Xray - Week 9 PP Flashcards
Importance of Interpretation
A lot of information about the teeth and supporting bone is obtained from image interpretation
- All dental images must be carefully reviewed and interpreted.
- Image interpretation is of paramount importance to the dental professional and plays a vital role in detection of diseases, lesions, and conditions of the teeth and jaws that cannot be identified clinically.
Who interprets images?
Any dental professional with training in interpretation can examine images.
This will involve identification of:
- normal anatomy
- dental restorations, dental materials, and foreign objects
- Dental caries
- periodontal disease
- traumatic injuries and periapical lesions
- Common artifacts and errors
Interpretation vs. Diagnosis
Interpretation
◦ An explanation of what is viewed on a dental image
Diagnosis
◦ The identification of disease by examination or analysis
* The final interpretation and diagnosis are the responsibilities of the dentist
* Dental hygienists and dental assistants are restricted by law from rendering a diagnosis
When are Where are images interpretated?
- It is best to have images taken at the beginning of the appointment and interpreted immediately after mounting in the presence of the patient
- Suspicious or questionable areas can be examined by the dentist or dental hygienist to obtain additional information or confirm a suspected problem
How is interpretation documented?
- All dental images must be reviewed & interpreted
- Interpretation must be documented
Interpretation must be documented and include:
- Date of exposure
- Number/type of images
- Evaluation of diagnostic quality
- List of limiting factors, retakes, or additional images needed
- Description of teeth
- Description of bone and supporting structures of teeth
- Detcription of artifacts
- indication of any areas that require additional images or clinic evaluation/confirmation
Images may be an educational tool in the dental setting…
- The patient may be educated through discussion of normal findings on dental images
- Specific problems and areas of concern may be identified
Why do you think that dental image interpretation is important for you as a dental assistant?
To be able to explain what is shown on the image to the patient
Normal Anatomy in Radiographs
The correct identification of normal radiographic anatomy will ensure a correct placement of
radiographs prior to an exposure and correct mounting technique.
Importance of Anatomy in Radiology - Film Placement
Promotes critical thinking and problem-solving to ensure all the necessary anatomy will be present in the radiograph after an exposure.
Importance of Anatomy in Radiology - Film Mounting
To understand where films are placed in the mount so they are easy to read for diagnosis.
Descriptive terms - in oral cavity affecting xrays
Tubercle - small bump or nodule
Tuberosity - rounded prominence
Canal – tube-like passageway through bone that contains nerves and blood vessels
Foramen – opening or hole that permits the passage of nerves and blood vessels
Fossa – broad, shallow, scooped-out, or depressed area
Sinus – hollow space, cavity, or recess
Dental Anatomy: The tooth - radiographic identifiable features of the tooth
Enamel - most radiopaque
◦ Dentin – less radiopaque
◦ Pulp cavity and canal(s) - radiolucent
Types of Bone
Cortical Bone - compact, dense layer of bone, appears radiopaque
Cancellous Bone - soft, spongey bone located between the cortical bone, appears radiolucent
Periodontal Ligament
the PDL shows as the space between the root of the tooth and the wall of the tooth socket. Appears as a thin radiolucent line aroundthe root of the tooth
The Alveolar Bone Crest
The most coronal portion of alveolar bone found between teeth
If it looks flat, deflated - indication of periodontal disease
Maxillary Anterior Landmarks
- Incisive Foramen
- Median palatine suture
- Nasal Septum
- Nasal cavity/fossa
Incisive Foramen
An opening or hole in the bone that is located at the midline of the anterior portion of the hard palate located between the maxillary central incisors
Median Palatal Suture
The immovable joint between the two palatine processes of the maxilla
Nasal Septum
A vertical bony wall that devides the nasal cavity into the right and left nasal fossae
Nasal Cavity / Fossa
A large radiolucent area above the maxillary incisors (separated betweeen the nasal septum)
Maxillary Posterior Landmarks
- Maxillary sinus
- Maxillary tuberosity
- Inverted Y
- Hamulus
- Zygomatic Process
- Nutrient Canals (Nerve Canal)
Maxillary Sinus
A large radiolucent area bordered by an irregular radiopaque line located above the apices of the premolars and molars
Maxillary Tuberosity
A rounded prominence of bone that extends posterior to the third molar region
Inverted Y
The intersection of the maxillary sinus and the nasal cavity
Hamulus
A radiopaque hook-like projection posterior to the maxillary tuberosity area
Zygomatic Process
Appears as a J or U shape radiopaque above the maxillary molars - this is your cheekbone!
Nutrient Canals
Tiny, tubelike passageways through bone, which contain blood vessels and nerves that supply maxillary teeth and interdental areas
common to landmark these nerves before exraction of wisdom teeth
Mandibular Anterior Landmarks
- Genial Tubercle
- Lingual Foramen
- Mental ridge
Genial Tubercle
Tiny bumps of bone on the linual aspect of the mandible
appears radipaque
Lingual Foramen
A tiny opening or hole in bone located on the internal surface of the mandible
appears radiolucent
Mental Ridge
a Line of bone located on the external surface of the anterior portion of the mandible, extending from the pre-molar region to the midline slopping upwards
Mandibular Posterior Landmarks
- Mental foramen
- Mandibular canal
- Mylohyoid ridge
- External oblique line (or ridge)
- Ramus
- Submandibular Fossa
Mental Foramen
An opening or hole in bone located on the external surface of the mandible near the mandibular near the mandibular premolars. Supplies nutrients to the lower lip
Mandibular Canal
A tubelike passageway that travels the length of the mandible. Houses the inferior alveolar nerve and blood vessles
Mylohyoid ridge
A line of bone located on the internal surface of the mandible. Extends from the third molar down and toward the premolar area
External Oblique Ridge
Also known as the external oblique line, it is a linear prominence of bone located on the external surface of the body of the mandible
Ramus
A slightly radiopaque vertical band posterior to the maxillary and mandibular molars
Submandibular Fossa
A radiolucent area in the molar region below the mylohyoid ridge
Purpose of interpreting dental images while patient is present
The dental professional should interpret all dental
images while the patient is present
▪ When dental images are interpreted without the patient present, some important clinical information is not available
Identification of Restorations
- Amalgam restorations
- Gold restorations
- Stainless steel and chrome crowns
restorations - Post and core restorations
- Porcelain restorations
- Composite restorations
- Acrylic restorations
Amalgam Restorations - One-Surface
These appear as distinct, small, round or void radiopacities
They may be seen on buccal, lingual, or occlusal surfaces
Amalgam Restorations - Large two-surface and multisurface
Appear radiopaque and are characterized by irregular outlines or borders
Amalgam Restorations - Amalgam Overhangs
Extensions of amalgam seen beyond the crown portion of a tooth in the interproximal region
- Disrupts natural cleansing contours of the tooth, traps food and plaque and contributes to bone loss
Amalgam Restorations - Amalgam Fragments
- Fragments of amalgam may be inadvertently embedded in adjacent soft tissue during restoration of a tooth
-They appear as dense radiopacities with irregular borders
Gold Restorations - Crowns and Bridges
Gold Restorations appear completely radiopaque and unlike amalgam restorations, exhibit a smooth marginal outline
- Gold crowns and bridges appear as large radiopaque restorations with smooth contours and regular borders
Gold Restorations - Onlas
Gold onlays seen on maxillary premolars
Note the distinct outline and contours
Restorations - Stainless Steel and Chrome Crowns
-Appear radiopaque but not as densely radiopaque as amalgam or gold
- outlines are margins appear smooth and regular
- Some areas may appear “see-through” on an image
Restortations - Post and Core
These can be seen in
endodontically treated
teeth
The core portion
resembles the prepared
portion of a tooth
crown, and the post
portion extends into the
pulp canal
Porcelain Restorations
All-porcelain crowns
and bridges
Appearance of porcelain restoratoins is slightly radiopaque and resembles the radiopacity of dentin
a thin radiopaque line outlining the prepared tooth that represents cement may be evident through the slightly radiopaque porcelein crown
Restorations - Porcelain-fused-tometal crown
The metal component appears completey radiopaque and the porcelain component appears slightly radiopaque
Restorations - Composite
Composite restorations may vary in appearance from radiolucent to slightly radiopaque
depending on the composition of the composite material
Restorations - Acrylic Restorations
Acrylic is the least dense of all nonmetallic restorations and appears radiopaque or barely visible on a dental image
These are often used as an interim or temporary crown or filling
Restorative dentistry - Base materials
Are used to as cavity liners placed on the floor of a cavity preparation to protect the pulp
The appear radiopaque less radiodense than amalgam
Restorative dentistry - metallic pins
Are used to enhance retention of amalgam or compostie
The appear as cyndrical or screw shaped radiopacities
Endodontics - Gutta Percha
Gutta Percha is a claylike material used to fill pulp canals
Appears radiopaque similar to base materials, is less radiodense than metallic restorations
Endodontics - Silver points
These are used to fill pulp canals
they are very radiopaque, similar to other metallic materials, appear more radiodense than gutta percha
Prosthodontics - complete dentures
*Patients should be instructed to remove all complete and partial dentures before dental images are taken
A complete denture that is not removed gives the illution of rootless or “floating” teeth
Prosthodontics - removable partial dentures
An RPD with a metal base with acrylic saddles appears densley radiopaque where metal is present and slightly radiopaque in the areas of acryllic
Orthodontics - bands
Orthodontic bands, brackets and wires may be observed on dental images
- they have a chracteristic appearance
Oral Surgery - Implants
Implants are being used with increased frequency
The appearance varies based on the shape and design of the implant used
Oral Surgery - Suture wires, metalic splints and plats, bone screws, and stabalizing arches
Used in oral surgery to stabalized fractures of the maxilla and mandible
Identification of Objects - Earrings
Earrings and ghost images can be seen on a panoramic images.
Identification of Objects - Necklaces
A metallic necklace appearing as a radiopaque loop in the region of the mandible.
Identification of Objects - Nose Jewelry
A maxillary anterior periapical image exposed ith nose jewelry in place.
Identification of Objects - Eyeglasses
The metal framework of the sides of eyeglasses can be seen on panoramic images. Appears as a radiopacity on dental images
Identification of Objects - Hearing Aids
Hearing aids can be seen on panoramic images.
If they contain any metal components, they should be removed prior to exposure of extraoral images
Identification of Objects - Shrapnel
Shrapnel or small metal fragments that scatter outward from an exploding device may be viewed on dental images
