The clinical value of Xray images of the

The clinical value of X-ray images of the teeth and jaws Laetitia BROCKLEBANK University of Glasgow, Scotland © l. m. brocklebank

Wilhelm Roentgen 27. 03. 1845 Lennep 8. 11. 1895 Wurzburg © l. m. brocklebank

von Kölliker’s hand © l. m. brocklebank

why X-ray the teeth and jaws ? © l. m. brocklebank

Abnormalities affecting the teeth and jaws • developmental • • traumatic inflammatory • • • cystic neoplastic osteodystrophies metabolic/systemic idiopathic foreign bodies © l. m. brocklebank

Presentation plan • • • what is a radiographic image? radiographic views for teeth and jaws critical production factors types of abnormalities normal dental development examples © l. m. brocklebank

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 © l. m. brocklebank

Dental radiographic views Intra-oral • bitewings • periapicals • occlusals Extra-oral • panoramic © l. m. brocklebank

Bitewings • • side teeth (premolars and molars) symmetry of upper and lower teeth minimal overlap of adjacent teeth inter-dental bone © l. m. brocklebank

Periapical • • shows the full length of at least one tooth peri = around apical - the apex or tip of the tooth surrounding anatomical features © l. m. brocklebank

Periapical similar to a zoom image © l. m. brocklebank

Panoramic like a wide-angle view © l. m. brocklebank

Occlusal radiography © l. m. brocklebank

Critical production factors • • adequate k. V: 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 © l. m. brocklebank

Abnormalities affecting the teeth and jaws - examples • • • developmental traumatic inflammatory cystic neoplastic • • osteodystrophies metabolic/systemic idiopathic foreign bodies • • artefacts iatrogenic © l. m. brocklebank

Normal dental development • deciduous - 20: – incisors - 8 – canines - 4 – premolars - 0 – molars - 8 • permanent - 32: – incisors - 8 – canines - 4 – premolars - 8 – molars - <12 © l. m. brocklebank

Dental development and abnormalities • number – increase or decrease • • position form – individual or multiple © l. m. brocklebank

Inflammatory lesions • • tooth - dental caries (decay) supporting structures – periodontal disease - bone level – around the root tip • bone - inflammation and infection © l. m. brocklebank

Cystic lesions of the jaws • odontogenic – radicular – dentigerous – keratocyst • non-odontogenic – nasopalatine – solitary bone cyst – Stafne cavity © l. m. brocklebank

Neoplastic, odontogenic • benign – cementomas – cementifying fibroma – myxoma • • • ameloblastoma * adenomatoid odontogenic tumour calcifying epithelial odontogenic tumour © l. m. brocklebank

• ameloblastoma * Neoplastic, odontogenic • • • male, 15, clinical expansion definite root resorption thinning of cortex lingually no cortex evident buccally findings suggest a locally aggressive lesion © l. m. brocklebank

What do you see? © l. m. brocklebank

family group Bart van der Leck The family, 1921 © l. m. brocklebank

Hidden pathology © l. m. brocklebank

© l. m. brocklebank