Radiographic assessment in paediatric dentistry
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Radiographic Assessment in Paediatric Dentistry
Presented By:
Sayfaldeen Muhannad Ali Kashmoola
Nur Alia Bt. Che Mohd Din
Supervised By:
Dr. Nur Asilah Bt. Harun
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Histroy of X-rays
Wilhelm Röntgen Dec. 1895
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Radiography in Medicine
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Radiography in Dentistry
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3
12
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Digital Radiography Device:1- The Patient2- X-Ray Generator3- Sensor4- Wireless connector between sensor and PC5- PC to view the Radiograph
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Dental X-Ray Film
clear cellulose acetate film base is coated on both sides with silver bromide, silver halide, and silver iodide.
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Processing the Film
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Rationale in taking X-Ray Should not be performed in a routine manner using the same practice for all individuals. Should only be performed when the patient
history and/or objective findings and symptomslead to the conclusion that further usefulinformation might be obtained.
If a radiograph is not expected to change diagnosis or treatment or add other useful information, it should not be taken.
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Criteria to take a radiograph
Based on objective findings/symptoms. Based on anamnestic information.
EAPD guidelines for use of radiographs in children 2003
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Based on objective findings/symptoms
1. Caries2. Pulpal and periapical pathology3. Traumatic injuries4. Problems of eruption5. Developmental anomalies6. Unexplained discolouration of teeth7. Orthodontic treatment planning and evaluation8. Evidence of swelling9. Unexplained tooth mobility10. Unexplained bleeding
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Based on objective findings/symptoms11. Deep periodontal pocketing12. Fistula formation13. Unexplained sensitivity of teeth14. Unusual spacing or migration of teeth15. Lack of response to conventional dental
treatment16. Unusual tooth morphology,17. Evaluation of growth abnormalities18. Altered occlusal relationship19. Aid in diagnosis of systemic disease
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Based on anamnestic information History of pain History of trauma to teeth Postoperative evaluation Familial history of dental anomalies
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General Indications for Radiographs
Detection of caries; Dental injuries; Disturbances in tooth development, Examination of pathological conditions other
than caries. Orthodontic treatment planning.
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Techniques of Dental radiographic views in Paediatric Dentistry
Dental Radiographs
Extraoral Intraoral
•Panoramic View•Lateral oblique/bi-molar View•CBCT
•Bitewing view•Periapical view•Occlusal view
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Bite-Wing Radiograph
horizontal Bitewing and vertical bitewing
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Indication for Bite-Wing Radiograph Detect proximal caries that cannot be
detected clinically, Estimate the extent of lesions, Monitor lesion progression, Determine pulp chamber configuration, Suspected secondary caries under old
restorations.
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Baseline bitewing
These factors should be considered for base line of radiograph for caries
relevant epidemiological data on the caries prevalence and rate of progression in the population;
caries experience; oral hygiene and dietary habits; exposure to fluorides; socioeconomic status.
Based on this knowledge, an individual risk assessment is carried out.
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The baseline examinations and intervals to the next bitewing examination in children.
Baseline bitewing examination
Interval to next bitewing examination
At age: Low caries risk High caries risk
5 years 3 years 1 year
8 or 9 years 3-4 years 1 year
12 to 16 years 2 years 1 year
16 years 3 years 1 year
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Limitation of BW
Active vs non-active lesions; Cavitated vs non-cavitated surfaces; Radiographic depth vs clinical depth.
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Periapical Radiograph
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Periapical techniques
Paralleling technique Bisecting technique
Based on Cieszynski’s rule of isometry.
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Indications for Periapical Radiograph Detection of pathologic changes associated with primary
teeth (such as apical infection/inflammation or internal resorption)
After trauma to the teeth and associated alveolar bone, Detect developmental abnormalities, Assessment of the presence and position of unerupted
teeth, Assessment of the periodontal status, Assessment of root morphology before extractions, Detailed evaluation of apical cysts and other lesions within
the alveolar bone, In endodontic/pulp treatment (Preoperative, Working length
estimation, Post condensation, Review).
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Occlusal Radiograph
The occlusal view is indicated when there is a desire to reveal the skeletal or pathologic anatomy of either the floor of the mouth or the palate.
The occlusal view taken with a large film (3X2.3 inches) and the patient is asked to bite on it.
It has two types which are: maxillary occlusal view ( Standard, oblique, and
Vertex) mandibular occlusal view (90°, 45°, oblique)
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Maxillary standard occlusal - clinical indications
Periapical assessment of the upper anterior teeth in patients unable to tolerate periapical films
Detecting the presence of unerupted canines, supernumeraries and odontomes
As the midline view, when using the parallax method for determining the bucco/palatal position of unerupted canines
Evaluation of the size and extent of lesions such as cysts or tumors in the anterior maxilla
Assessment of fractures of the anterior teeth and alveolar bone, especially useful for children
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Mandibular – true occlusal indication
Detection of the presence and position of calculi in the submandibular salivary ducts
Assessment of the bucco/lingual position of unerupted mandibular teeth by parallax technique
Evaluation of the bucco/lingual expansion of lesions in the body of the mandible like cysts, tumours or osteodystrophies
Assessment of displacement fractures of the anterior body of the mandible in the horizontal plane
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Upper standard occlusal view
Diagram showing the position of the film packet in relation to the lower arch. B Positioning from the front; note the use of the protective thyroid shield. C Positioning from the side. D Diagram showing the positioning from the side
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Upper oblique occlusal
Diagram showing the position of the film packet in relation to the lower arch for a left upper oblique occlusal. B Positioning for the left upper oblique occlusal from the front; note the use of the protective thyroid shield. C Diagram showing the positioning from the front.
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Vertex occlusal
Diagram showing the position of the cassette in relation to the lower arch. B Positioning for the vertex occlusal from the front; note the use of the protective thyroid shield. C Positioning from the side. D Diagram showing the positioningfrom the side.
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Lower 90° (true) occlusal
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Lower 45° (standard) occlusal
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Lower oblique occlusal
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Lateral oblique/bimolar radiograph
Radiograph of molars and premolars using film/sensor positioned beside the face
Useful in difficult and uncooperative patient small children, mentally/physically disable patient Can tolerate with extraoral radiograph better than intraoral
radiographs Beneficial in having a short exposure time Limitation – distortion of teeth Indication : 1. To Examine the posterior region of the mandible.2. Patients who have fractures or swelling.3. It evaluate the condition of the bone and to locate impacted
teeth or large lesions.
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LATERAL OBLIQUE
Cassette positioned against cheek and centered over the mandibular first molar area.
•The patient presses the tube side of the cassette firmly against the cheek with the palm of one hand and the thumb is placed under the lower edge of the cassette.
•Head position tilted 10 to 20 toward the side to be examined and the chin is protruded.
•The central ray directed toward the first molar region of the mandible from a point slight underneath the opposite side of the mandible and directed as perpendicular to the horizontal plane as possible
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LATERAL OBLIQUE
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Panoramic Radiograph (OPG)
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What can we gain from OPG
Presence or absence of permanent teeth and their Positions in relation to the primary teeth.
Evaluation of bony lesions and the TMJ Bone loss Estimate the age of the patient
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Indications for Panoramic Radiograph Diagnose missing and supernumerary teeth, Detect gross pathoses, Asses development of the dentition, Estimate the dental age of the patient, Detect bone fractures, traumatic cysts, Detect anomalies, In some patients with disabilities (if the
patient can sit in a chair and hold head in position).
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Parallax Technique
Two types:1. Horizontal parallax involves taking either: Two periapicals with different angulations and follow the (SLOB)rule1-4 or An upper occlusal and a periapical views.
2. Vertical parallax involves taking either: An upper occlusal (Standard) view and an orthopantomogram (OPG) A periapical view and an orthopantomogram (OPG).
http://www.midemos.com/demos/elsevier/haring/SlobRule.html
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Indication for Parallax technique Over-retention of the primary canine. Delayed eruption of the permanent canine. Absence of a upper labial canine bulge in a
10- or 11- year-old patient. Presence of a palatal bulge. Distal crown tipping of the lateral incisor.
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Adverse effects of X-ray X rays are carcinogenic. Chest x-ray vs background radiation Dental x-ray vs background radiation. Patient’s age and radiation The x-rays can cause damage by two mechanisms:1. Direct damage.
Somatic: It happens when X-ray photon or a high-energy ejected electron cause breakage of weak bonds between nucleic acids in RNA or DNA. This can cause inability to pass information, abnormal replication, or cell death. Or it might be resolved and the damage is repaired.
Genetic : Radiation-induced congenital abnormalities.
2. Indirect damage. Indirect damage occurs due to formation of free radicals inside the
cells.
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Radiation protection
Protection of staff a.Position b.Workload c.Local rules d.Good practice guidelines
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Radiation protection
Protection of patient - a. justification b.dose limitation c.quality assurance
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Justification Don’t take x-rays for fun
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Dose limitation
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Quality assurance DON’T BY X-RAY MACHINE BECAUSE IT IS
CHEAP. A yearly maintenance and periodic check up
with the manufacturer. Request for extended warranty. Quality assurance certification every two
years.
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A Good quality x-rayArea Improving methods
Radiographic technique Use film-holding/beam aiming device Careful positioning for OPG Careful selection and instruction of patients
X-rays set Regular maintenance and service
Film and cassettes Use film before expiry date
After care Mount, name and date radiograph
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Radiographic assessment
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Errors in radiographs
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http://www.dentalcare.com/en-US/dental-education/continuing-education/ce137/ce137.aspx?ModuleName=testpreview&PartID=-1&SectionID=-1
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