19.10.

06

IMAGING SYSTEMS
IN
DENTISTRY

UNDER THE VALUABLE SUPPORT AND

GUIDANCE OF:

Prof. Dr. Srinivasa Raju.

Prof. Dr. Satish Reddy.
Dr. Ravi Prakash SM.
Dr. Raghunath.

DHIR

Dentistry

By:
Dr. RUCHI
MDS- Iyr.
Deptt. Conservative
&
2
Endodontics.

CONTENTS

Introduction.
Classification of dental imaging system.
Conventional Radiography:
Intra-oral.
Extra-oral.
Temporomandibular Joint Projections
Panoramic Radiography.
Specialized Techniques:
Electric Thermography.
Tomography.
Stereography.
Scanography.
3

Digital Radiography.
Magnetic Resonance Imaging.
Nuclear Medicine
Ultrasonography.
Xeroradiography.
Arthrography.
Sialography.

Conclusion.

INTRODUCTION
The history of dental imaging system began with the discovery
of
X-rays that revolutionized the practicing medicine and dentistry
by making it possible to visualize the internal body structures.
The X-rays were discovered by Prof. Willehm Conrad Roentgen
accidently while working with cathode tube, in November
1895, in a darkened room.
But as Neil Armstrong stated for his mission to moon applies
equally well to the discovery of X-rays:
One step forward for man and a giant leap for
mankind !
5

Roentgen called the discovered rays as X-rays, since their

nature
was then unknown.
They are actually a form of high energy electromagnetic
radiations and are part of electromagnetic spectrum.
They consist of wave packets of energy.
Each packet is called a photon and is equivalent to one
quantum
of energy.
The X-ray beam, as used in diagnostic radiology, is made up
of
million of individual photons.
X-rays are produced when high speed electrons bombard a
target
material and are brought suddenly to rest, thereby,
6
producing an image on the film.

Radiographic Imaging forms the backbone of dental science.

Conventional radiography ( intra-oral and extra-oral ) began the
era of diagnostic aids in dentistry in the beginning of
nineteenth century.
But, today, increasing awareness of the importance of risks
associated with exposure to ionizing radiation and infection
control; there is introduction of faster films, improved film/
screen combinations; improved technology for complex
motion tomography; rapid developments in new imaging
modalities such as Digital Radiography, Computed
Tomography [CT], Magnetic Resonance Imaging [MRI] etc.

CLASSIFICATION OF DENTAL
IMAGING SYSTEM
CONVENTIONAL
SPECIALIZED
RADIOGRAPHY

RADIOGRAPHY
Intra-Oral Radiography:
Electronic Thermography

Tomography.

Stereoscopy.

Intra-oral Periapical

Scanography.
Radography.

Computed Tomography

Bitewing Radiography.
( CT Scans).

Occlusal .Radiography.

Magnetic Resonance

SLOB / Clarks
Imaging ( MRI ).
technique.

Ultrasonography ( USG ).
8

Extra-Oral Radiography

Joint

Skull Projections.
Lateral Mandibular
Oblique Projections.
Oral Pantamogram.
Temporomandibular
Projections.

Nuclear Medicine
(Scintigraphy)
Digital Imaging:

- Direct Digital
Imaging.
- Indirect Digital
Imaging.
-Digital Subtraction
Radiography
-Digitised Image
Interpretation.

Xeroradiography.
Sialography.
Arthrology.

1. INTRA-ORAL RADIOGRAPHY
It includes the radiographic techniques that involve
placement of
X-ray films inside the mouth.
Intra-oral radiographs can be divided into four categories:
1.

Peri-apical Projections.

2.

Bitewing Projections.

3.

Occlusal Projections.

4.

SLOB / Clarks Technique.

10

I.

PERI-APICAL PROJECTIONS

Main indications:

Detection of apical infection or inflammation.

Assessing the periodontal status.

After trauma to teeth and associated alveolar bone.

Assessment of presence and position of unerupted

teeth.

During endodontic procedures.

Pre-operative
assessment
appraisal of apical surgery.

and

post-operative
11

Detailed evaluation of apical cysts and other lesions

within
the alveolar bone.
Evaluation of Implants post-operatively.

It includes:
a.) Paralleling Technique.
Technique.

b.) Bisecting Angle

12

A.) PARALLELING TECHNIQUE: RIGHT ANGLE

TECHNIQUE
LONG CONE
TECHNIQUE.
Principle:
The X-ray film is
supported parallel to
the
long axis of the teeth
and the central ray of
the X-ray beam is
directed at right
angles
to the teeth and film.

13

Advantages:

Minimum geometric distortion of the image.

Use of long source to object distance reduces the size
of the
apparent focal spot.
The image is sharp and defined.

the

The shadow of the zygomatic buttress appears above

apices of the molars.

The periapical tissues are clearly shown with minimal

14
distortion.

The crowns of teeth are well defined to detect proximal

caries.

The horizontal and vertical angulations of the X-ray tube

head are automatically determined by the positioning
devices, if correctly positioned.

The X-ray beam is aimed accurately at the centre of the

film- all areas of film are irradiated and there is no coning
off or cone cutting.

The relative positions of the film packet, teeth and X-ray

beam are maintained irrespective of the patients head
position.

15

Disadvantages:

Film positioning can be uncomfortable to the patient

specially the posterior teeth.

Positioning the holders is difficult for inexperienced

operators.

Anatomy of mouth makes the technique difficult

eg. shallow, flat palate.

Root apices may appear very near to the edge of the

film.

Positioning the holder in lower third molar region is

16
difficult.

The technique cannot be performed satisfactorily by

using a
short focal spot to skin distance due to resultant
magnification.
The holders need to be autoclavable or disposable.

17

B.) BISECTING ANGLE TECHNIQUE

Principle:
It is based on a
simple
geometric theorem,
Cieszynskis rule of
isometry:
Two triangles are
equal when they
share
one complete side
and
have two equal
angles.

18

Advantages:

the

Comfortable positioning of film packet in all areas of

mouth.

Quick and simple positioning.

Tooth image is same as the tooth itself.

Disadvantages:
Distorted image due to use of many variables.

or

Incorrect vertical angulation results in foreshortening

elongation of the image.
Periodontal bone levels are poorly defined.

19

Shadow of zygomatic buttress overlies the roots of the

upper molars.

Coning off or cone cut may result if the central ray is not
aimed at the centre of the film.

Incorrect horizontal angulation results in the overlapping

of

the crowns and roots.

The crowns of the teeth are often distorted, thereby,

preventing the detection of proximal caries.

are

The buccal roots of the maxillary premolars and molars

often foreshortened.

20

Hence, Paralleling technique is the technique of

choice for
peri-apical radiography.
But due to lack of required armamentarium and
tedious
procedure, Bisecting Angle Technique is still
followed
in the routine practice.
Its use is recommended by the NRPB/ RCR in their
document Guidelines on Radiology Standards in
Primary
Dental Care and in the new 2001 Guidance Notes.
21

CLARKS TECHNIQUE

SAME LINGUAL
OPPOSITE BUCCAL
22
( SLOB )

II. BITEWING PROJECTIONS:INTERPROXIMAL

They are named so on the basis of original technique
where
the patient is required to bite on a small
wing attached to an intra-oral film packet.
TYPES
Horizontal

Vertical

The films are positioned either with the help of tabs

or film holding device .
Indications:
Detection of incipient, proximal carious lesions.
Detection of secondary caries.
Assessment of the inter-dental alveolar bone height
using the vertical bitewing radiographs.
23
Detection of inter-dental calculus deposits.

FILM HOLDING DEVICE

BITEWING LOOP TAB

24

Advantages:

The device is simple.

The tabs are inexpensive and disposable, so no

cross-infection.

Tabs can be used easily in children also.

If film packet holders are used then film packet

cannot be displaced by tongue.

If film holders are used, it avoids coning-off or cone

cutting of anterior part of film by approximating the
external localizing ring.

Holders are autoclavable and disposable.

25

Disadvantages:

Radiographs are not accurately reproducible, so not

ideal for monitoring the progression of caries.

Coning off or cone cut of anterior part of film is

common if tabs are used.

Some film holders are expensive.

Holders are not comfortable for children.

26

III.

OCCLUSAL TECHNIQUE

It is the intra-oral radiographic technique where Xray film is placed on the occlusal plane.
The film size is: 5.7 X 7.6 cm.
Indications:

Peri-apical assessment of the upper anterior teeth.

Detecting the presence of unerupted canines,

impacted teeth, supernumeraries and odontomes.

To evaluate the integrity of anterior, medial, and

lateral outlines of the maxillary sinus.

Evaluating the size and extent of lesions such as

27
cysts or tumors in the anterior maxilla.

Assessment of fractures of the anterior teeth and

alveolar bone.

To localize foreign bodies in the jaws and stones in

the ducts of sublingual and submandibular salivary
glands.

To examine the patients with restricted mouth

opening.

28

Various Occlusal Radiographic techniques include:

Maxillary Occlusal Projections:

Anterior Maxillary Occlusal Projection ( Topographical

)
Cross-sectional Maxillary Occlusal Projection.
Lateral Maxillary Occlusal Projection.

Mandibular Occlusal Projections:

Anterior Mandibular Occlusal Projection.

Cross-sectional Mandibular Occlusal Projection.
Lateral Mandibular Occlusal Projection.
29

ANTERIOR MAXILLARY OCCLUSAL

PROJECTION
Image field
Anterior maxilla.
Anterior floor of nasal fossa.
Teeth from canine to canine.
Projection of Central Ray:
vertical angulation: +45 0
horizontal angulation: 00
Point of entry: tip of nose.

p. 154 wp

30

CROSS-SECTIONAL MAXILLARY OCCLUSAL

PROJECTION
Location:
The palate, zygomatic processes
of the maxilla, antero-inferior
aspects of antra, teeth from
second molar to second molar,
and nasal septum.
Projection of Central Ray:
Vertical angulation: + 650
Horizontal angulation: 00
Point of entry; bridge of nose.

31
p155 wp

LATERAL MAXILLARY OCCLUSAL

PROJECTION
Image field: Quadrant of
alveolar ridge of maxilla,
inferolateral aspect of
antrum,
teeth from lateral incisor
to contralateral third
molar.
Projection; +600.
Point of entry; 2cm.
below the lateral canthus
of eye, toward the centre
of film.

32

ANTERIOR MANDIBULAR
OCCLUSAL PROJECTION
Image field: Anterior
portion of mandible,
dentition from canine
to canine,
inferior cortical border
of the mandible.
Projection of central
ray:
-100.
Point of entry; Through
chin.

33

CROSS-SECTIONAL MANDIBULAR
OCCLUSAL PROJECTION
Image

field: Soft tissue of

the floor of mouth,
lingual and buccal plate of
mandible from second
molar to molar.
Projection of central ray:
900 to the centre of film.
Point of entry: Midline
through the floor of mouth,
3cm. below the chin.

34

LATERAL MANDIBULAR
OCCLUSAL PROJECTION
Image field:
Soft tissue of half the
floor of mouth, buccal
and lingual cortical
plates of half of
mandible from lateral
incisor to third molar.
Projection of central
ray: 900.
Point of entry: Beneath
the chin. 3cm. posterior
to the chin and 3cm.
lateral to midline.

35

2. EXTRA-ORAL RADIOGRAPHY
Extra-oral radiographic examinations include all the
views made of the oro-facial region with the films
positioned
extra-orally
in
conjunction
with
intensifying screens within a cassette.
Use of Intensifying Screens;
To decrease the patient radiation exposure.

36

a.) Skull Projections.

b.) Mandibular Oblique

Lateral
Projections.

1. Postero-anterior Projection.
2.

1. Mandibular Body Projection.

Antero-posterior Projection. 2. Mandibular Ramus Projection.

3. Lateral Skull Projection.

(Lateral Cephalometric).
4. Waters Projection.
5. Reverse Townes Projection.
6. Submento-vertex Projection
( Jug Handle View/ Base or Full Axial Projection)
37

C. ORTHO PANTOMOGRAPHY ( OPG )

D. TMJ PROJECTIONS:
1.
2.
3.

Trans-cranial View ( Open and Closed Mouth).

Trans- pharyngeal View.
Trans-Orbital View.

38

POSTERO-ANTERIOR PROJECTION
Indication:

Skull examination.

Progressive changes in
mesio-lingual
dimensions.

Frontal or ethmoidal
sinuses,
nasal fossae, orbits.
Projection of central ray:
900 to the image
receptor and parallel to
patients mid-sagittal
plane at the bridge of
nose.
Distance: 30-40.

39

For Cephalometric evaluation,

FHP is perpendicular to film.

Cantho meatal line is 100 above horizontal.

Superior border of petrous temporal ridge in lower

third of the orbit.

Occlusal plane is in horizontal position.

40

POSTERO-ANTERIOR CEPHALOMETRIC
PROJECTION

41

LATERAL SKULL PROJECTION

Indications:

Skull survey.
Naso-pharyngeal soft
tissue, PNS, hard palate.
Facial growth
assessment.
Soft tissue profile.

Projection of Central Ray:

The central beam makes
900 with patients midsagittal plane and is
centered over external
auditory meatus.

42

LATERAL SKULL PROJECTION

43

Indications;

WATERS PROJECTION

PNS, zygomatic frontal

suture.
Position of coronoid
process between
maxillary and
zygomatic arch.
Sphenoid sinus.

Projection of Central Ray:

900 to the film and is
centered at the level
of maxillary sinus.

44

WATERS PROJECTION

45

Reverse Townes projection

Indications:

Condylar fracture of neck.

Medially displaced
condyle.

Postero- lateral wall of

maxillary antrum.

Projection of Central Ray:

900 to the cassette and
parallel to patients midsagittal plane and
centered at level of
condyles.

46

REVERSE- TOWNE PROJECTION

47

SUBMENTO VERTEX PROJECTION

Indication:

Base of skull.

Position and orientation of

condyles.

Sphenoid sinus.

Curvature of mandible.

Lateral wall of maxillary sinus.

Fracture zygoma
( Jug handle view).

Medial/ lateral pterygoid

plate.

Foramen f base of skull

Projection of Central Ray:
Through vertex to the centre
of film, 2cm. from a line
connecting the two condyles.
.

48

SUBMENTO VERTEX PROJECTION

49

B. MANDIBULAR LATERAL OBLIQUE

PROJECTIONS
Mandibular
Projection

Body

Indications:

Image of teeth, alveolar

ridge and body of mandible.
Projection of Central Ray;

Towards the molar- premolar

region from a point 2cm.
below the angle of mandible
of opposite side. p218 11.6

50

MANDIBULAR BODY PROJECTION

51

Mandibular Ramus
Indications:
Projection
To view third molar- retromolar area
Angle of mandible
Ramus, and
Condylar head.

Projection of central ray:

Towards the centre of the
imaged ramus, 2cm. below
the inferior border of the
opposite side of the mandible
at the area of first molar.

52

MANDIBULAR RAMUS PROJECTION

53

TMJ PROJECTIONS

Transcranial Projection.

Transpharyngeal Projection.

Transorbital Projection.

54

TRANSCRANIAL PROJECTION

55

Projection of X-ray beam:

Downward from the opposite side , through the

cranium and above the petrous ridge of the
temporal bone, at a 250 positive angle centered
through the joint.

Indications:

Identification of gross osseous changes on the

lateral aspect of the joint only.

Displaced condylar fractures.

Range of condylar motion.

56

57

TRANSPHARYNGEAL ( PARMA) PROJECTION

58

Projection of X-ray beam:

50 through the sigmoid notch and 7 80 from the

anterior.

Advantages:

Helps visualizing erosive changes of the condyles.

59

60

3. TRANSORBITAL PROJECTION
Projection of Central Ray:
Downward 100 and 300 laterally through the
ipsilateral
orbit, so that centered over the TMJ.
Advantages:
Helps viewing condylar neck fractures.

61

62

3. PANORAMIC IMAGING: PANTOMOGRAPHY.

: DENTAL PANORAMIC TOMOGRAPHY.
The radiologic technique
used for producing a
single image of the
facial structures that
includes both the
maxillary
and
mandibular
dental
arches and their
supporting
structures.

63

Principle: The dental arch, though curved, is not the

shape of an arc of a circle.
To produce the required elliptical, horse-shoe shaped focal
trough, panoramic imaging employs the principle of
narrow-beam rotational tomography while
using two or more centers of rotation.

64

Two stationary centers of rotation

65

One centre of rotation

66

SHIFTING CENTER OF ROTATION

67

INDICATIONS

To evaluate the trauma, third molars, extensive or

unique pathoses, and their associated surgical
procedures.

To evaluation tooth development.

To evaluate developmental anomalies.

68

CONTRA- INDICATIONS

Not suitable for diagnostic examinations requiring

high image resolution.

When a full mouth set of radiographs is available for

a patient receiving a general screening examination.

69

PATIENT POSITIONING AND HEAD

ALIGNMENT PARAMETERS

The dental arches are located in the centre of focal

trough.

Place the incisal edges on a bite block.

The MSP must be in the exact center of the focal

trough.

Patients occlusal plane is angled 20-300 below the

horizontal, and FHP is parallel to the floor.
70

Advantages:

Broad coverage of the facial bones and teeth.

Low patient radiation dose.

Can be used in patients who are unable to open their

mouth.

Less time consuming.

The image is easy for patients to understand, and is,

therefore, a useful teaching aid.

Positioning is relatively simple and minimal expertise

is required.
71

Disadvantages:

Images do not show fine anatomic display.

Structures or abnormalities not in the focal trough

may not be evident.

Soft tissue and air shadows can overlie the required

hard tissue structures.

The tomographic movement, together with the

distance between the focal trough and film produce
distortion and magnification of the final image.

72

Recent Development :
A recent development in panoramic tomography is the ability to
programme the equipment to only X-ray certain parts of
the jaws ( segmental panoramic image) when only specific
information is required.
This leads to the significant reduction in radiation dose.
It is the Field Limitation Technique.

73

SPECIALIZED RADIOGRAPHIC
TECHNIQUES
i.

Electronic Thermography

ii.

Tomography

iii.

Stereoscopy

iv.

Scanography

v.

Digital radiography
Direct Digital Radiography
Indirect Digital Radiography
Digital Subtraction Radiography
Digitized Image Interpretation

vi.

Computed Tomography (CT SCAN)

74

vi.

Magnetic Resonance Imaging (MRI)

vii.

Ultrasonography (USG)

viii.

Nuclear medicine (Scintigraphy)

ix.

Xeroradiography

x.

Sialography

xi.

Arthrography

xii.

RadioVisioGraphy (RVG)
75

ELECTRONIC THERMOGRAPHY
THERMOGRAPHY-Methods of temperature pattern
resolution and analysis
ABNORMAL TEMPERATURE PATTERNS

Alteration in blood supply

Presence of inflammation
SENSORS

Thermistors

Liquid crystals

Infrared scanners (small tv cameras)

PROTOTYPE MIGHT BE A USEFUL METHOD IN

Tooths vitality.

Atypical odontalgia.

Internal derangement of TMJ

76

TOMOGRAPHY
TECHNIQUESTo image more clearly
objects lying within a
plane of interest.

-Process of Motion
Unsharpness.

77

DISADVANTAGES OF
LINEAR TOMOGRAPHY
-

Streaked/ Parasitic Lines

.

No optimal blurring.

Inconsistent
magnification.

TYPES OF
TOMOGRAPHIC
MOVEMENTS

Indications of Tomography

High contrast anatomy.

TMJ.

Dental implants.

78

TOMOGRAPHIC LAYER ____

1______________
TOMOGRAPHIC ANGLE
WIDE ANGLE TOMOGRAPHY

Uses >100 angulation.

Layers as thin as 1mm can be imaged.

Best used for studying dense tissues.

NARROW ANGLE TOMOGRAPHY (ZONOGRAPHY)

Uses < 1O0 angulation.

Tissue thickness up to 25mm. is sharply imaged.

Best used for studying soft tissues.

79

LINEAR TOMOGRAM OF TMJ

OF TMJ

SPIRAL TOMOGRAM

80

XERORADIOGRAPHY
TWO TYPES
1-

MEDICAL XRG SYSTEM : Mammography.

Cephalography.

2-

DENTAL XRG SYSTEMS: Dental pathologies.

ADVANTAGES

Pronounced edge enhancement.

A choice of positive and negative display.

Good details.
81

Wide exposure latitude.

No need of x-ray films.

Less radiation required than e-speed films.

DISADVANTAGES

High cost.

Only marginally better images than conventional

radiography.

RECORDING MEDIA:

Selenium plate - retains charge on it.

is semiconductor.

82

MECHANISM
X-ray Exposure.
Charge pattern
on selenium
coated plate.
Lines of force
produced as a
result of
difference in
charge densities
on plate surface.
Toner distribution
83
on plate.

NUCLEAR MEDICINE
SCINTIGRAPHY / RADIONUCLIDE
SCANS

RADIOPHARMACEUTICLES

Radioactive elements or compounds

18F-,
99mTcO4- , 113M In+++
Non radioactive carrier compounds
Labelled with a radioactive isotope
67 Ga labelled citrate.
99 M Tc labelled polyphosphate.
125 I
labelled human albumin.
Of all, 99 M Tc is the most frequently used isotope.

RADIOACTIVE DETECTORS

Gamma cameras.

Rectilinear scanner.

84

PROCEDURE OF RADIONULIDE
IMAGING

85

SODIUM IODIDE CRYSTAL

Converts photon energy into fluorescent emission /

scintillation.

PHOTOMULTIPLIER TUBE
Detects and amplifies the scintillations.
Relays it to console.

OSCILLOSCOPE
Displays the emission pattern
Allows precise patient positioning
86

The images are displayed on:

Polaroid Film: Low resolution images.

White dots on a black background.

X-ray film High resolution Images.

Black dots on a white background.

87

Salivary Gland Scanning:

Dynamic Study:

Nose faces imaging head.

30- 120 s. images are taken.
Yields information regarding vascularity.

Static Study:

30-40 min.
Head turned laterally.
Demonstrates anatomy of salivary Glands and ability
to produce and secrete saliva.
Finally, 1% Citric acid given.

Demonstrates: Stimulated secretory capability.

88

Indications and Interpretations:

Acute, Chronic Inflammations.
Tumors.
Auto- Immune Diseases.

89

Bone Scans:

10- 15 mci
given i.v.

TcO4- labelled phosphate compound

99m

Uptake quantity and rate of bone deposition.

Uses:

Bone grafts.

Extent of lesions and infections in jaws.

Planning of surgical margins.

TMJ Diseases.

As a research tool.
90

Tumor Scans:

TcO4- cannot differentiate between Inflammation

and Hot Spots.

Overcome by the use of Galium citrate scans.

99m

Overall Advantages of Scintigraphy;

More sensitive to early changes than conventional
radiographs.
Overall Disadvantages:
Poor image.
Not economical.
Radiation exposure is high.
91
Confusion between neoplasia and inflammation.

INCREASED UPTAKE OF RADIOISOTOPE IN

INFLAMMATORY REGIONS IN MAXILLA AND
MANDIBLE

92

COMPUTERIZED TOMOGRAPHY
(CT SCAN)
INTRODUCTION:
By Godfrey Housefield, 1972.
Three important factors made CT possible:

Scintillation of certain crystals sodium iodide and

cesium iodide.

Advent of electronics.

Revolution in computer sciences.

93

ADVANTAGES:
X-ray beam is limited to tissue section under study.
-

No scattered radiation produced, therefore no image

degradation.

X-ray detectors used in CT are highly efficient

collecting 100% of incident photons.

Inherent noise in CT systems is less than 0.5 %

Since image is recorded electronically, it can be

displayed with wide range of contrast settings
without the need to repeat the scan.

Combining consecutive CT scans, a 3-D image of the

object can be accurately reconstructed.
94

LIMITATIONS OF CT :

Costly, expensive to maintain.

Number of patients that can be scanned per standard

work day is limited.

Scan times are relatively long.

Motion of the structures during scanning will degrade

the image.

Special artefacts are produced to high contrast

discontinuities and peculiar curvilinear anatomic areas.

CT Scan is available only in axial plane

95

Uses of CT in maxillofacial region:

To see anatomically precise location of the lesion and

extension and extension.

It is of unique value in delineating those lesions that

have both osseous and soft tissue extension.

Involvement of Infra-temporal, parapharyngeal

spaces, skull base can be easily determined.

To distinguish between benign and malignant lesions.

To assess the extent of infection in maxillary facial

region.

Using i.v contrast materials, sinus diseases are

diagnosed.

96

Improves staging of malignant tumors.

To documents the results of irradiation and

chemotherapy.

To locate the fractures precisely.

To diagnose TMJ pathologies.

97

X-RAY TUBE
PATIENT

SCINTILLATION
DETECTOR

98

3600 rotation of scanner.

One projection made every
1/3 of a degree= 1080
projections that make
1image
Image matrix.

Interpolaration
3-D CT Image

99

pic in three sections

100

ULTRASONOGRAPHY (USG)

Audible frequency 1,500-20,000 Hz.

Diagnostic USG 1-20 MHz.

Scannner generate electrical impulse.

TRANSDUCER

Ultra- high frequency sound waves.

101

TRANSDUCER

Most important component is a thin

piezo - electrical crystal which is made up of a
great number of dipoles arranged in a
geometric pattern
(most widely used dipole is PZT ).

It serves as both a transmitter and a receiver.

ACOUSTIC IMPEDENCE OF TISSUES =

DENSITY X Beam angle of
incidence.

REAL TIME IMAGING.

102

pic

103

MAGNETIC RESONANCE IMAGING

( MRI )

MRI uses non-ionizing radiation from the radio frequency

band of the electromagnetic spectrum.
Indications:

Assessment of intra-cranial lesion involving particularly

the posterior cranial fossa, the pituitary and the spinal
cord.

Tumor- staging: Evaluation of the site, size and extent

of all soft tissue tumors including nodal involvement
involving all areas in particular:
salivary glands.
tongue and floor of mouth.
pharynx and larynx.
sinuses.
104
orbits.

Investigation of the Temporo-mandibular Joint to

show both the bony and the soft tissue components
of the joint including the disc position. MRI may be
indicated :

doubt.

When diagnosis of internal derangement is in

As a pre-operative assessment before disc

surgery.

Implant assessment.

105

Advantages:

Ionizing radiation is not used.

No adverse effects.

Image manipulation available.

High- resolution images can be constructed in all

planes ( using three dimensional volume techniques).

Excellent differentiation between different soft tissues

is possible and between normal and abnormal
tissues, thereby, between benign and malignant
disease and between recurrence and post-operative
effects.

Useful in determining intra-medullary spread.

106

Disadvantages:

Bone does not give an MR signal, a signal is only

obtainable from bone marrow.

Scanning time can be long and is thus demanding on

the patient.

It is contra-indicated in patients with certain types of

surgical clips, cardiac pace makers, cochlear
implants and in the first trimester of pregnancy.

Equipment tends to be claustrophobic and noisy.

Metallic objects, eg. endotracheal tubes need to be

replaced by non- ferromagnetic alternatives.
107

Equipment is expensive.

The very powerful magnets can pose problem with

siting of equipment.

Bone, teeth , air and metallic objects all appear

black making differentiation difficult.

108

MAGNETIC RESONANCE IMAGE OF TMJ

109

DIGITAL RADIOGRAPHY
It allows for

Image acquistion.

Manipulation.

Storage.

Retrieval.

Transmission.
110

COMPONENTS

Electronic sensor / detector (CCD / CMOS).

Analog to digital converter (digitizer).

A computer.

Monitor / printer.
TYPES OF DIGITAL RADIOGRAPHY :

Direct Digital Radiography (RVG).

Indirect Digital Radiography.

Digital Subtraction Radiography.

Digitized Image Interpretation.

111

DIGITAL IMAGE ACQUISTION AND DISPLAY

Image from radiographic film.
captured

Detector ( CCD)
Image.

Analog Output Signal.

Digitised in the Computer ( 256 shades of gray ).

Storage.

Printout.

112

Transmission.

DIGITIZATION

Digitizer measures the voltage of the analog output

signal and assigns a number from 0 to 256 ,
according to the intensity of voltage

The 256 voltage levels are displayed on the screen

as 256 shades of gray .

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DIRECT DIGITAL RADIOGRAPHY (RVG )

Radio : X-ray unit and Image detector ( CCD ).

Visio : Converts the output signal from CCD to a

digital system that is recognizable by the computer.

Graphy : Data storage unit and a printer.

Advantages:

Immediate image display.

Ability to manage image contrast and density.

Significant dose reduction as compared to direct

exposure films.

114

Disadvantages:

Decreased image resolution and contrast as

compared to film radiology.

Expensive.

Indications:

Detection of periodontal bone loss.

Detection of early or incipient caries.

During Root Canal Treatment.

115

INDIRECT DIGITAL RADIOGRAPHY

Scanner
or
camera.

photomultiplier tube

or

video

Advantages:

Ability to manipulate digitized image: Optimum

contrast and density can be obtained.

Allows for storage and transmission.

Disadvantages:

May result in loss of information during processing

(scanning).
116

DIGITAL SUBTRACTION RADIOGRAPHY

Applications:

Early diagnosis of minute periodontal defect and

carious lesions.

Evaluation of early changes in mandibular condyle

position and integrity of articular surface.

Assessment of osseous remodelling around implants.

Advantages:

Very sensitive to detect even minute change of .12mm.

Contrast can be further enhanced with colour.

Disadvantages:

Demands for identical alignment of X-ray tube, film and

patient position for two exposures.
117

STEREOSCOPY
Invented by J. Mackenzie Davidson in 1898.
Principle:
Uses stereoscope that uses mirrors or prisms to
coordinate the accomodation and convergence of
the viewers eyes so that brain can fuse the two
images.

118

Indications:

Evaluation of bony pockets.

Determination of root configurations of teeth that

require endodontic therapy.

Assessment of the relationship of the mandibular

canal to the roots of unerupted mandibular third
molars.

Assessment of bone shape, when placement of

dental implants is considered.

119

Advantages:

Educational value.

Understanding of normal anatomy is simplified.

Location of small intra-canal calcifications and multiple

foreign bodies in dense or thick body sections.

To evaluate the relationships margins of bony fractures.

Disadvantages:

High radiation exposure.

Long patient positioning.

More time consuming.

120

SCANOGRAPHY
Principle:
Uses a narrow, collimated, fan- shaped beam of radiation
to scan an area of interest, sequentially producing
image data relative to this area on to moving film,
much the same as in panoramic radiography.
Advantages:

Higher contrast with perception of greater detail

since collimation of beam reduces the amount of
radiation scattered to the film during exposure.
eg. Soredex.
Scanora.

Perform both rotational and linear scanography.

121

ROTATIONAL SCANOGRAPHY:

The beam of radiation rotates about a fixed axis that is

pre-determined based on the area to be imaged.
It produces two or four scanograms.
Multiple images are produced. Any two can be used as
stereoscopic pairs.

LINEAR SCANOGRAPHY:

The X-ray film and scanner move in a linear fashion,

thereby, scanning the area of interest.
It is similar to Straightened out OPG.
Capable of both P-A and lateral linear scanning pf the
maxillary facial complex.
More optimal image contrast is produced.

122

ARTHROGRAPHY
Principle:
Technique in which an
indirect image of
the disk is obtained
by injecting a
radiopaque
contrast agent into
one or both joint
spaces under
fluoroscopic
guidance during
open and closing
movements.

123

Indication:

To assess disk position, function and morphology

and integrity of diskal attachments .

Disadvantages:

The procedure is invasive.

There may be allergy to non-ionic iodine contrast

agent and infection.

Post-operative discomfort.
124

SIALOGRAPHY
A radiographic technique wherein radiopaque
conttrastagent is infused into the ductal system of a
salivary gland before imaging.
Armamentarium:

Lacrimal probe.

Canula.

Disposable syringe.
Contrast Agents:

Lipid soluble : eg. Ethoidal .

Lipid- insoluble: eg. Sinografin.

125

Indications:

To evaluate chronic inflammatory diseases of

salivary glands.

To evaluate any ductal pathoses.

To detect any tumor in salivary duct.

Contra- indications:

Any Acute infection of salivary gland .

Any known sensitivity to iodine.

Immediately anticipated thyroid function tests. 126

If a patient has to undergo both Sialography and

Scintigraphy, he should first be imaged for
Scintigraphy, since, intra-venous injection of
dye may inflame the ducts and ductal
epithelium is liable to rupture and spill the dye
to the salivary gland.

127

CONCLUSION
With the advent of science and technology, recent
advances have been done in the field of dental
radiology. But, due to lower socio-economy,
conventional radiography that makes use of
radiographic films is used .
Hence, there is need to develop imaging systems
that combine simple technique and equipment while
maintaining quality and infection control at
reasonable costs.

128

REFERENCES

White and Pharoah, Oral Radiology: Principles and

Interpretation, 5th. edn., Mosby Publications.

Eric Whaites, Essentials of Oral Radiology, 2nd edn.,

Mosby Publications.

Anil Govindrao Ghom, Text Book of Oral Medicine, 5th

edn., Jaypee Publishers.

J. Oral Surg. Oral Med. Endodont. Radiol, 1999, Vol.

88, 100-104.

J. Oral Surg. Oral Med. Endodont. Radiol, 2002, Vol.

129
94, 131-135.

J.

Oral Surg. Oral Med. Endodont. Radiol.,2004, Vol.

33 3A, 408-412.

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