Al-Azhar University of Gaza

Faculty of Dentistry

ORAL RADIOLOGY
Introduction To Oral Radiology
DR/ ASHRAF SHAMIA
DR/ NOOR M. ABU AMARA
Sep. 2015

Terminology

1- Radiology
2- Roentgenology
3- Dental radiology
4- Dental radiography
5- Radiograph
6- Radiation
7- Radiolucent
8- Radiopaque

 Radiology
Science that deals with application of high- energy

radiation in diagnosis, therapeutic and researches.

Roentgenology
Science that deals with application of X-ray on any
field.

 Dental radiology
It is the branch of science that deals with the use of
radiation in diagnosis of dental diseases.
Dental radiography
It is the art of producing an image or picture for intra- or
extra-oral structures on a dental film using X-ray.

 Radiograph
It is the shadow features (image) received on a

radiation-sensitive film emulsion by exposure to

ionizing radiation directed through an area or region
or substance of interest, followed by chemical
processing of the film. It is basically dependent on the
differential absorption of radiation directed through
heterogeneous media.
Radiation
It is the process of emission, propagation and
transmission of energy by atoms in the form of waves.

 Radiolucent
Objects that permitting the passage of radiant energy

with relatively little attenuation by absorption and

appear black on the film, such as silicate restoration,
pulp tissues, gingiva, and carious lesion.
Another definition; Objects partly or wholly penetrable
by roentgen rays; the image of such a material on the
film ranges from dark gray to black.

 Radiopaque
Objects that absorb X-rays and appear white on
radiograph, such as amalgam restoration, enamel, and
bone.

Another def. : Objects that not freely penetrable by

radiation.
OR Objects highly resistant to penetration by roentgen
rays; the image of such a material appears on the film
within range of gray to white.

Purposes of Dental Radiology

The purpose of dental radiography is to record images

of a patient's oral structures on film by using X-rays.
When the X-ray films are processed, the resulting
radiographs provide the dental officer with a valuable
diagnostic aid.
In the case of death, radiographs can be used to aid in
identification "Forensic Dentistry."

Radiographic examination provides important anatomical

information to determine the different pathologies and conditions
of the teeth's and tissues like bone supports:

Defects and Variations in Tooth Density

Trauma and Exodontia
Fractures
Endodontic Treatment of Teeth
Developmental Defects and Anomalies
Swellings, Cysts and Neoplasm
Metabolic Diseases
Orthodontic treatment
Presence and severity of periodontal diseases, abscesses or infections
Shape and sizes of the roots
Maxillary sinus disease
The exact locations of impacted teeth, position of third molars and the status
of develop
Cavities that can not be seen directly or in early stage, allowing patients to
receive preventive treatment.

FRACTURE

PERIAPICAL RADIOLUCENCY

ENDODONTICS

DENTINOGENESIS IMPERFECTA

DENTIGEROUS CYST

MALOCCLUSION

??

??

Radiographs

Clinical
Examination

Diagnosis

Treatment

X-Rays
Are a form of pure energy units belonging to
electromagnetic spectrum characterized by having a
very short wave length and have the ability of producing
images of the body tissues.
They are invisible, penetrative and travel with the same
speed as visible light. They are usually produced by
bombarding a target of high atomic number with fast
electrons in a high vacuum

 How are X-rays created?

When fast-moving electrons collide with matter, Xradiation is produced.
The most efficient means of generating X-rays is an Xray tube.

In it, X-rays are produced by directing a high- speed

stream of electrons against a metal target. As they
strike the atoms of the target, the electrons are stopped.
Most of their energy is transformed into heat, but a
small proportion is transformed into X-rays.

 X-ray machine consists of :

1. Tubehead : produces the x-rays

Tube: Cathode + Anode

Accessories: Filters + collimators + cones
2. Control panel: which allows you to alter the duration
of the x-ray beam (exposure time) and, on some x-ray
machines, the intensity (energy) of the x-ray beam.
3. Support arms: which allow you to move the tubehead
around the patients head .

X-ray Tubehead
degrees

PID, BID
(cone)PID = position indicating device

BID = beam indicating device

Control panel

Timer :
A/ Automatic timers
1- Direct or immediate timers: It attached to a long cord to
enable the operator to go away from the field of radiation.
Operator press on a button just to activate the exposure while the
time is pre adjusted and the exposure will stop automatically even
if the operator continuous to press the button.
2- Delayed timers: This type provide about 9 second before the
start of exposure.
B/ Manual timers
Direct type in old x-ray machines. The exposure is controlled
manually (like the clock alarm) and exposure will stop only if the
operator stop pressing on the button.

Classification of Dental Radiographic

Techniques

Intraoral Radiographic Techniques:

films located inside the mouth
Extra-oral Radiographic Techniques:
films located outside the mouth

Intra-oral Radiographic
Techniques

A- Periapical

B- Bite-wing

Paralleling
technique

Bisecting angle
technique

C- Occlusal

USES
Periapical film
(Parallel method)

Extent of alveolar bone loss

Periapical film
(Bisection method)

The whole length of teeth,

Periapical area

Bitewing film

Interproximal Caries
Alveolar bone involvement

Occlusal film

A section of maxilla or mandible

Periapical Radiography
Highlights the entire tooth.
Shows tooth apices and surrounding structures in a particular

intra oral area.

Detects changes in the bone surrounding the roots of the tooth.
Used to study crown & root length and tooth morphology.
To evaluate root apex formation.

PERIAPICAL RADIOGRAPHIC TECHNIQUES

1- BISECTING ANGLE TECNIQUE

PERIAPICAL RADIOGRAPHIC TECHNIQUES

2- The paralleling technique (long cone tech.) or
Right angle technique

Bitewing Radiography
Reveals the crown, neck and coronal third roots of both upper

and lower posterior teeth and dental arches.

Detects inter-proximal lesions.
Useful for determining the proper fit of a crown/cast
restoration and marginal integrity of fillings.

Occlusal Radiography
Shows relationship of the teeth to underlying structures in the

alveolar process (such as cysts, abscesses)

Nearly the full upper or lower arch is shown.
To determine bucco-lingual position of impacted teeth
To examine cleft palate.

Extra-oral Radiographic
Techniques

They allow the Dentist to view large areas of the jaws and skull
on a single radiograph not covered by intraoral films.
Purpose and uses:
Examine large areas of the jaws and Skull.
Study growth and development of bone and teeth.
Detect fractures and evaluate trauma
Detect pathological lesions and Diseases of the jaws.
Detect and evaluate impacted teeth.
Evaluate TMJ Disorders.

Except for the panoramic radiographs, extra-oral radiographs are

not frequently used by General practitioners, Major users are
orthodontists, prosthodontists, oral surgeons.
Orthodontists: uses lateral cephalometric radiograph to:
Measure and compare changes in Growth and development of
bone and the teeth through pre & progress and post treatment
records.

Prosthodontists: Use Facial profile radiographs (lateral

cephalometric ) to record :
The contour of the lips and the face
The relationship of the teeth before removal, this will help
them construct prosthetic appliances that look natural.

Oral surgeons: use Extra-oral radiographs extensively to:

Evaluate trauma.
Determine the location and extent of fractures.
Locate impacted teeth & abnormalities .
Malignancies .
Injuries to TMJ

Extra-oral Radiographic Techniques:

Panoramic radiograph
Skull views
PA Skull
PA Cephalogram
AP Skull
Townes view
Submento-vertex view (base of the skull)
Lateral skull Lateral cephalogram
Maxillary sinus
PA Waters view
Modifications - Grengers view
Caldwells projection
Mandible
PA Mandible
Lateral oblique views
Body
Ramus
TMJ views
Transcranial
Transpharyngeal
Transorbital
Reverse Townes view

Panoramic Radiography (OPG)

Panorex
Shows a 2-dimensional view of a half circle from ear to ear.

Purpose:
Evaluation of trauma and 3rd molars.
Evaluation of teeth development & developmental anomalies.
Evaluation of cysts , tumors.
Temporomandibular Joint Dysfunction and ankylosis.
Examination of maxillary sinuses.

( Lateral skull )
Cephalometric Radiography
It shows the entire skull from the side and the X-ray passes

from the lateral side

Purpose:
Orthodontic purpose
1.Pre and post treatment records.
2.Evaluate the growth and development
3.Facial soft tissue profile of the face
Surgeons also use it for pre and post treatment records
Trauma
Pathology
Developmental Abnormalities

Waters view Radiography

Purpose:
To Evaluate the maxillary , frontal and ethmoid sinuses.

Reverse towne Radiography

Purpose:
To examine fractures of the condylar neck of the mandible.

Submento-vertex Radiography
Purpose:
Used to show the base of the skull.
The position and orientation of the condyles.
Sphenoid sinus and fractures of the Zygomatic arch.

Advanced Radiographic
Techniques

Tomograms
Sialography
Computed tomography
MRI
Ultrasonography (USG)
Cone beam CT

Tomograms
Show a particular layer or "slice" of the mouth while blurring

out all other layers. This type of X-ray is useful for examining
structures that are difficult to clearly see for instance,
because other structures are in very close proximity to the
structure to be viewed .

Sialography
Involves visualization of the salivary glands following the

injection of a dye. The dye, called a radiopaque contrast

agent, is injected into the salivary glands so that the organ can
be seen on the X-ray film (the organ is a soft tissue that would
not otherwise be seen with an X-ray). Dentists might order this
type of test to look for salivary gland problems, such as
blockages or Sjogren's syndrome.

Computed tomography
Otherwise known as CT scanning, shows the body's interior

structures as a three-dimensional image. This type of X-ray is

performed in a hospital rather than a dentist's office.
Indications:
The diagnosis and extent of Variety of infections
Osteomyelitis
Cysts
Benign and malignant tumors
Trauma in the maxillofacial region
Lesions involving the bone
3D CT has been applied to trauma and craniofacial reconstructive surgery and used
for treatment of congenital and acquired deformities

MRI
Indications:
To evaluate the position and integrity of the disk in the TMJ.
Neoplasia involving the soft tissues, such as tongue, cheek, salivary glands,

and neck.
Determining malignant involvement of lymphnodes.
Determining peri-neural invasion by malignant neoplasms.
With contrast, enhances the image resolution of neoplasia.

Ultrasonography (USG)
Indications:

For the evaluation of

Neoplasms in the thyroid, parathyroid or salivary glands or
lymph-nodes.
Stones in salivary glands or ducts
Vessels of neck
To guide fine-needle aspiration in the neck

CONE-BEAM Computed
Tomography
A recent technology initially

developed for angiography in

1982 and subsequently applied to
maxillofacial imaging.
It constitutes of:
1. Two-dimensional digital array
providing an area detector fixed
on a rotating gantry
2. A three-dimensional (3D) cone
shaped x-ray beam

PRINCIPLE :
Cone-beam scanners use a two-dimensional digital array
providing an area detector rather than a linear detector as CT
does.
This is combined with a three-dimensional (3D) x-ray beam
with circular collimation so that the resultant beam is in the
shape of a cone, hence the name "cone beam."

APPLICATIONS :
Orthodontic treatment planning
Dental implants
Temporomandibular joints for osseous degenerative changes
Evaluation of wisdom teeth vs. mandibular nerve
Endodontic assessment
Assessment of impacted teeth, fractured teeth and jaws,

periapical infections and periodontal diseases.

Benign calcifications ( tonsilloliths, lymph-nodes, salivary
gland stones) can also be identified.

C B C T - ORTHO ,,,, Cephalo Tracing

C B C T ,,, Nerve Mapping

CBCT- TMJ view

ADVANTAGES:
Lower dose than helical
Compact design
Superior images to Panoramic
Low cost
Low heat load
High speed scanning (less than 30 secs)
DISADVANTAGES:
Worse low contrast detectability
Poor soft tissue contrast
Long scan times = motion artifacts
Slightly Inferior quality to conventional
CT
Image noise
Metal artifacts

Digital Radiography
Dental radiographs produced with a special computer create

digital images (computerized dental radiographs) that can be

displayed and enhanced on the computer monitor.
It involves the use of a radiography machine like that used for
conventional x-rays. But instead of using films, the clinician
makes digital images using a small electronic sensor or an
image receptor placed in mouth to capture the image.

ADVANTAGES

DOSE REDUCTION
IMAGE MANIPULATION
TIME
STORAGE
TELERADIOLOGY
ENVIRONMENTALLY FRIENDLY

DISADVANTAGES

COST
CROSS-INFECTION CONTROL