Table Of Content

Essentials of Dental Radiography and Radiology FIFTH EDITION To our families Content Strategist: Alison Taylor Content Development Specialist: Barbara Simmons Project Manager: Caroline Jones Designer/Design Direction: Miles Hitchen Illustration Manager: Jennifer Rose Illustrator: Antbits Essentials of Dental Radiography and Radiology FIFTH EDITION Eric Whaites MSc BDS(Hons) FDSRCS(Edin) FDSRCS(Eng) FRCR DDRRCR Senior Lecturer and Honorary Consultant in Dental and Maxillofacial Radiology, Head of the Unit of Dental and Maxillofacial Radiological Imaging, King’s College London Dental Institute at Guy’s, King’s College and St Thomas’ Hospitals, London, UK Nicholas Drage BDS(Hons) FDSRCS(Eng) FDSRCPS(Glas) DDRRCR Consultant and Honorary Senior Lecturer in Dental and Maxillofacial Radiology, University Dental Hospital, Cardiff and Vale University Health Board, Cardiff, UK EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2013 © 2013 Elsevier Ltd. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). First edition 1992 Second edition 1996 Third edition 2002 Fourth edition 2007 Fifth edition 2013 ISBN 9780702045998 eBook ISBN 9780702051685 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. 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Working together to grow The libraries in developing countries publisher’s policy is to use www.elsevier.com | www.bookaid.org | www.sabre.org paper manufactured from sustainable forests Printed in China v Contents Preface vii Acknowledgements viii List of colour plates ix PART 1 Introduction 1 1. The radiographic image 3 PART 2 Radiation physics, equipment and radiation protection 13 2. The production, properties and interactions of X-rays 15 3. Dental X-ray generating equipment 25 4. Image receptors 31 5. Image processing 45 6. Radiation dose, dosimetry and dose limitation 57 7. The biological effects associated with X-rays, risk and practical radiation protection 65 PART 3 Radiography 77 8. Dental radiography – general patient considerations including control of infection 79 9. Periapical radiography 85 10. Bitewing radiography 119 11. Occlusal radiography 129 vi ESSENTIALS OF DENTAL RADIOGRAPHY AND RADIOLOGY 12. Oblique lateral radiography 135 13. Skull and maxillofacial radiography 143 14. Cephalometric radiography 161 15. Tomography and panoramic radiography 171 16. Cone beam computed tomography (CBCT) 193 17. The quality of radiographic images and quality assurance 209 18. Alternative and specialized imaging modalities 231 PART 4 Radiology 247 19. Introduction to radiological interpretation 249 20. Dental caries and the assessment of restorations 255 21. The periapical tissues 269 22. The periodontal tissues and periodontal disease 281 23. Implant assessment 293 24. Developmental abnormalities 303 25. Radiological differential diagnosis – describing a lesion 327 26. Differential diagnosis of radiolucent lesions of the jaws 333 27. Differential diagnosis of lesions of variable radiopacity in the jaws 359 28. Bone diseases of radiological importance 377 29. Trauma to the teeth and facial skeleton 391 30. The temporomandibular joint 415 31. The maxillary antra 433 32. The salivary glands 447 Bibliography and suggested reading 461 Index 465 vii Preface It is now 20 years since the first edition of Essen- teaching and learning resource for students and tials was published and I felt that the time was practitioners. right for the injection of new ideas and to bring on The aims and objectives of this book remain the board a co-author. I am delighted that my friend same, namely to provide a basic and practical and colleague for many years, Nicholas Drage, account of what we consider to be the essential accepted both the offer and the challenge. subject matter of both dental radiography and Together we have gone through, revised and radiology required by undergraduate and post- updated every chapter. Now that Cone Beam CT graduate dental students. As in previous editions is established as the imaging modality of choice in some things have inevitably had to be omitted, or certain clinical situations, this section has been sometimes, over-simplified. It therefore remains expanded and numerous new examples of first and foremost a teaching manual, rather than advanced imaging have been added throughout. a comprehensive reference book. We hope the We have also replaced some of the conventional content remains sufficiently broad, detailed and images with new and better examples. up-to-date to satisfy the requirements of most A major change has been the establishment of a undergraduate and postgraduate examinations. website linked to the book. This has allowed us Students are encouraged to build on the informa- the opportunity to remove the detailed UK legisla- tion acquired here by using the excellent and more tive details (only relevant to UK dentists) from the comprehensive textbooks already available. book. We can now update this information, as and Once again, we hope that the result is a clear, when necessary, and readers from outside the UK logical and easily understandable text, that con- are spared unnecessary and irrelevant details. tinues to make a positive contribution to the chal- More importantly the linked website has given us lenging task of teaching and learning dental the opportunity to include on-line self-assessment radiology. questions based on each chapter. We hope this EW innovation will provide a useful additional London 2013 viii Acknowledgements As with previous editions, this edition has only Protection Board) for their permission to again been possible thanks to the enormous amount of reproduce parts of the 2001 Guidance Notes (that help and encouragement that we have received now appear in the on-line section on the book) from our families, friends and colleagues (now too and to reproduce parts of their specific guidance numerous to mention them all by name) in both on the use of CBCT. We are also grateful to Profes- London and Cardiff. sor Keith Horner and the Faculty of General Over the years many people have contributed Dental Practice (UK) for their permission to repro- their help and advice for which we are very grate- duce sections from their 2013 Selection Criteria ful, but none more so than Professor Rod Cawson booklet and to Professor Horner and SEDENTEX who died in the summer of 2007. Without his help CT project for their permission to reproduce some and involvement the first Essentials manuscript material from their 2011 guidelines on the clinical would never have been completed. Sadly, for the use of CBCT. first time, there is no Foreword written by him in Special thanks to the team at Elsevier including this edition. However, his unfailing support and Alison Taylor, Caroline Jones, Barbara Simmons, encouragement will never be forgotten. Richard Tibbetts and Jim Chiazzese for all their For this edition we would like to thank in par- help and advice with project – both the book itself ticular Chris Greenall and Tim Huckstep from the and the on-line resource. Dental Radiology Department in Cardiff Dental Finally, the most special thanks of all to our Hospital and Christie Lennox from the Dental wives Catriona and Anji and our children Stuart, Illustration Unit in Cardiff University for their Felicity and Claudia, and Karisma and Jaimini for help in producing many of the new radiographic their love, encouragement and understanding images. We would also like to thank Wil Evans for throughout the production of this edition. his help with the section on radiation dose and EW Arnold Rust for his help with the section on London 2013 dosemeters. ND We are also grateful to the Health Protection Cardiff 2013 Agency (formerly the National Radiological ix List of colour plates Fig. 9.6 A A selection of film packet and digital phos- A Rinn Endoray® suitable for film packets and digital phor plate holders designed for the paralleling tech- phosphor plates (green) and solid-state digital sensors nique. Note how some manufacturers use colour (white). B Anterior Planmeca solid-state digital sensor coding to identify holders for different parts of the holder. Note the modified designs of the biteblocks mouth. B Holders incorporating additional rectangu- (arrowed) to accommod ate the handles of the endo- lar collimation – the Masel Precision all-in-one metal dontic instruments. Colour coding of instruments by holder and the Rinn XCP holder with the metal colli- some manufacturers is now used to facilitate clinical mator attached to the locator ring. C Blue anterior and use. C Dia gram of the Rinn Endoray® in place. (See yellow posterior Rinn XCP-DS solid-state digital p. 112) sensor holders. D Green/yellow anterior and red/ yellow posterior Hawe–Neos holders suitable for film Fig. 10.5 Bitewing image receptor holders with beam- packets and digital phosphor plates. (See p. 88) aiming devices. A A selection of horizontal bitewing holders set up using a film packet as the image recep- Fig. 9.7 A The anterior Rinn XCP holder suitable tor – note the red colour coding for the Rinn XCP for imaging the maxillary incisors and canines. System. B The Hawe–Neos Kwikbite horizontal holder B Diagram showing the four small image receptors set up using a digital phosphor plate. C Vertical bitew- required to image the right and left maxillary incisors ing holders – the red Rinn XCP holder and the yellow and canines. C The anterior Rinn XCP holder suitable Hawe–Neos Parobite holder set up using film packets. for imaging the mandibular incisors and canines. D The red Rinn XCP-DS horizontal bitewing solid- D Diagram showing the three small image receptors state digital sensor holder. E The Planmeca horizontal required to image the right and left mandibular inci- bitewing holder designed specifically for use with sors and canines. (See p. 88) their dixi2 solid-state digital sensors. (See p. 121) Fig. 9.8 A The posterior Rinn XCP holder assembled Fig. 23.4 Examples of pre-implant assessment CBCT for imaging the RIGHT maxillary premolars and images of the mandible. A Axial, panoramic and a molars. B The posterior Rinn XCP holder assembled series of cross-sectional images (or transaxial) images. for imaging the LEFT maxillary premolars and molars. B Example of an implant planning software program C Diagram showing the two large image receptors being used to plan the placement of implants in required to image the right and left premolars and the lower right and left canine regions. Using the molars in each quadrant. D The posterior Rinn XCP software the ideal position of the implants can be holder assembled for imaging the RIGHT mandibular planned in three dimensions. The software is then premolars and molars. E The posterior Rinn XCP used to design a drill guide, so the implant fixtures holder assembled for imaging the LEFT mandibular can be placed at the proposed sites (© Materialise premolars and molars. (See p. 89) Dental NV-SimPlant®). C The tooth-borne drill guide constructed to place implants in the lower canine Fig. 9.38 Specially designed image receptor holders regions. (Kindly provided by Dr Matthew Thomas.) and beam-aiming devices for use during endodontics. (See p. 297)