MEDICAL IMAGING METHODS

IN STOMATOLOGY
MEDICAL IMAGING METHODS IN STOMATOLOGY

• Radiological methods:
– Intraoral radiography
– Extraoral radiography
– Special methods:
• With contrast media (artrography, sialography)
• Panoramic Radiography
• CT
• Ultrasonography
• MRI
 Intraoral Dental Radiographs

• Periapical projection – shows all of a tooth,

including the surrounding bone, for optimum
depiction of apical or periapical lesions.
• Bitewing (coronal, interproximal) projection –
shows only the crowns of teeth and the adjacent
alveolar crests, this is particularly indicated for
interproximal caries detection.
• Occlusal projection – shows an area of teeth
and bone larger than periapical radiograph, for
depicting the jaws in the third dimension.
 Intraoral Dental Radiographs
• The lowest level of distortion and the highest level of
image clarity will always be found in the region of the
central ray projection.
• The clinical indication actually sets the priority for
selection of the individual types of intraoral radiographs,
and the radiographic quality of other structures is of
secondary importance.
• The image receptor (film) should be as perpendicular as
possible to the central ray and as parallel as possible to
the tooth long axis in order to guarantee optimum
radiographic interpretability.
 Intraoral Dental Radiographs

Periapical projection

• Projection techniques
– Paralleling technique (right-angle or long-cone
technique)
– Bisecting-angle technique
 Intraoral Dental Radiographs
Periapical projection
Paralleling technique
• The x-ray film is supported parallel to the long axis of the teeth
• The central ray of the x-ray beam is directed at right angles to the
teeth and film.
• This orientation of the film, teeth, and central ray minimizes
geometric distortion. To reduce geometric distortion further, the x-
ray source should be located relatively distant from the teeth.
 Intraoral Dental Radiographs
Periapical projection
Paralleling technique
Film-holding instruments
 Intraoral Dental Radiographs
Periapical projection
Paralleling technique
• Film-holding instruments
 Intraoral Dental Radiographs
Periapical projection
Bisecting-angle technique (by Dieck)
• Cieszynski's rule of isometry (geometric theorem): two triangles are
equal when they share one complete side and have two equal
angles.
• Position the film as close as possible to the lingual surface of the
teeth, resting in the palate or in the floor of the mouth.
 Intraoral Dental Radiographs
Periapical projection
Bisecting-angle technique
• The plane of the film and the long axis of the teeth form an angle
with its apex at the point where the film is in contact with the teeth.
• Construct an imaginary line that bisects this angle and direct the
central ray of the beam at right angles to this bisector.
• This forms two triangles with two equal angles and a common side
(the imaginary bisector).
 Intraoral Dental Radiographs
Periapical projection
Bisecting-angle technique
• Consequently, when these conditions are satisfied, the images cast
on the film theoretically are the same length as the projected object.
To reproduce the length of each root of a multirooted tooth
accurately, the central beam must be angled differently for each
root. Another limitation of this technique is that the alveolar ridge
often projects more coronally than its true position.
 Intraoral Dental Radiographs
Periapical projection
Bisecting-angle technique

Angulation of the tube head.

• when the occlusal plane is oriented parallel with the floor.

• NOTE: With a positive (+) angulation the aiming tube is pointed
downward, and with a negative (-) angulation it is pointed upward.
Angulation of the tube head
Angulation of the tube head
 Intraoral Dental Radiographs
Bite-wing projection (by Raper)
• Projection technique
– Place the film between the tongue and the teeth, far enough from
the lingual surface of the teeth to prevent interference by the
palate on closing and parallel to the long axes of the teeth.
– Project the central ray to the center of the film.
 Intraoral Dental Radiographs
Occlusal projection
• Projection technique for maxilla
– The patient’s head is straight up and the central ray enters
perpendicularly through the region of the maxillary first molars.
 Intraoral Dental Radiographs
Occlusal projection
• Projection technique for mandible
– The patient’s head is tipped far backward and the central ray is
targeted perpendicularly through the region of the mandibular
molars onto the film.
 Intraoral Dental Radiographs
Occlusal projection
Maxillary full occlusal view technique (Simpson)
 Intraoral Dental Radiographs
Occlusal projection
Maxillary anterior occlusal view technique (Belot)
 Intraoral Dental Radiographs
Occlusal projection
Maxillary posterior occlusal view technique (Belot)
 Intraoral Dental Radiographs
Occlusal projection
Mandibular full occlusal view technique (Simpson)
 Intraoral Dental Radiographs
Occlusal projection
Mandibular anterior occlusal view technique (Belot)
 Intraoral Dental Radiographs
Occlusal projection
Mandibular posterior occlusal view technique (Belot)
Intraoral Dental Radiographs
Occlusal projection
Intraoral Dental Radiographs
Occlusal projection
Intraoral Dental Radiographs
Occlusal projection
Intraoral Dental Radiographs
Occlusal projection
Mounted full-mouth set of radiographs consisting of 17 periapical views
and four bitewing views.
 Extraoral radiography

• Posteroanterior Skull Projection

• Lateral Skull Projection
• Axial Skull Projection
• Mandibular Radiograph
 Posteroanterior Skull Projection
Is used for documentation of skull and facial skeletal asymmetries.
 Lateral Skull Projection
Is used for documentation of skull and facial skeletal asymmetries.
 Axial Skull Projection
As an initial radiograph to check the condylar axes, or as a supplement to a
panoramic radiograph for localization of extremely laterally impacted
maxillary third molars.
 Mandibular Radiograph
For the clear depiction of the angle of the mandible, the ramus, and the
mandibular canal.
 Panoramic radiography
(orthopantography (OPG) or panoramic tomography)

• The X-ray tube (right) and the film holder (left) move in
the clockwise direction around the skull.
 Panoramic radiography
• Makes it possible to depict in a single image a complete
representation of the jaws, teeth, temporomandibular joints (TMJ),
and the alveolar recess of the maxillary sinuses.
• Gives dentists the opportunity to record and analyze all components
of the masticatory system and their interrelationships.
 Sialography
• Involves the injection of a small amount of a water-soluble contrast
medium into the salivary ducts of a single gland, followed by routine
X-ray projections.
• Indications: since the advent of contrast CT, sialography and
ultrasonography are rarely indicated in the investigation of the
patient who has parotid disease. Sialography is helpful in suspected
cases of ductal stricture, calculi or sialectasia.
 Computed Tomography
• Reproduces only those anatomic and pathologic details that lie within
the selected slice.
• Offers the possibility of multi-planar reconstructions of the region.
 MRI
• The method of choice for determining the position of the articular disk
and for examination of the intra-articular soft tissue structures
 Ultrasonography
• For the examination of joints, articular disk, the intra-articular soft
tissue and salivary glands.
 Radiographic Anatomy
• 1 Orbit • 14 Basal compact bone
• 2 Cervical vertebrate, with tooth axis • 15 Mylohyoid line
• 3 Basal compact bone of the opposing jaw • 16 Mandibular canal
• 4 Nasal septum • 17 Mental foramen
• 5 Inferior nasal concha • 18 Digastric fovea or mental fovea, depending upon
• 6 Maxillary sinus (borders) the positioning of the mandibular anterior segment
• 7 Anterior nasal spine in the plane of focus
• 8 Horizontal osseous palatal lamina • 19 External ear, with auditory opening
• 9 Laterobasal border of the nasal cavity • 20 Mandibular articular process (condyle)
• 10 Palatal velum • 21 Muscular process of the mandible
• 11 Pterygopalatal fossa • 22 Styloid osseous temporalis process
• 12 Body of the zygomatic bone, with innominate line • 23 Hyoid bone
• 13 Zygomatic arch • 24 Base of the tongue
 Radiographic Anatomy
• 1 Enamel cap enhanced by the tangential effect
• 2 Cervical region between the enamel cap and the
alveolar crest; burn-out effects
• 3 Periodontal ligament space and lamina dura
• 4 Root canal
• 5 Vestibular crest of the alveolar bone
• 6 Palatal crest of the alveolar bone
• 7 Soft tissues of the nose
• 8 Entrance into the nose
• 9 Median suture, incisive foramen, nasopalatal
(incisive) canal
• 10 Foramen of the nasal nasopalatal canal
• 11 Piriform aperture
• 12 Laterobasal border of the nasal cavity
• 13 Palatal root, tooth 14
• 14 Palatal cusp, tooth 14
• 15 Vestibular cusp, tooth 14
• 16 Anterior lobe of the maxillary sinus
• 17 Maxillary nasal crest with anterior nasal spine
• 18 Laterobasal border of the maxillary sinus
• 19 Floor of the maxillary sinus
• 20 Three-rooted tooth 24
 Radiographic Anatomy
• 1 Enamel cap enhanced by the tangential effect
• 2 Cervical region between the enamel cap and the
alveolar crest; burn-out effects
• 3 Periodontal ligament space and lamina dura
• 4 Root canal
• 5 Vestibular crest of the alveolar bone
• 6 Palatal crest of the alveolar bone
• 7 Soft tissues of the nose
• 8 Entrance into the nose
• 9 Median suture, incisive foramen, nasopalatal
(incisive) canal
• 10 Foramen of the nasal nasopalatal canal
• 11 Piriform aperture
• 12 Laterobasal border of the nasal cavity
• 13 Palatal root, tooth 14
• 14 Palatal cusp, tooth 14
• 15 Vestibular cusp, tooth 14
• 16 Anterior lobe of the maxillary sinus
• 17 Maxillary nasal crest with anterior nasal spine
• 18 Laterobasal border of the maxillary sinus
• 19 Floor of the maxillary sinus
• 20 Three-rooted tooth 24
 Radiographic Anatomy
• 1 Enamel cap enhanced by the tangential effect
• 2 Cervical region between the enamel cap and the
alveolar crest; burn-out effects
• 3 Periodontal ligament space and lamina dura
• 4 Root canal
• 5 Vestibular crest of the alveolar bone
• 6 Palatal crest of the alveolar bone
• 7 Soft tissues of the nose
• 8 Entrance into the nose
• 9 Median suture, incisive foramen, nasopalatal
(incisive) canal
• 10 Foramen of the nasal nasopalatal canal
• 11 Piriform aperture
• 12 Laterobasal border of the nasal cavity
• 13 Palatal root, tooth 14
• 14 Palatal cusp, tooth 14
• 15 Vestibular cusp, tooth 14
• 16 Anterior lobe of the maxillary sinus
• 17 Maxillary nasal crest with anterior nasal spine
• 18 Laterobasal border of the maxillary sinus
• 19 Floor of the maxillary sinus
• 20 Three-rooted tooth 24
 Radiographic Anatomy
• 1 Laterobasal boundary of the nasal cavity
• 2 Floor of the nasal sinus
• 3 Laterobasal border of the maxillary sinus
• 4 Floor of the maxillary sinus
• 5 Intrasinus septum
• 6 Anterior lobe of the maxillary sinus
• 7 Alveolar lobe of the maxillary sinus
• 8 Zygomatic lobe of the maxillary sinus
• 9 Zygomatic process of the maxilla
• 10 Body of the zygomatic bone
• 11 Zygomatic arch
• 12 Alveolar ridge
• 13 Lateral lamina of the pterygoid process
• 14 Hamulus of the medial lamina of the pterygoid
process
• 15 Pyramidal process of the palatal bone
• 16 Maxillary tuberosity
• 17 Zygomaticomaxillary suture
• 18 Coronoid (muscular) process of the mandibular
ramus
• 19 Root tips of the maxillary first premolars. The
longer root is the palatal root
• 20 Burn-out effect
• 21 Secondary caries
 Radiographic Anatomy
• 1 Laterobasal boundary of the nasal cavity
• 2 Floor of the nasal sinus
• 3 Laterobasal border of the maxillary sinus
• 4 Floor of the maxillary sinus
• 5 Intrasinus septum
• 6 Anterior lobe of the maxillary sinus
• 7 Alveolar lobe of the maxillary sinus
• 8 Zygomatic lobe of the maxillary sinus
• 9 Zygomatic process of the maxilla
• 10 Body of the zygomatic bone
• 11 Zygomatic arch
• 12 Alveolar ridge
• 13 Lateral lamina of the pterygoid process
• 14 Hamulus of the medial lamina of the pterygoid
process
• 15 Pyramidal process of the palatal bone
• 16 Maxillary tuberosity
• 17 Zygomaticomaxillary suture
• 18 Coronoid (muscular) process of the mandibular
ramus
• 19 Root tips of the maxillary first premolars. The
longer root is the palatal root
• 20 Burn-out effect
• 21 Secondary caries
 Radiographic Anatomy
• 1 Laterobasal boundary of the nasal cavity
• 2 Floor of the nasal sinus
• 3 Laterobasal border of the maxillary sinus
• 4 Floor of the maxillary sinus
• 5 Intrasinus septum
• 6 Anterior lobe of the maxillary sinus
• 7 Alveolar lobe of the maxillary sinus
• 8 Zygomatic lobe of the maxillary sinus
• 9 Zygomatic process of the maxilla
• 10 Body of the zygomatic bone
• 11 Zygomatic arch
• 12 Alveolar ridge
• 13 Lateral lamina of the pterygoid process
• 14 Hamulus of the medial lamina of the pterygoid
process
• 15 Pyramidal process of the palatal bone
• 16 Maxillary tuberosity
• 17 Zygomaticomaxillary suture
• 18 Coronoid (muscular) process of the mandibular
ramus
• 19 Root tips of the maxillary first premolars. The
longer root is the palatal root
• 20 Burn-out effect
• 21 Secondary caries
 Radiographic Anatomy
• 1 Vestibular interdental bony septum tip • 11 Trabecular bone of the alveolus in the
• 2 Lingual bony interseptal tip depression of the root cross-section
• 3 Mental spine • 12 Slender root tip massively superimposed by
• 4 Vertically coursing vascular canal trabecular bone
• 5 Vascular canal in cross-section • 13 Alveolar crest
• 6 Mental fovea • 14 Root fragment
• 7 Burn-out effect • 15 Mandibular canal
• 8 Radiopacity due to the chin prominence • 16 Mental foramen
• 9 Basal compact bone of the mandible • 17 Incomplete root canal filling with chronic apical
periodontitis
• 10 Periodontal ligament space irregularities due to
variations in the cross-sectional profile
(depressions)
 Radiographic Anatomy
• 1 Vestibular interdental bony septum tip • 11 Trabecular bone of the alveolus in the
• 2 Lingual bony interseptal tip depression of the root cross-section
• 3 Mental spine • 12 Slender root tip massively superimposed by
• 4 Vertically coursing vascular canal trabecular bone
• 5 Vascular canal in cross-section • 13 Alveolar crest
• 6 Mental fovea • 14 Root fragment
• 7 Burn-out effect • 15 Mandibular canal
• 8 Radiopacity due to the chin prominence • 16 Mental foramen
• 9 Basal compact bone of the mandible • 17 Incomplete root canal filling with chronic apical
periodontitis
• 10 Periodontal ligament space irregularities due to
variations in the cross-sectional profile
(depressions)
 Radiographic Anatomy
• 1 Vestibular interdental bony septum tip • 11 Trabecular bone of the alveolus in the
• 2 Lingual bony interseptal tip depression of the root cross-section
• 3 Mental spine • 12 Slender root tip massively superimposed by
• 4 Vertically coursing vascular canal trabecular bone
• 5 Vascular canal in cross-section • 13 Alveolar crest
• 6 Mental fovea • 14 Root fragment
• 7 Burn-out effect • 15 Mandibular canal
• 8 Radiopacity due to the chin prominence • 16 Mental foramen
• 9 Basal compact bone of the mandible • 17 Incomplete root canal filling with chronic apical
periodontitis
• 10 Periodontal ligament space irregularities due to
variations in the cross-sectional profile
(depressions)
 Radiographic Anatomy
• 1 Typical trabecular structure in the alveolar • 7 Internal oblique line (continuation of the temporal
process of the mandible crest of the right mandible)
• 2 Radiolucency (subtraction effect) caused by the • 8 External oblique line (anterior margin of the right
submandibular fovea mandible)
• 3 Typical trabecular structure of the body of the • 9 Mylohyoid line
mandible • 10 Retromolar triangle, with medial and lateral crura
• 4 Mental foramen • 11 Island of bone marrow following tooth extraction
• 5 Taurodont • 12 Basal compact bone of the mandible
• 6 Mandibular canal • 13 Interdental calculus
 Radiographic Anatomy
• 1 Typical trabecular structure in the alveolar • 7 Internal oblique line (continuation of the temporal
process of the mandible crest of the right mandible)
• 2 Radiolucency (subtraction effect) caused by the • 8 External oblique line (anterior margin of the right
submandibular fovea mandible)
• 3 Typical trabecular structure of the body of the • 9 Mylohyoid line
mandible • 10 Retromolar triangle, with medial and lateral crura
• 4 Mental foramen • 11 Island of bone marrow following tooth extraction
• 5 Taurodont • 12 Basal compact bone of the mandible
• 6 Mandibular canal • 13 Interdental calculus
 Radiographic Anatomy
• 1 Typical trabecular structure in the alveolar • 7 Internal oblique line (continuation of the temporal
process of the mandible crest of the right mandible)
• 2 Radiolucency (subtraction effect) caused by the • 8 External oblique line (anterior margin of the right
submandibular fovea mandible)
• 3 Typical trabecular structure of the body of the • 9 Mylohyoid line
mandible • 10 Retromolar triangle, with medial and lateral crura
• 4 Mental foramen • 11 Island of bone marrow following tooth extraction
• 5 Taurodont • 12 Basal compact bone of the mandible
• 6 Mandibular canal • 13 Interdental calculus