Textbook of Dental and Maxillofacial Radiology Textbook of Dental and Maxillofacial Radiology Second Edition Freny R Karjodkar MDS (Mumbai) Professor and Head Department of Oral Medicine and Radiology I/C Head of the Department of Pathology Nair Hospital and Dental College Mumbai, Maharashtra, India Foreword KS Nagesh ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD St Louis (USA) • Panama City (Panama) • New Delhi • Ahmedabad • Bengaluru Chennai • Hyderabad • Kochi • Kolkata • Lucknow • Mumbai • Nagpur Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd Corporate Office 4838/24, Ansari Road, Daryaganj, New Delhi 110 002, India. 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City of Knowledge, Bld. 237, Clayton, Panama City, Panama Ph: 507-317-0160 Textbook of Dental and Maxillofacial Radiology © 2009, Freny R Karjodkar All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher. This book has been published in good faith that the material provided by author is original. Every effort is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only. First Edition: 2006 Second Edition: 2009 ISBN 978-81-8448-643-8 Typeset at JPBMP typesetting unit Printed at To My Venerable Teachers whose perseverance, understanding and encouragement has inspired me and My Enquiring Students who have enlightened me with their discussions and queries and helped me reach my goals "Give me a fish and I eat for a day Teach me to fish and I eat for a lifetime !!!" — Confucius F OREWORD I am privileged to write a foreword to the book titled Textbook of Dental and Maxillofacial Radiology (2nd Edition) authored by Dr Freny R Karjodkar, Professor and Head of the Department of Oral Medicine and Radiology, and I/C Head of the Department of Pathology, Nair Dental College. She has over 20 years of experience in areas of teaching and scientific research and succeeded in compiling a comprehensive book on essentials of Oral and Maxillofacial Radiology The author has directed her understanding of the subject to the dental surgeons and the undergraduate and postgraduate students and has achieved in producing an eminently readable, comprehensive text with high quality illustrations. The book not only covers the basic principles and interpretation of conventional radiographic procedures but also gives detailed information regarding the newer imaging modalities like CT and MRI with the production, basic physics involved, techniques and interpretation of the obtained images and the normal anatomic landmarks. The subject has been discussed in the comprehensive manner to make it easy for the undergraduates to understand. The newer advances in the field have been discussed in detail for the benefit of the postgraduate students. Chapters have been added on implant imaging and forensic dental radiology. This book is an excellent contribution to our scientific literature. I wish her all the best. Dr KS Nagesh MDS Professor and Head of Department Oral Medicine and Radiology Principal, DA Pandu Memorial RV Dental College Bengaluru, Karnataka, India P S E REFACE TO THE ECOND DITION When a storm assaults a tree Its weakest boughs that fall … It's the rotten branch that crashes In the fury of the gale… When the storm of interpretive technologies comes raging It's the point where knowledge is weakest That collapses with the strain … Do look to your defenses and where time has worn them Mark the places that need repairing… And before the storm begins… Do the work of restoration Do it now… "What the mind doesn't know, the eye doesn't see…" This is true especially with reference to interpretation of radiographs and other diagnostic imaging modalities. It is with this very thought in mind that the second edition of the Textbook of Dental and Maxillofacial Radiology has been written for the new generation of dental students and the practitioners, so that they can update their knowledge. The past three decades have witnessed great advances in the field of diagnostic imaging. Many of these advances have greatly facilitated the diagnosis and treatment of a number of maxillofacial disorders. These modalities while employing different physical principles, are often complimentary, providing valuable information about different aspects of a given disease process. Many chapters have been entirely rewritten and the rest of the text has been significantly revised, reorganized and updated. These major changes are necessary to reflect the increasing complexity and sophistication of this expanding field. The number of chapters has increased from eighteen to thirty seven with the underlying aim to include all pathologies that a general practitioner could encounter about which diagnostic imaging technique to opt for and how to read and interpret the resulting image obtained. Separate chapters on CT, MRI imaging techniques and their basic interpretation and landmarks seen on a CT and MRI plate have been discussed. New topics of growing importance in Oral and Maxillofacial Radiology like, role of Oral Radiology in Forensic Medicine and Implant Radiology have been added. Freny R Karjodkar