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RadiologyRadiology -- ortopantomogramortopantomogram
3.DM3.DM
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DentalDental panoramicpanoramic XX--rayray
Y.V.PateroY.V.Patero, 1959, , 1959, HelsinkyHelsinkyFilm 15x30cmFilm 15x30cmTomographyTomographyrotationrotation ofof tube and film, tube and film, headheadstabilestabile15sec, 5515sec, 55--85kV, 285kV, 2--30mA30mA
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IndicationsIndications::OverallOverall picturepicture ofof bothboth dentitiondentition, , retentionretention ofof teethteeth, , developmentaldevelopmental stagesstagesAssesmentAssesment ofof anyany pathologypathology whichwhich isis tootoo largelarge forfor periapicalperiapicalxx--rayrayFracturesFractures, , cystscysts, , tumorstumorsAntralAntral diseasediseaseOrthodonticOrthodontic assesmentassesmentCondylarCondylar headsheads ofof TMJ TMJ –– surfacesurfacePeriodontalPeriodontal diseasedisease –– overalloverallProsthodonticProsthodontic evaluationevaluationImplantsImplants –– verticalvertical heightheight ofof alveolaralveolar boneboneAcuteAcute facialfacial swellingswelling withwith restrictedrestricted mouthmouth openingopening
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OPGOPG
MagnificationMagnification 1,5x1,5xRealReal shadowsshadows –– structuresstructures withinwithinfocalfocal linelineGhostGhost shadowsshadows –– structuresstructures oppositeoppositeto to focalfocal lineline
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HardHard tissuetissue realreal shadowsshadows
TeethTeeth, , jawsjawsFloorFloor ofof maxillarymaxillary sinussinusHardHard palatepalateZygomaticZygomatic archesarchesStyloidStyloid processesprocessesHyoidHyoid boneboneNasal Nasal septumseptum and and conchaeconchaeOrbitalOrbital rimrim
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Soft Soft tissuetissue shadowsshadows
MouthMouth cavitycavityMaxillaryMaxillary sinussinusSoft Soft palatepalateNasal Nasal cartilagescartilagesEarEar lobelobeLipsLips, , cheekscheeks, , nasolabialnasolabial foldsfolds
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ArtefactsArtefacts -- shadowsshadows
CervicalCervical spinespine –– vertebraevertebraeContralateralContralateral sideside ofof thethe mandiblemandiblePalatePalateEaringsEarings, , necklacenecklace, , skeletonskeleton denturesdentures, , fixedfixed orthodonticorthodontic applianceappliance, , osteosyntheticosteosynthetic platesplatesProtectiveProtective apronapron placedplaced highhigh on on thetheneckneck
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OPG OPG schemescheme
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OPG OPG shadowsshadows //radioopacityradioopacity
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OPG OPG artefactsartefacts
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Obr. RTG –
20-ročný muž
s
diagnózou ALL po indukčnej liečbe. 25 –
zubný kaz blízky zubnej dreni;
38,48 –
semiretencia
s perikoronitídou
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Obr. RTG – Stav chrupu 33-ročného muža s
relapsom
ALLPonechané
korene zubov 16,15,12,25,35,48; radikulárna
cysta čeľuste zo zuba 12, retencia
zuba 45, zubný kaz blízky zubnej dreni zuba 27 (vlastný materiál)
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AdvantagesAdvantages::
EasyEasy to to examinexamin, , goodgood overalloverall picturepictureofof largelarge areaarea –– goodgood screeningscreeningmethodmethodLowerLower dossagedossage in in comparisoncomparison to to intraoralintraoral status (10 status (10 i.o.xi.o.x--raysrays))ComparisonComparison ofof bothboth sidessides, , relationrelation ofofpathologiespathologies to to adjacentadjacent structuresstructuresFieldField limitationlimitation techniquetechnique –– dosedosereductionreduction
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DissadvantagesDissadvantages::
StructuresStructures notnot in in focalfocal lineline notnot visiblevisibleOverlyingOverlying shadowsshadowsMagnificationMagnification ofof finalfinal picturepicture 1.31.3--1.5x1.5xRequiresRequires cooperationcooperation withwith patientpatient forfora a longerlonger timetime 15 15 secsec. . –– childrenchildrenDeformitiesDeformities ofof cervicalcervical spinespine ––possitioningpossitioning ofof thethe patientpatient
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DigitalDigital imageimage
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DigitalDigital sensorssensors
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FollicularFollicular cystcyst 38 38 –– destructingdestructing thethe bone bone ofof angulusangulus and and ramusramus
mandibulaemandibulae
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OPG in OPG in ImplantologyImplantology: :
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A systematic approach is always required. You must be logical, ordered & thorough.
This avoids missing any details. Apply this systematic approach to both the entire radiograph & specific lesions.
General overview of entire filmGeneral overview of entire film
What type of radiograph is it? Which area of the mouth is it?
If a young patient do chronological & developmental ages match? Trace the outline of normal anatomical structures
Investigate pathologies (i.e. fracture, bone loss, periapical inflamation)
Radiography Assessment
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Specific observations of Teeth
Apical tissues Periodontal tissues
Other structures depending upon view
Specific observations of Periodontal tissues Width of periodontal ligament space
Level & quality of crestal bone Vertical or horizontal bone loss
Furcation involvement's Calculus deposits Apical pathology
Furcation pathology
Specific observations of specific lesions Site Size
Shape Outline
Radiodensity & internal structure Effect on adjacent structures
Comparison with previous films
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LD
AFloor of Antrum
ACMaxillary Antrum
C Coronoid Process
SSoft tissue outline of Tuberosity
TMaxillary Tuberosity
VVascular canals in antral wall
Z Root of Zygoma
LDLamina Dura
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2 Inferior Alveolar Canal
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1Alveolar Crest
2Lamina Dura
3Periodontal Ligament Space (superimposed)
4 Bony Trabecular Plate including marrow space
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1 Answer:: Marrow space
2 Answer:: Periodontal ligament space
3 Answer:: Bony trabecular plate
4 Answer:: Lamina dura
5 Answer:: Pulp canal
6 Answer:: Alveolar crest
7 Answer:: Root dentine
8 Answer:: Enamel
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BA A
A – vertical bone loss
B - calculus present, distal to the 1st molar.
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Calculus - arrows.
resorption of alveolar bone: Vertical 16, horizontal 14, 15
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The floor of the maxillary sinus.
The maxillary sinus is where the arrow is and the pointer is pointing to the floor, an opaque line.
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A periapical radiograph showing an infrabony defect
on the distal of the upper first molar.
This patient has periodontitis and a bruxing
habit. This is termed “secondary”
occlusal trauma
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Posttraumatic apical root resorption of 14
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A periapical radiograph of 14 showing completed endodontic treatment and after adjustment of occlusal
trauma (from previous slide).
Cervical burnout is arrowed.Cervical burnout is a radiolucent shadow seen at the
neck of the teeth and is a radiological artifact.The x-ray beam has less tissue to pass through in this
area of the tooth. Therefore there is less tooth to absorb the x-ray beam
giving its characteristic triangular appearance.
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A periapical radiograph showing alveolar bone loss
around the lower incisor teeth in a patient with
periodontitis.
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A periapical radiograph showing an endo-periolesion affecting the mesial root of 46.
The distal canal has been root filled prior to mesial root amputation
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The thin extension of the restoration onto the root is an overhang that should be
removed as it may contribute to plaque
accumulation. Note the residual cyst 46
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Retained deciduous root tips (note periodontal membrane space & lamina dura around
fragments)
The roots of the deciduous molar are very long and flared and retained remnants
of them are relatively common, particularly in the premolar area.
Also note the round radiolucency at the apex of the second premolar tooth (consistent with
the mental foramen).
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A radio-opacity was noted as incidental finding from the following periapicals. Further radiographic examination was undertaken with a
dental orthopantomogram (OPG): A Salivary calculus in the duct of the sub-mandibular salivary gland
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OPG (orthopantomograph)- 4 regions
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1 nasal septum
2 inferior nasal concha
3 orbit
4 basal border of the nasal cavity
5 posterior border of the nasal cavity
6 maxillary sinus
8 incisive foramen
9 anterior nasal spine
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1 maxillary sinus
4 zygomatic arch
5 coronoid process
6 pterygoid process of the sphenoid bone
8 pterygopalatine fossa
9 articular process
10 articular tubercle of the temporal bone
11 styloid process
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1 lower Mn border
2 mental protuberance
4 mental fovea
5 mental foramen
6 mylohyoid line
7 submaxillary fovea
8 hyoid bone
9 base of the tongue
10 external auditory meatus + ear
12 shadow of lips
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Normal OPG
Mn movement during exposure
ERRORS
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Foreign body
Static electricity Dirty film Water drops
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Insuficient rinsing
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Cyst in paranasal sinus
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Cysts:
Left – radicular cyst 34
Below – follicular cyst 38
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Mandibular fracture
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Osteosynthesis, interfering opacity
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Subperiosteal implant
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Deposition of filling material