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Radiology > Lecture 10 > Flashcards

Lecture 10 Flashcards

1
Q

What types of patients have specific dental needs?

A

Patients with specific dental needs include:
• Endodontic patients
• Edentulous patients

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2
Q

What does ‘edentulous’ mean?

A

‘Edentulous’ means ‘without teeth.’ An edentulous patient is a patient without teeth.

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3
Q

What are examples of patients with special dental needs?

A

Examples include:
• Patients with a hypersensitive gag reflex
• Patients with physical or developmental disabilities
• Pediatric patients
• Endodontic patients
• Edentulous patients

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4
Q

What are endodontic patients often referred to as?

A

Endodontic patients are often referred to as ‘RCT patients’ because they frequently undergo root canal therapy.

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5
Q

What is the origin of the term ‘endodontic’?

A

The term ‘endodontic’ is derived from two Greek words:
• ‘Endon,’ meaning ‘within’
• ‘Odontos,’ meaning ‘tooth’

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6
Q

What is endodontics?

A

Endodontics is a branch of dentistry concerned with diagnosing and treating diseases of the dental pulp within the tooth.

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7
Q

What does endodontic treatment typically involve?

A

Endodontic treatment involves:
1. Removal of the dental pulp (nerve tissue) from the pulp chamber and canals within the tooth.
2. Filling the empty pulp chamber and canals with materials like gutta-percha or silver points.

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8
Q

What are the challenges in receptor placement for endodontic patients?

A

Receptor placement is challenging due to poor visualization of the tooth.

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9
Q

What device can aid in positioning the receptor during endodontic procedures?

A

The EndoRay beam alignment device aids in positioning the receptor during root canal procedures. This device fits around a rubber dam clamp and provides space for root canal instruments and filling materials.

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10
Q

What does ‘edentulous’ mean, and who are edentulous patients?

A

‘Edentulous’ means ‘without teeth.’ Edentulous patients are individuals without teeth.

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11
Q

Why do edentulous patients require dental imaging examinations?

A

Dental imaging is required for edentulous patients to:
1. Detect the presence of root tips, impacted teeth, and lesions (e.g., cysts, tumors).
2. Identify objects embedded in bone.
3. Establish the position of normal anatomic landmarks (e.g., mental foramen) relative to the alveolar ridge.
4. Observe the quantity and quality of the bone present.

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12
Q

What is an alternative to a panoramic image?

A

14 periapical projections (6 anterior and 8 posterior).
Use both occlusal and periapical projections to examine the edentulous patient.

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13
Q

Why might this alternative be used?

A

It provides detailed imaging for edentulous patients when panoramic imaging is unavailable or unsuitable.

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14
Q

What differences are noted between primary and adult enamel?

A

Primary teeth are smaller with thinner enamel layers compared to adult teeth.

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15
Q

What does the term ‘panorama’ mean in dental imaging?

A

‘Panorama’ refers to an unbroken view of the entire region surrounding the observer.

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16
Q

What is shown in a panoramic image?

A

A wide view of the maxilla, mandible, and surrounding structures.

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17
Q

Why is panoramic imaging significant?

A

It captures a comprehensive view, aiding in diagnostics for both arches and adjacent areas.

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18
Q

When does the upper central incisor erupt?

A

The upper central incisor erupts at 7–8 years.

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19
Q

When does the upper lateral incisor erupt?

A

The upper lateral incisor erupts at 8–9 years.

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20
Q

When does the upper canine (cuspid) erupt?

A

The upper canine erupts at 11–12 years.

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21
Q

When does the upper first premolar erupt?

A

The upper first premolar erupts at 10–11 years.

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22
Q

When does the upper second premolar erupt?

A

The upper second premolar erupts at 10–12 years.

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23
Q

When does the upper first molar erupt?

A

The upper first molar erupts at 6–7 years.

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24
Q

When does the upper second molar erupt?

A

The upper second molar erupts at 12–13 years.

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25
Q

When does the upper third molar (wisdom tooth) erupt?

A

The upper third molar erupts at 17–21 years.

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26
Q

When does the lower central incisor erupt?

A

The lower central incisor erupts at 6–7 years.

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27
Q

When does the lower lateral incisor erupt?

A

The lower lateral incisor erupts at 7–8 years.

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28
Q

When does the lower canine (cuspid) erupt?

A

The lower canine erupts at 9–10 years.

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29
Q

When does the lower first premolar erupt?

A

The lower first premolar erupts at 10–12 years.

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30
Q

When does the lower second premolar erupt?

A

The lower second premolar erupts at 11–12 years.

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31
Q

When does the lower first molar erupt?

A

The lower first molar erupts at 6–7 years.

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32
Q

When does the lower second molar erupt?

A

The lower second molar erupts at 11–13 years.

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33
Q

When does the lower third molar (wisdom tooth) erupt?

A

The lower third molar erupts at 17–21 years.

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34
Q

What does the term ‘Panorama’ mean in the context of panoramic imaging?

A

Panorama refers to an unbroken view of the whole region surrounding an observer.

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35
Q

What does a panoramic image show in dental imaging?

A

A panoramic image shows a wide view of the maxilla, the mandible, and the surrounding structures.

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36
Q

What are the primary purposes of a panoramic image in dentistry?

A
  1. To evaluate the dentition and supporting structures.
  2. To evaluate impacted teeth.
  3. To evaluate eruption patterns, growth, and development.
  4. To detect diseases, lesions, and conditions of the jaws.
  5. To examine the extent of large lesions.
  6. To evaluate trauma.
37
Q

Why might someone suggest just taking a panoramic image instead of an intraoral radiograph?

A
  1. You can see more areas in a panoramic image.
  2. It requires less work for both the patient and the operator.
38
Q

Why can’t a panoramic image replace intraoral radiographs completely?

A
  1. Panoramic images have inferior image quality compared to intraoral projections.
  2. Panoramic images are not as sharp as intraoral projections.
  3. Even with proper technique, distortion is to be expected with panoramic images.
  4. Panoramic images cannot diagnose caries effectively when used alone.
39
Q

What are some limitations of a panoramic image in terms of diagnostic capability?

A

A panoramic image cannot be used alone to diagnose caries because of the potential distortion and lack of sharpness compared to intraoral images.

40
Q

What happens during panoramic imaging?

A

In panoramic imaging, the receptor and the x-ray tubehead move around the patient to create an image.

41
Q

How does movement affect image production in panoramic imaging?

A

The movement produces an image through a process called tomography, which allows imaging of one specific section of the body while blurring other planes.

42
Q

What is tomography?

A

Tomography is an imaging technique used to capture a specific layer or section of the body while blurring other areas.

43
Q

How does intraoral imaging differ from panoramic imaging?

A

In intraoral imaging (e.g., periapical and bite-wing images), the receptor and the x-ray tubehead remain stationary.

44
Q

What is the focal trough?

A

The focal trough, also called the image layer, is a three-dimensional curved zone where dental arches must be positioned to obtain the sharpest image.

45
Q

What happens to structures outside the focal trough?

A

Structures positioned outside the focal trough appear blurred or indistinct and are not readily visible on the panoramic image.

46
Q

What are the types of images produced during a panoramic exposure cycle?

A

Real image, double image, and ghost image.

47
Q

What is a real image?

A

A real image is a ‘true’ image formed when a structure lies between the receptor and the moving rotation center.

48
Q

What is a double image?

A

A double image occurs when a structure is penetrated twice by the x-ray beam, appearing on both sides of the receptor with the same proportions.

49
Q

What is a ghost image?

A

A ghost image is formed when an object is located outside the focal plane but close to the x-ray source. It appears blurred, magnified, and opposite to its actual location.

50
Q

Give an example of a ghost image in a panoramic radiograph.

A

Earrings can create ghost images as they are outside the focal plane.

51
Q

What is the role of the x-ray tubehead in a panoramic unit?

A

The tubehead has a collimator with a narrow vertical slit and rotates behind the patient’s head, while the receptor rotates in front.

52
Q

What is the purpose of the head positioner?

A

The head positioner ensures correct alignment of the patient and consists of a chin rest, notched bite block, forehead rest, and lateral head supports.

53
Q

What are exposure controls?

A

Exposure controls regulate the x-ray beam’s intensity and timing.

54
Q

What additional equipment is used with film-based panoramic imaging?

A

Film-intensifying screens and a cassette are used to enhance and hold the image.

55
Q

What are the types of image receptors used in panoramic X-ray units?

A

Direct digital sensors (CCD or CMOS), PSP plates, or film.

56
Q

What is required for film-based panoramic imaging?

A

Intensifying screens and a cassette holder. These are not used in digital imaging.

57
Q

What is the purpose of a cassette in film-based panoramic imaging?

A

The cassette holds extraoral film and intensifying screens.

58
Q

How should film be loaded in a panoramic cassette?

A

It must be loaded in a darkroom under safelight conditions.

59
Q

How should the imaging procedure be explained to the patient?

A

Briefly and clearly explain the imaging procedure.

60
Q

How should the lead apron be placed?

A

Without a thyroid collar, low around the neck to avoid blocking the X-ray beam.

61
Q

What objects should the patient remove before imaging?

A

Eyeglasses, earrings, piercings, necklaces, napkin chains, hearing aids, hairpins, barrettes, and intraoral prostheses.

62
Q

What is the correct spine position for panoramic imaging?

A

The patient should sit or stand ‘as tall as possible’ with straight shoulders.

63
Q

How should the patient’s teeth be positioned?

A

Bite in the groove of the bite-block, aligning teeth in the focal trough.

64
Q

What is the correct head position?

A

Align the midsagittal plane perpendicular to the floor and the Frankfort plane parallel to the floor.

65
Q

What is the correct position for the lips and tongue?

A

Lips should close around the bite-block, and the tongue should press against the roof of the mouth.

66
Q

What final instructions should be given before exposure?

A

Instruct the patient to remain still while the machine rotates during exposure.

67
Q

What should be assessed first during image evaluation?

A

Non-teeth features.

68
Q

What aspects should be evaluated in terms of overall symmetry?

A

Technique errors and artifacts.

69
Q

When should the teeth be assessed during the evaluation?

A

After evaluating other anatomical features.

70
Q

What areas are included in the panoramic image for review?

A

The panoramic image is divided into six areas for review:
1. Dentition - Teeth arranged in a smile-like curve with crowns and apices visible.
2. Ramus and Cervical Spine - Should not overlap but appear along the edges.
3. Nasal Cavity and Maxillary Sinus - Hard palate double image appears above apices of maxillary teeth.
4. Body of Mandible - Smooth, continuous inferior border.
5. Condyle - Equal size on both sides, positioned on the same horizontal plane.
6. Hyoid Bone - Appears as a double image.

71
Q

What additional capabilities do panoramic x-ray machines have?

A

They can capture:
• Cone-beam CT images.
• Cephalometric images.
• Temporomandibular joint (TMJ) imaging.
• Extraoral bite-wing images.

72
Q

What is the difference between overexposed and underexposed images?

A

• Overexposed Image: Appears excessively dark with ‘burnout’ areas.
• Underexposed Image: Appears excessively light with ‘whiteout’ areas.

73
Q

What should be considered when adjusting exposure factors?

A

Consider patient size and set kilovoltage, milliamperage, and time according to the manufacturer’s recommendations.

74
Q

Why is density and contrast important in panoramic imaging?

A

Proper density and contrast ensure visibility of anatomical structures and help avoid diagnostic errors.

75
Q

What are some common patient preparation errors in panoramic imaging?

A

• Ghost image
• Lead apron artifact

76
Q

What are common patient positioning errors in panoramic imaging?

A

• Positioning of lips and tongue
• Head turned
• Slumped posture
• Incorrect chin positioning (tipped up or down)
• Incorrect anterior teeth positioning (too anterior or too posterior)

77
Q

What can cause ghost images in panoramic radiographs?

A

Objects in the head-and-neck area that interfere with the procedure, including:
• Glasses
• Earrings or nose jewelry
• Necklaces
• Hair clips (in front of ears)
• Hearing aids
• Napkin chains
• Any removable oral prostheses (e.g., dentures, retainers)

78
Q

How can a lead apron artifact be avoided in panoramic imaging?

A

• Place the lead apron low around the neck, ensuring it does not block the x-ray beam.
• Avoid using a thyroid collar on the lead apron for panoramic imaging.

79
Q

What happens if the patient’s head is turned during panoramic imaging?

A

• The midline will not be aligned.
• The side farthest from the receptor will appear magnified.
• The side closest to the receptor will appear smaller.

80
Q

Can you provide an example of head turn error in panoramic imaging?

A

If the patient’s head is turned to the left, the teeth on the left side will appear smaller, while those on the right side will appear larger.

81
Q

What happens when the chin is tipped up during a panoramic X-ray?

A

• The condyles may not be visible or may appear near the lateral edge of the image.
• The hard palate and floor of the nasal cavity appear superimposed over the roots of the maxillary teeth.
• The maxillary incisors appear blurred and magnified.
• A loss of detail occurs in the maxillary incisor region.
• A “reverse smile line” is seen on the image.

82
Q

What are the characteristics of an image when teeth are positioned anterior to the focal trough?

A

• The anterior teeth appear “narrow” and out of focus on the image.
• Pronounced overlap of the premolars may be seen.

83
Q

What are the characteristics of an image when teeth are positioned posterior to the focal trough?

A

• If the patient’s anterior teeth are positioned too far back in the bite block or posterior to the focal trough, the anterior teeth appear “widened” and out of focus.
• The roots of the anterior teeth may appear to be cut off.

84
Q

How can patient positioning errors affect the quality of a panoramic image?

A

• Errors in positioning the lips and tongue can result in obscured anatomical structures.
• If the patient’s head is turned, the side closest to the receptor appears smaller, and the side farthest appears magnified.
• Incorrect chin positioning (too tipped up or down) can distort the image and lead to a “smile” or “reverse smile” effect.
• Misalignment of anterior teeth in the focal trough can cause them to appear blurred, narrow, or wide.

85
Q

What are the advantages of panoramic imaging?

A
  1. Field size:
    • Covers the entire maxilla and mandible.
    • Allows viewing of more anatomic structures compared to a complete mouth series (CMS).
    • Detects lesions and conditions of the jaws that may not be visible in intraoral images.
  2. Simplicity:
    • Exposure of a panoramic receptor is relatively simple.
    • Requires minimal time and training for the dental radiographer.
  3. Patient cooperation:
    • More acceptable for patients as no discomfort is involved.
    • Suitable for children or patients who cannot tolerate intraoral projections.
  4. Minimal exposure:
    • Involves only minimal radiation exposure to the patient.
86
Q

What are the disadvantages of panoramic imaging?

A
  1. Image quality:
    • Images are not as sharp as those produced with intraoral projections.
    • Cannot diagnose dental caries, periodontal disease, or periapical lesions.
  2. Focal trough limitations:
    • Objects outside the focal trough cannot be seen.
  3. Distortion:
    • Magnification, distortion, and overlapping can occur, even with proper technique.
  4. Equipment cost:
    • Panoramic x-ray units are relatively expensive compared to intraoral x-ray units.
87
Q

What are the common extraoral imaging techniques?

A
  1. Lateral jaw imaging:
    • Used to evaluate facial trauma, development, and abnormalities.
  2. Skull imaging:
    • Includes various projections like lateral cephalometric and posteroanterior views to evaluate facial growth, development, and trauma.
  3. Extraoral bite-wing imaging:
    • Primarily used for detecting interproximal decay and evaluating periodontal bone levels.
  4. Temporomandibular joint imaging (TMJ):
    • Evaluates the TMJ area for joint issues or fractures.
88
Q

What is the significance of 3-D imaging in dentistry?

A

• Provides three-dimensional views of the craniofacial region in coronal, axial, and sagittal planes.
• Useful for implant placement, identifying fractures, and detailed assessment of oral structures.

89
Q

What planes are visualized in 3-D imaging?

A
  1. Coronal plane.
  2. Axial plane.
  3. Sagittal plane.

Radiology (12 decks)

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