© l.m.brocklebank

The clinical value of X-ray images of the teeth and jaws

Laetitia BROCKLEBANK University of Glasgow, Scotland

© l.m.brocklebank

Wilhelm Roentgen

27.03.1845Lennep

8.11.1895Wurzburg

© 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 viewsIntra-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 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

© 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

• permanent - 32:– incisors - 8

–canines - 4

–premolars - 8

–molars - <12

• deciduous - 20: – incisors - 8

–canines - 4

–premolars - 0

–molars - 8

© 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

Neoplastic, odontogenic• ameloblastoma *

• 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 LeckThe family, 1921

© l.m.brocklebank

Hidden pathology

© l.m.brocklebank