Essentials of Dental Radiography and Radiology E-Book : Essentials of Dental Radiography and Radiology E-Book

This is a new edition of a classic text that presents all of the information that a dental student needs to know in order to safely capture high-quality clinical images and accurately interpret their findings. In this latest edition, both traditional methods of imaging and new modalities are included, such as cone beam CT, and the author team has been expanded to bring a fresh approach to the subject area. Written in an accessible manner which avoids unnecessary detail, each page spread has been carefully designed to ensure clarity of understanding by the reader to ensure both exam success and confidence and safety in the clinical situation. Topics address the whole curriculum and range from the physics of imaging to radiation protection and image interpretation. Suitable for undergraduate students and post-graduates alike, this book has become essential reading for all readers who intend to practice clinical dentistry. Provides a comprehensive account of the radiology and radiography topics usually examined at undergraduate and postgraduate level Clear and accessible approach to the subject makes learning especially easy More than 1100 illustrations present clinical, diagnostic and practical information in an accessible manner Written by a world authority on the subject area Contains recent classifications and advanced imaging modalities including cone beam CT imaging techniques An online, regularly updated, summary of the current UK ionising radiation legislation and guidance on good practice for all dental practitioners as well as a summary of the latest UK guidance in relation to the use of Cone Beam CT (CBCT) equipment An all new online self assessment questions and answers module. Questions have been specially prepared for each of the 32 chapters to enable students to assess their own knowledge and understanding as they prepare for examinations. These include a mixture of single best answer and multiple correct answer questions, drag and drop identification of radiological anatomy as well as new examples of various pathological conditions to enable practice of diagnostic skills. Includes a new chapter on cone beam technology and numerous examples of advanced imaging throughout the book Essentials of Dental Radiography and Radiology, Fifth Edition (2013) 493pp. 978-0-7020-4599-8 Front cover 1 Half title page 2 Dedication 3 Essentials of Dental Radiography and Radiology 4 Copyright page 5 Table of Contents 6 Preface 8 Acknowledgements 9 List of colour plates 10 Additional online material 11 1 Introduction 12 1 The radiographic image 14 Introduction 14 Nature of the radiographic image 14 The radiographic shadows 14 The three-dimensional anatomical tissues 16 The limitations imposed by a two-dimensional image and superimposition 18 Appreciating the overall shape 18 Superimposition and assessing the location and shape of structures within an object 18 Quality of the radiographic image 20 Positioning of the image receptor, object and X-ray beam 20 X-ray beam characteristics 21 Perception of the radiographic image 22 Effect of partial images 22 Effect of contrast 22 Effect of context 23 Common types of dental radiographs 23 2 Radiation physics, equipment and radiation protection 24 2 The production, properties and interactions of X-rays 26 Introduction 26 Atomic structure 26 Useful definitions 27 Main features of the atomic particles 27 Nuclear particles (nucleons) 27 Protons 27 Neutrons 27 Electrons 27 Summary of important points on atomic structure 27 X-ray production 27 Main features and requirements of an X-ray tube 29 Practical considerations 29 Interactions at the atomic level 29 Heat-producing collisions 29 Important points to note 30 X-ray-producing collisions 30 X-ray spectra 31 Continuous spectrum 31 Summary of important points 31 Characteristic spectrum 31 Summary of important points 32 Combined spectra 32 Summary of the main properties and characteristics of X-rays 32 Interaction of X-rays with matter 33 Definition of terms used in X-ray interactions 33 Interaction of X-rays at the atomic level 33 Photoelectric effect 33 Summary of the stages in the photoelectric effect 33 Important points to note 33 Compton effect 34 Summary of the stages in the Compton effect 35 Important points to note 35 3 Dental X-ray generating equipment 36 Ideal requirements 37 Main components of the tubehead 37 Focal spot size and the principle of line focus 38 Main components of the control panel 38 Circuitry and tube voltage 40 Other X-ray generating apparatus 41 4 Image receptors 42 Radiographic film 42 Direct-action (non-screen) film 42 Uses 42 Sizes 42 The film packet contents 42 The radiographic film 43 Film orientation 43 Indirect-action film 43 Uses 43 Indirect-action film construction 44 Characteristics of radiographic film 44 Optical density (OD) 44 Characteristic curve 44 Background fog density 45 Film speed 45 Film sensitivity 45 Film latitude 45 Film contrast 45 Film gamma and average gradient 46 Resolution 46 Intensifying screens 46 Action 46 Useful definitions 47 Fluorescent materials 47 Rare earth and related screens 47 Calcium tungstate screens 48 Cassettes 48 Types 48 Construction 49 Important practical points to note 49 Film storage 49 Screen maintenance 49 Digital receptors 49 Uses 49 Solid-state sensors 50 Intraoral sensors 50 Construction and design 51 CCD (charge-coupled device) 51 CMOS (complementary metal oxide detectors) 51 Extraoral sensors 52 Photostimulable phosphor storage plates 53 Plate construction and design 53 5 Image processing 56 Chemical processing 56 Theory 56 Stage 1: Development 56 Stage 2: Washing 57 Stage 3: Fixation 57 Stage 4: Washing 57 Stage 5: Drying 57 Practical methods 57 Manual processing 57 Manual processing cycle 57 Processing solutions 58 Important points to note regarding development 58 Important points to note regarding fixing 58 Automatic processing 58 Automatic processing cycle 59 Advantages 59 Disadvantages 59 Self-developing films 59 Advantages 59 Disadvantages 59 Computer digital processing 60 Digital image 60 Computer input 60 Solid-state sensors 60 Phosphor plates 61 Computer processing theory 61 Image manipulation 62 Brightness 64 Contrast 64 Hard copy printed images 66 Advantages 66 Disadvantages 66 6 Radiation dose, dosimetry and dose limitation 68 Dose units 68 Radiation-absorbed dose (D) 68 Equivalent dose (HT) 68 Effective dose (E) 69 Collective effective dose or collective dose 72 Dose limits 72 Dose rate 73 Estimated annual doses 73 Dose limitation 73 Patients 74 Examinations directly associated with illness 74 Systematic examinations (periodic health checks) 74 Examinations for occupational, medico-legal or insurance purposes 74 Examinations for medical research 74 Radiation workers 74 Classified workers 75 Non-classified workers (most dental staff) 75 General public 75 7 The biological effects associated with X-rays, risk and practical radiation protection 76 Radiation-induced tissue damage 76 Direct action or damage 76 Indirect action or damage 76 Classification of the biological effects 77 Tissue reactions (deterministic effects) 77 Stochastic effects 77 Cancer induction 78 Heritable effects (genetic effects) 79 Effects on the unborn child 79 Summary of the harmful effects important in dental radiology 79 Practical radiation protection 79 Practical radiation protection of patients 80 Clinical judgement 80 Equipment 81 Radiographic technique 82 Specific radiation protection requirements for female patients of childbearing age 82 Practical radiation protection of the general public 83 Practical radiation protection of radiation workers 84 Monitoring 84 Film badges 85 Advantages 85 Disadvantages 85 Thermoluminescent dosimeters (TLDs) 86 Advantages 86 Disadvantages 86 Optically stimulated luminescence dosimeters (OSLDs) 86 Advantages 86 Disadvantages 86 Personal electronic dosimeters (PEDs) 86 Advantages 86 Disadvantages 86 Footnote 86 3 Radiography 88 8 Dental radiography – general patient considerations including control of infection 90 General guidelines on patient care 90 Specific requirements when X-raying children and patients with disabilities 91 Control of infection 92 Main infections of concern 92 Important point to note 92 Infection control measures 92 Important points to note 94 Footnote 94 9 Periapical radiography 96 Main indications 96 Ideal positioning requirements 96 Radiographic techniques 96 Paralleling technique 97 Theory 97 Film packet/sensor holders 97 Positioning techniques 101 Positioning using solid-state digital sensors 101 Bisected angle technique 111 Theory 111 Vertical angulation of the X-ray tubehead 111 Horizontal angulation of the X-ray tubehead 111 Positioning techniques 112 Using film packet/digital sensor holders 112 Using the patient’s finger 113 Positioning using film packets and digital phosphor plates 114 Comparison of the paralleling and bisected angle techniques 118 Advantages of the paralleling technique 118 Disadvantages of the paralleling technique 118 Advantages of the bisected angle technique 118 Disadvantages of the bisected angle technique 118 Conclusion 120 Positioning difficulties often encountered in periapical radiography 120 Problems posed by mandibular third molars 120 Possible solutions 121 Problems of gagging 122 Possible solutions 122 Problems encountered during endodontics 123 Possible solutions 123 Problems of the edentulous ridge 125 Possible solutions 125 Problems encountered in children 125 Assessment of image quality 126 Ideal quality criteria 126 Subjective rating of image quality 127 Assessment of rejected films and determination of errors 127 Patient preparation and positioning (radiographic technique) errors (Fig. 9.44) 127 10 Bitewing radiography 130 Main indications 130 Ideal technique requirements 130 Positioning techniques 132 Using image receptor holders with beam-aiming devices 132 Advantages 134 Disadvantages 134 Using a tab attached to the image receptor 134 Advantages 135 Disadvantages 135 Resultant radiographs 135 Assessment of image quality 137 Ideal quality criteria 137 Subjective rating of image quality 137 Assessment of rejected films and determination of errors 137 Patient preparation and positioning (radiographic technique) errors (Fig. 10.13) 137 11 Occlusal radiography 140 Terminology and classification 140 Maxillary occlusal projections 140 Mandibular occlusal projections 140 Upper standard (or anterior) occlusal 140 Main clinical indications 140 Technique and positioning 140 Upper oblique occlusal 142 Main clinical indications 142 Technique and positioning 142 Lower 90° occlusal 143 Main clinical indications 143 Technique and positioning 143 Lower 45° (or anterior) occlusal 144 Main clinical indications 144 Technique and positioning 144 Lower oblique occlusal 145 Main clinical indications 145 Technique and positioning 145 12 Oblique lateral radiography 146 Introduction 146 Terminology 146 True lateral positioning 147 Oblique lateral positioning 147 Main indications 147 Equipment required 147 Basic technique principles 147 Cassette position 147 Patient’s head position 148 X-ray tubehead position 148 Positioning examples for various oblique lateral radiographs 149 Important points to note 149 Bimolar technique 151 13 Skull and maxillofacial radiography 154 Equipment, patient positioning and projections 154 Standard occipitomental (0° OM) 155 Main indications 155 Technique and positioning 155 30° occipitomental (30° OM) 157 Main indications 157 Technique and positioning 157 Posteroanterior of the skull (PA skull) 159 Main indications 159 Technique and positioning 159 Posteroanterior of the jaws (PA jaws/PA mandible) 161 Main indications 161 Technique and positioning 161 Reverse Towne’s 163 Main indications 163 Technique and positioning 163 Rotated posteroanterior (rotated PA) 165 Main indications 165 Technique and positioning 165 True lateral skull 167 Main indications 167 Technique and positioning 167 Submentovertex (SMV) 169 Main indications 169 Technique and positioning 169 14 Cephalometric radiography 172 Main indications 172 Orthodontics 172 Orthognathic surgery 172 Equipment 172 Traditional film-based equipment 173 Digital equipment 175 Using phosphor plates 175 Using solid-state sensors 175 Main radiographic projections 176 True cephalometric lateral skull 176 Technique and positioning 176 Cephalometric tracing/digitizing 177 Main cephalometric points 177 Main cephalometric planes and angles 178 Cephalometric posteroanterior of the jaws (PA jaws) 179 Technique and positioning (Fig. 14.9) 179 15 Tomography and panoramic radiography 182 Introduction 182 Tomographic theory 183 Principle of tomographic movement 183 Broad-beam linear tomography 184 Slit or narrow-beam linear tomography 184 Narrow-beam rotational tomography 185 Important points to note 185 Panoramic tomography 185 Selection criteria 187 Equipment 187 Control panel 187 Equipment movement 187 Technique and positioning 191 Patient preparation 191 Equipment preparation 191 Patient positioning 191 Important points to note 191 After exposure 191 The importance of accurate patient positioning 191 Technique variations 192 Normal anatomy 193 Real or actual shadows (see Fig. 15.20 and 15.21) 194 Ghost or artefactual shadows (see Fig. 15.22) 194 Advantages and disadvantages 195 Advantages 195 Disadvantages 195 Assessment of image quality 197 Ideal quality criteria 197 Subjective rating of image quality 198 Assessment of rejected films and determination of errors 198 Patient preparation errors (Fig. 15.27) 198 Patient positioning errors (Figs 15.28 and 15.29) 198 Equipment positioning errors (Fig. 15.30) 198 Footnote 198 16 Cone beam computed tomography (CBCT) 204 Main indications 204 The developing dentition 204 Restoring the dentition 204 Surgical applications 205 Equipment and theory 205 Stage 1 – Data acquisition 206 Stage 2 – Primary reconstruction 206 Stage 3 – Secondary or multiplanar reconstruction 206 Technique and positioning 209 Patient preparation 209 Equipment preparation 210 Patient positioning 210 Normal anatomy (Figs 16.8–16.12) 212 Radiation dose 217 Advantages and disadvantages 217 Advantages 217 Disadvantages 217 Assessment of image quality 218 Footnote 218 17 The quality of radiographic images and quality assurance 220 Introduction 220 Film-based image quality 220 Contrast 220 Subject contrast 220 Film contrast 221 Fog and scatter 221 Image geometry 221 Characteristics of the X-ray beam 221 Image sharpness and resolution 221 Practical factors influencing film-based image quality 221 Typical film faults 222 Film too dark (Figs 17.1 and 17.2) 222 Possible causes 222 Film too pale (Fig. 17.3) 222 Possible causes 222 Film with inadequate or low contrast (Figs 17.1–17.3) 223 Possible causes 223 Image unsharp and blurred (Fig. 17.4) 223 Possible causes 223 Film marked (Fig. 17.5) 223 Possible causes 223 Patient preparation and positioning (radiographic technique) errors (Fig. 17.6) 227 Intraoral technique errors 227 Panoramic technique errors 227 Quality assurance in dental radiology 228 Terminology 228 Quality assurance programme 228 Quality control procedures for film-based radiography 228 Image quality and film reject analysis 228 Film reject analysis 229 Patient dose and X-ray equipment 229 Darkroom, image receptors and processing 231 Darkroom 231 Image receptors 232 X-ray film 232 Cassettes 232 Processing 233 Chemical solutions 233 Processing equipment 234 Working procedures 234 Staff training and updating 234 Audits 234 Digital image quality 235 Practical factors influencing digital image quality 235 Typical digital image faults 235 Solid-state detectors 235 Photostimulable phosphor plates 237 Computer software malfunction 238 Quality control procedures for digital radiography 239 Digital image quality assessment and image reject analysis 239 Image reject analysis 239 Digital equipment 239 Solid-state sensors 239 Phosphor plates 240 Monitors 241 Footnote 241 18 Alternative and specialized imaging modalities 242 Introduction 242 Contrast studies 242 Types of contrast media 242 Harmful effects of contrast media 244 Important point to note 244 Complications 244 Patients particularly at risk 244 Main causes of complications 244 Prophylactic measures to minimize complications 244 Main contrast studies used in the head and neck 244 Main indications for angiography in the head and neck 245 Radioisotope imaging 245 Radioisotopes and radioactivity 245 Radioisotopes used in conventional nuclear medicine 245 Main indications for conventional isotope imaging in the head and neck 246 Advantages over conventional radiography 246 Disadvantages 246 Computed tomography (CT) 248 Equipment and theory 248 Image manipulation 250 Window level and window width 250 Reconstructed images 250 Main indications for CT in the head and neck 250 Advantages over conventional film-based tomography 251 Disadvantages 251 Ultrasound 251 Equipment and theory 251 Main indications for ultrasound in the head and neck 252 Advantages over conventional X-ray imaging 252 Disadvantages 254 Magnetic resonance (MR) 254 Equipment and theory 254 Main indications for MR in the head and neck 256 Advantages 256 Disadvantages 256 4 Radiology 258 19 Introduction to radiological interpretation 260 Essential requirements for interpretation 260 Optimum viewing conditions 260 The nature and limitations of different radiographic images 261 Critical assessment of image quality 262 Film-captured images 262 Radiographic Technique (see Fig. 19.3) 262 Exposure factors and film density (see Fig. 19.4) 262 Processing 262 Digitally captured images 263 Radiographic Technique 263 Image processing 263 Detailed knowledge of normal anatomy 263 Detailed knowledge of pathological conditions 264 Systematic approach 264 The entire radiograph 264 Specific lesions 264 Comparison with previous images 265 Conclusion 265 20 Dental caries and the assessment of restorations 266 Introduction 266 Classification of caries 266 Levels of disease 266 Diagnosis and detection of caries 267 Occlusal caries 267 Approximal caries 267 Secondary or recurrent caries (caries developing adjacent to a restoration) 267 Radiographic detection of lesions of caries 267 Radiographic assessment of caries activity 268 Radiographic appearance of caries lesions 268 Other important radiographic appearances 271 Residual caries 271 Radiodensity of adhesive restorations 271 Cervical burn-out or cervical translucency 271 Important points to note 273 Dentinal changes beneath amalgam restorations 273 Limitations of radiographic detection of caries 273 Radiographic assessment of restorations 276 Critical assessment of the restoration 276 Assessment of the underlying tooth 276 Limitations of the radiographic image 277 Suggested guidelines for interpreting bitewing images 278 Overall critical assessment 278 Technique (film or digitally-captured images) 278 Exposure factors (film-captured images) 278 Processing (film-captured images) 278 Image processing (digitally-captured images) 278 Systematic viewing 278 21 The periapical tissues 280 Introduction 280 Normal radiographic appearances 280 The periapical tissues of permanent teeth (Fig. 21.2) 281 Important points to note 281 The periapical tissues of deciduous teeth (Fig. 21.3) 281 The periapical tissues of developing teeth (Fig. 21.4) 283 The effects of normal superimposed shadows 283 Radiolucent shadows 283 Important points to note 283 Radiopaque shadows 283 Radiographic appearances of periapical inflammatory changes 285 Types of inflammatory changes 285 Cardinal signs of acute inflammation 285 Hallmarks of chronic inflammation 285 Treatment and radiographic follow-up 288 Other important causes of periapical radiolucency 290 Suggested guidelines for interpreting periapical images 290 Overall critical assessment 290 Technique (film or digitally-captured images) 290 Exposure factors (film-captured images) 291 Processing (film-captured images) 291 Image processing (digitally-captured images) 291 Systematic viewing 291 22 The periodontal tissues and periodontal disease 292 Introduction 292 Selection criteria 292 Important points to note 293 Radiographic features of healthy periodontium 293 Important points to note 293 Classification of periodontal disease 294 Radiographic features of periodontal disease and the assessment of bone loss and furcation involvement 295 Gingival diseases 295 Periodontitis 295 Terminology 295 Chronic periodontitis (Figs 22.5–22.11) 296 Aggressive periodontitis (Figs 22.12, 22.13) 300 Abscesses of the periodontium 300 Evaluation of treatment measures 302 Limitations of radiographic diagnosis 303 23 Implant assessment 304 Introduction 304 The Brånemark system 304 Main indications 305 Treatment planning considerations 305 Clinical examination 305 Radiographic examination 306 Radiographic information provided 307 Important points to note 307 Postoperative evaluation and follow-up 310 Criteria for success 310 Radiographic evaluation (see Figs 23.7–23.9) 310 Footnote 312 24 Developmental abnormalities 314 Introduction 314 Classification of developmental abnormalities 314 Anomalies of the teeth 314 Abnormalities in number 314 Missing teeth 314 Additional teeth (hyperdontia) 314 Abnormalities in structure 314 Genetic defects 314 Acquired defects 315 Abnormalities in size 315 Abnormalities in shape 315 Anomalies affecting whole teeth 315 Anomalies affecting the crowns 315 Anomalies affecting roots and/or pulp canals 315 Odontomes 315 Abnormalities in position 315 Delayed eruption 315 Other positional anomalies 315 Skeletal anomalies 315 Abnormalities of the mandible or maxilla 316 Micrognathia 316 Macrognathia (prognathism) 316 Other mandibular anomalies 316 Cleft lip and palate 316 Localized bone defects 316 Other rare developmental diseases and syndromes 316 Typical radiographic appearances of the more common and important developmental abnormalities 316 Radiographic assessment of mandibular third molars 324 Radiographic views used 324 Radiographic interpretation 324 Lower third molar assessment 324 Angulation (see Fig. 24.36) 324 The crown 324 The roots 325 The relationship of the apices to the ID canal 325 The depth of the tooth in the alveolar bone 325 Winter’s lines (see Fig. 24.40) 325 Using the roots of the second molar as a guide (see Fig. 24.41) 327 The buccal or lingual obliquity 327 Lower second molar assessment 328 The crown 328 The roots 328 Assessment of the surrounding bone 328 Radiographic assessment of unerupted maxillary canines 331 Assessment of the canine size and shape and the surrounding tissues 331 Radiographic views used (see Fig. 24.50) 331 Radiographic interpretation 331 The crown 331 The root 331 Surrounding structures 331 Assessment of the position of the canine – localization 332 Main localization methods 332 The principle of parallax 332 Parallax in the horizontal plane 333 Parallax in the vertical plane 335 Localization using cross-sectional tomography and cone beam CT 336 25 Radiological differential diagnosis – describing a lesion 338 Introduction 338 Detailed description of a lesion 338 Site or anatomical position 338 Size 339 Shape 339 Outline/edge or periphery 340 Discrete or well-defined outlines, which may also be: 340 Non-discrete or poorly defined outlines, which may: 340 Relative radiodensity and internal structure 340 Effects on adjacent surrounding structures 341 The teeth 341 Surrounding bone 341 Surrounding soft tissues 341 Time present 342 Footnote 342 26 Differential diagnosis of radiolucent lesions of the jaws 344 Introduction 344 Step-by-step guide 344 Step I 344 Step II 344 Step III 345 Step IV 345 Step V 345 Typical radiographic features of cysts 347 Inflammatory odontogenic cysts 347 Radicular (dental) cyst (Fig. 26.2) 347 Residual radicular cyst (Fig. 26.3) 348 Developmental odontogenic cysts 348 Lateral periodontal cyst (Fig. 26.4) 348 Dentigerous (follicular) cyst (Fig. 26.5) 349 Odontogenic keratocyst (keratocystic odontogenic tumour) (Fig. 26.6) 350 Non-odontogenic cysts 351 Nasopalatine duct/incisive canal cyst (Fig. 26.7) 351 Bone cysts or pseudocysts 352 Simple (solitary) bone cyst (Fig. 26.8) 352 Aneurysmal bone cyst (see Fig. 26.21) 352 Typical radiographic features of tumours and tumour-like lesions 353 Odontogenic tumours 353 Ameloblastoma (Fig. 26.9) 353 Solid/multicystic ameloblastoma 353 Unicystic ameloblastoma 353 Ameloblastic fibroma (Fig. 26.10) 355 Other epithelial odontogenic tumours 356 Calcifying epithelial odontogenic tumour (CEOT), Pindborg tumour 356 Ameloblastic fibro-odontoma 356 Adenomatoid odontogenic tumour (AOT) 356 Calcifying cystic odontogenic tumour (calcifying odontogenic cyst or Gorlin’s cyst) 356 Odontogenic fibroma (Fig. 26.11) 357 Odontogenic myxoma (Fig. 26.12) 357 Radiolucent non-odontogenic tumours 358 Intrinsic primary benign bone tumours 358 Central haemangioma (Fig. 26.13) 358 Intrinsic primary malignant bone tumours 359 Osteosarcoma (Fig. 26.14) 359 Early features: 359 Later features: 359 Fibrosarcoma and chondrosarcoma 359 Extrinsic primary malignant tumours involving bone 360 Squamous cell carcinoma (Fig. 26.15) 360 Secondary (metastatic) bone tumours (Fig. 26.16) 361 Lymphoreticular tumours of bone (Fig. 26.17) 362 Multiple myeloma (Fig. 26.17) 362 Others 362 Langerhans cell disease (histiocytosis X) 363 Typical radiographic features of bone-related lesions 364 Giant cell lesions 364 Central giant cell lesion (granuloma) (Fig. 26.19) 364 Brown tumours in hyperparathyroidism 365 Cherubism (Fig. 26.20) 365 Aneurysmal bone cyst (Fig. 26.21) 366 Bone-related lesions – osseous dysplasias 367 Periapical osseous dysplasia (Fig. 26.22) 367 Florid osseous dysplasia (Fig. 26.23) 368 Other bone-related lesions 368 Stafne’s bone cavity (Fig. 26.24) 369 Footnote 369 27 Differential diagnosis of lesions of variable radiopacity in the jaws 370 Step I 370 Step II 370 Step III 371 Step IV 371 Step V 371 Typical radiographic features of abnormalities of the teeth 372 Unerupted or misplaced teeth including supernumeraries (Fig. 27.2) 372 Odontomes 373 Compound odontome 373 Complex odontome 373 Root remnants (Fig. 27.5) 373 Hypercementosis (Fig. 27.6) 374 Typical radiographic features of conditions of variable opacity affecting bone 374 Developmental 374 Exostoses, including tori (mandibular or palatal) 374 Tumours 375 Calcifying epithelial odontogenic tumour (CEOT or Pindborg tumour) (Fig. 27.8) 375 Ameloblastic fibro-odontoma (Fig. 27.9) 376 Adenomatoid odontogenic tumour (AOT) (Fig. 27.10) 376 Calcifying cystic odontogenic tumour (calcifying odontogenic cyst or Gorlin’s cyst) (Fig. 27.11) 377 Cementoblastoma (Fig. 27.12) 378 Osteoma (Fig. 27.13) 379 Osteosarcoma (Fig. 27.14) 380 Early features 380 Later features 380 Osseous dysplasias 381 Periapical osseous dysplasia (Fig. 27.15) 381 Focal osseous dysplasia (Fig. 27.16) 381 Florid osseous dysplasia (Fig. 27.17) 382 Familial gigantiform cementoma 382 Bone-related lesions 383 Fibrous dysplasia (Fig. 27.18) 383 Ossifying fibroma (Fig. 27.19) 384 Other important bone conditions 385 Summary 385 Typical radiographic features of soft tissue calcifications 385 Radiopaque salivary calculi (see Ch. 32) 385 Calcified lymph nodes (Fig. 27.21) 385 Calcified tonsils (Fig. 27.22) 386 Phleboliths (Fig. 27.23) 386 Calcified acne scars 386 Typical radiographic features of foreign bodies 387 28 Bone diseases of radiological importance 388 Introduction 388 Developmental or genetic disorders 389 Cleidocranial dysplasia 389 Main radiographic features 389 Osteopetrosis (Albers–Schönberg disease) 390 Main radiographic features 390 Infective or inflammatory conditions 391 Osteomyelitis 391 Main radiographic features of acute osteomyelitis 391 Main radiographic features of chronic osteomyelitis 391 Osteoradionecrosis 393 Main radiographic features 393 Bisphosphonate-related osteonecrosis (Fig. 28.7) 393 Main radiographic features 393 Hormone-related diseases 394 Hyperparathyroidism 394 Main radiographic features 394 Acromegaly 395 Main radiographic features 395 Blood dyscrasias 396 Sickle cell anaemia 396 Main radiographic features 396 Thalassaemia (Cooley’s anaemia) 397 Main radiographic features 397 Diseases of unknown cause 398 Fibrous dysplasia 398 Main radiographic features of monostotic fibrous dysplasia affecting the jaws 398 Paget’s disease of bone (osteitis deformans) 399 Main radiographic features of early-stage Paget’s disease of bone 399 Main radiographic features of late-stage Paget’s disease of bone 400 29 Trauma to the teeth and facial skeleton 402 Introduction 402 Injuries to the teeth and their supporting structures 402 Types of injury 402 Fractures of the teeth 402 Luxation injuries 402 Fractures of the alveolar bone 403 Other injuries 403 Radiographic investigation 403 Diagnostic information provided 403 Radiographic interpretation 403 Limitations of radiographic interpretation of fractured roots 406 Skeletal fractures 407 Fractures of the mandible 407 Main fracture sites 407 Radiographic projections required 407 Radiological features of mandibular fractures (Fig. 29.6) 408 Important points to note 408 Radiographic limitations 408 Important points to note 409 Interpretation of fractures 409 Systematic approach 409 Postoperative and follow-up appraisal 409 Examples of mandibular fractures 410 Fractures of the middle third of the facial skeleton 415 Classification and the main fracture sites 415 Radiographic investigation 416 Important points to note 416 Postoperative and follow-up appraisal 416 Interpretation of middle third fractures 417 Systematic approach 417 Examples of middle third facial fractures 421 Orbital blow-out fracture 425 Other fractures and injuries 425 30 The temporomandibular joint 426 Introduction 426 Normal anatomy 426 Investigations 428 Panoramic radiography 428 Main indications 428 Technique summary 429 Diagnostic information 429 Panoramic TMJ programmes 429 Main indications 429 Technique summary 429 Diagnostic information 430 Transpharyngeal radiography 431 Main indications 431 Technique and positioning 431 Diagnostic information 432 Cone beam CT 433 Main indications 433 Diagnostic information 433 Magnetic resonance (MR) 435 Computed tomography (CT) 435 Diagnostic information 435 Arthrography 435 Main indications 435 Main contraindications 435 Technique (Fig. 30.13) 436 Diagnostic information 436 Arthroscopy 436 Main pathological conditions affecting the TMJ 436 TMJ (myofascial) pain dysfunction syndrome 436 Main radiographic features 437 Internal derangements 437 Osteoarthritis 437 Main radiographic features (see Figs 30.14–30.17) 437 Rheumatoid arthritis 439 Main radiographic features (see Figs 30.18–30.20) 439 Juvenile rheumatoid arthritis (Still’s disease) 440 Ankylosis 440 Main radiographic features 440 Tumours 441 Fractures and trauma 441 Developmental anomalies 442 Footnote 443 31 The maxillary antra 444 Introduction 444 Normal anatomy 444 Normal appearance of the antra on conventional radiographs 444 Antral disease 446 Investigation and appearance of disease within the antra 447 Infection/inflammation 447 Acute sinusitis 447 Chronic sinusitis (Figs 31.5–31.9) 447 Important causes 447 Typical effects on the antrum 448 Main radiological features 448 Trauma 451 Oro-antral communication 451 Important causes 451 Main radiographic features 451 Fractures of the maxillofacial skeleton 451 Important sites possibly involving the antra 451 Main radiographic features 451 Foreign bodies in the antrum 452 Important causes 452 Main radiographic features 452 Cysts 452 Mucosal retention cyst 452 Cause 452 Main radiographic features (see Figs 31.7 and 31.9B) 452 Odontogenic cysts 453 Main radiographic features of a small cyst 453 Main radiographic features of a large cyst 453 Tumours 454 Benign intrinsic tumours 454 Malignant intrinsic tumours 454 Main radiographic features of a small early lesion 454 Main radiographic features of a large well-established lesion 455 Extrinsic tumours 455 Other paranasal air sinuses 457 32 The salivary glands 458 Salivary gland disorders 458 Investigations 458 Plain radiography 459 Sialography 460 Preoperative p

This is a new edition of a classic text that presents all of the information that a dental student needs to know in order to safely capture high-quality clinical images and accurately interpret their findings.

In this latest edition, both traditional methods of imaging and new modalities are included, such as cone beam CT, and the author team has been expanded to bring a fresh approach to the subject area.

Written in an accessible manner which avoids unnecessary detail, each page spread has been carefully designed to ensure clarity of understanding by the reader to ensure both exam success and confidence and safety in the clinical situation. Topics address the whole curriculum and range from the physics of imaging to radiation protection and image interpretation.

Suitable for undergraduate students and post-graduates alike, this book has become essential reading for all readers who intend to practice clinical dentistry.

• Provides a comprehensive account of the radiology and radiography topics usually examined at undergraduate and postgraduate level
• Clear and accessible approach to the subject makes learning especially easy
• More than 1100 illustrations present clinical, diagnostic and practical information in an accessible manner
• Written by a world authority on the subject area
• Contains recent classifications and advanced imaging modalities including cone beam CT imaging techniques

• Includes a new chapter on cone beam technology which includes the latest RCS (Eng) Guidelines for patient selection
• Contains an on-line self-assessment bank to aid exam preparation
• Chapter on legislation now on-line to ensure constant currency of information