rays proyection

• Bite-wing: during the exam a special “wing”- centrator is hold between the teeth. This particular radiographic projection allows a precise examination of the interproximal areas, the crown of a tooth and the periodontal bone, to promptly identify pathologies of these structures

Radiographic Exams

General Dentistry


• Periapicals: thanks to a specific film of small dimensions, it is possible to display the teeth examined in their entirety (crowns, the roots till the peeks, surrounding tissues). Periapical exams allow to identify abscesses, cysts, cracked teeth, pyorrhea, cavities, included teeth

• Posteriors: very similar to periapical projections, these exams allow to see molar area; they are taken with mouth closed

Radiographic Exams

General Dentistry


• Occlusals: during these exams the film is hold still between the two arches, over the examined area, in parallel to the occlusal plane. It is possible to obtain a projection of almost the whole upper and lower arches.

• Full-mouth: it allows to display the entire set of teeth and the surrounding alveolar bone. It is composed of 18 projections:

- 4 bite-wing

- 8 posterior periapicals

- 6 anterior periapicals

Radiographic Exams

General Dentistry





Contents


• Endodontics

• Periodontics

• Orthodontics

• Pediatric Dentistry or Paedodontics

• Gnathology

• Implantology

• Prosthodontics

• Oral and Maxillofacial Surgery

Dental Specialties


• Endodontics (from the Greek endo "inside" and odons "tooth") is the dental specialty that concerns the study and treatment of the dental pulp (containing nerves, arterioles, venules, lymphatic tissue, and fibrous tissue). Endodontists perform a variety of procedures including endodontic therapy (commonly known as "root canal therapy"), endodontic retreatment, surgery, treating cracked teeth and treating dental trauma

• The root canal therapy is one of the most common procedures. If the pulp becomes diseased or injured, the endodontic treatment is required to save the tooth. If the tooth is irremediably compromised the dentist will proceed with the explant and, eventually, will implant a new one

Dental SpecialtiesEndodontics


• The endodontist is a dentist specialized in endodontics; he/she mostly intervenes on dental pulp or endodontium.

The main interventions are canal therapy for teeth with necrotic pulp, devitalization for compromised teeth with cavity, traumas, pulpotomy, apicoectomy (tooth's root tip is removed and a root end cavity is prepared and filled with a biocompatible material), and endodontic microsurgery.



• X-ray exams are fundamental for the endodontic diagnostics, in order to reveal pathological conditions, such as cavities or pyorrea.

• In order to identify an endodontic lesion, a radiographic proyection must display both the cortical and the medullary tissues of the maxillary bones. It may be necessary to take an orthopanthomography or, rarely, a local 3D.

• The most common are the intraoral exams. In particular:

-Periapicals

-Generic Intraoral

-Posteriors



• Periodontology or Periodontics (from Greek peri "around"; and odous "tooth") is the specialty of dentistry that studies supporting structures of teeth, diseases and conditions that affect them.

The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone,cementum, and the periodontal ligament

Dental SpecialtiesPeriodontics


• Periodontal diseases take on many different forms but are usually a result of a coalescence of bacterial plaque of the gums and the teeth. They are usually called pyorrhea and may be distinguished in:

- Gengivitis: inflammation of the gum tissue, characterized by swelling, reddening, gums that are tender and painful to the touch, bleeding gums

- Periodontitis: involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth



• A periodontologist or periodontist is a dentist who is specialised in the prevention, diagnosis and treatment of gum diseases. A periodontologist can be also expert with implantation, plastic and reconstructive surgery, to restore the aesthetic of the smile

• Periodontal diseases are usually diagnosed through a set of bite-wing and periapical proyections, rarely with panoramics or 3D



• Orthodontics is the branch of dentistry that corrects teeth and jaws that are positioned improperly. Its aim is to diagnose, prevent and treat irregularities of the teeth and face, in order to:

- Get a good teeth alignment

- Obtain an efficient chewing function

- Achieve a good aesthetic of the smile

- Reach and/or improve the health of the teeth and periodontium

- Keep the results over time

Dental SpecialtiesOrthodontics


• The orthodontist is a dentist who has specialized in orthodontic branch. His/her patients are primarily children or teenagers who

need an orthodontic correction treatment. Recently, the orthodontic care has become more common among adults, in order to reduce the smile flaws

• The most common required exams are:

- Orthopanthomography (panoramic)

- Latero-lateral teleradiography of the skull

- Radiographic exam of the carpus (carpal index of growth)

- Posteroanterior radiographic exam to reveal asimmetries



• Fundamental is the Cephalometric reading in relation to landmarks, that can be executed manually or with dedicated programs, over the latero-lateral teleradiography and posteroanterior radiography (when it's necessary).

Image source: Oris Ceph


Image source: Oris Ceph


• Paedodontics is the branch of dentistry that includes the following:

- training the child to accept dentistry

- restoring and maintaining the primary, mixed and permanent dentitions

- applying preventive measures for dental caries and periodontal disease

- preventing, intercepting and correcting various problems of occlusion

• It is important to establish a comprehensive and accessible ongoing relationship between the dentist and patient, because early detection is essential to maintain oral health, modify aberrant habits and treat as simply as possible.

Dental SpecialtiesPediatric dentistry or Paedodontics


• Pediatric dentists promote the dental health of children as well as serve as educational resources for parents: program of preventative home care (brushing/flossing/fluorides), caries risk assessment, information on finger, thumb and pacifier habits, advice on preventing injuries to the mouth and teeth of children, diet counseling and information on growth and development.

• Beyond an accurate medical history, it may be useful:

- Intraoral exams

- Orthopanthomography

- Teleradiography

- Exam of the Carpus

Dental SpecialtiesPediatric dentistry or Paedodontics


Gnathology • Gnathology is a field of dental study that deals with the entire chewing apparatus,

including its anatomical, histological, morphological, physiological and pathological characteristics

Dental Specialties

• First of all, the Gnathologist takes a dental examination, the occlusion of the upper and lower jaws, that is the fitting of the upper and lower teeth against each other in order to determine how the joints and muscles of the jaws are functioning.

• The radiographic exams that may be required are: - Ortopanthomography- Extraoral TMJ- Teleradiography- Digital Tomography (Cone Beam), which can also display 3D recreation of the examined areas


• Dental implantology is a set of surgical techniques aiming at the functional rehabilitation of a patient affected by total or partial edentulism, by using dental implants, i.e. metal elements surgically inserted in the mandibular/maxillary bone or above them but under the gum. These elements are fitted with connectors to fasten them to fixed or removable prostheses, to enable chewing functionality.

• Dental implantology is subdivided in endosteal and justaosteal. The latter utilizes only grid-shaped implants with an exposed fixed head. Depending on how they are loaded, they may be made of chrome-cobalt-molybdenum if they are not destined for osteointegration, or they may be made of titanium and inserted with appropriate surgical techniques to favor the formation of bone above their structure.

Implantology

Dental Specialties


• The radiographic exams required are:

- Intraoral exams

- Orthopantomograpghy

- Implant (2D)

- Tomography(3D)

Image source: OnDemand3D by Cybermed

• Pre-prosthetic and pre-implantar surgery, which is the preparation of the alveolar bone for dental implant and prosthesis placement, are performed by the dentist or, in some cases, by a maxillo-facial surgeon

Implantology

Dental Specialties

Image source: OnDemand3D by Cybermed


• Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes.

• A prosthodontist is a dental specialist who is skilled in the replacement of missing teeth and the restoration of natural teeth. Common procedures treated by a prosthodontist may include dentures, partial dentures, fixed bridges, crowns, implants, veneers and more.

• In order to get a clear image of the tooth affected with cavity, the prosthodontist frequently uses intraoral radiography: single, bite-wing or posterior.

Prosthodontics

Dental Specialties


• Oral and maxillofacial surgery is surgical intervention to treat many diseases, injuries and defects in head, neck, face, jaws and hard and soft tissues of the oral (mouth) and maxillofacial (jaws and face) region. Treatments include:

- Dentoalveolar surgery- Surgery to insert osseointegrated (bone fused) dental implants and maxillofacial implants for attaching craniofacial prostheses and bone anchored hearing aids- Cosmetic surgery of the head and neck- Surgical treatment and/or splinting of sleep apnea, maxillomandibular advancement, mentoplasty

Oral and maxillofacial surgery

Dental Specialties


• The oral and maxillofacial surgeon is the orthopedic surgeon of the facial region. He/she is an individual who addresses problems ranging from the removal of impacted teeth to the repair of facial trauma.

• The radiographic exams required are:

- Rarely: intraoral

- Frequently: orthopantomography and tomography (3D)

Case of mandibular cyst

Oral and maxillofacial surgery

Dental Specialties


Kind Model Villa Applications

Panoramics Rotograph PlusRotograph Evo

• Adult/child panoramics• TMJ open/close mouth• Maxillary Sinus P-A• Latero-Lateral Cephs

• AP-PA Cephs• Carpus• Bite-wings

Panoramics and 3D tomography

Rotograph Evo 3D All standard panoramic exams and with 3D programs:

• Full Dentition • TMJ right/left • Sinus

Intraorals Endograph DCEndos AC/ACPVideographVideograph HDScanograph

• Intraoral exams• Periapical• Endo• Posterior

•Occlusal•Bite-wings•Full mouth series

Dental Specialties


Thank you for your attention!

Villa Sistemi Medicali Sales & Marketing Team

basics of dentistry

Health & Medicine