Imaging for dental implants is a simplified informative presentation about imaging modalities used in dental implants procedure. it will give you a brief about the development of the Xray.

1. WWW.ASSEMWAD.COM
Founder of Xscan Dental Digital Solutions

2. IMAGING
MODALITIES
IN DENTAL
IMPLANTS

3. CONTENT
INTRODUCTION
HISTORY
CLASSIFICATION OF IMAGING TECHNIQUES
ALARA PRINCIPLES
IMPROVING IMAGE QUALITY
IMAGING PHASES IN DENTAL IMPLANT
IMAGING MODALITIES
WORKSHOP

4. INTRODUCTION

5. INTRODUCTION
• Successful rehabilitation with implants is highly dependent on
accurate imaging as well as skillful interpretation.
• Implant imaging provides accurate and reliable diagnostic
information of the patient’s anatomy at the proposed implant
site.
• Until the late 1980s conventional radiographic techniques such
as intraoral radiographs, cephalometric and panoramic views
were the accepted standards.
• Evolving from there many developments in cross-sectional
imaging techniques, such as spiral tomography and reformatted
computerized tomograms.

6. OBJECTIVES OF
IMAGING IN
DENTAL IMPLANT

7. OBJECTIVES OF IMAGING IN DENTAL IMPLANT
• Decide if implant treatment is appropriate for the patient.
• Identify the location of vital anatomical structures.
• Ascertain bone quantity and quality.
• Detect any possible pathological conditions.
• Decide the length and width of the implant to be placed.

8. WHAT X RAY IS ?

9. HISTORY

10. MAGICAL
LAMP

11. THE MAGICIAN
THE MAGICAL LAMP
Wilhelm Röntgen
Crookes Tube

12. THE MAGIC
Hand with Rings
Print of Wilhelm Röntgen's first
medical X-ray, of his wife's hand,
taken on 22 December 1895

13. HISTORICAL PERSPECTIVE
1895 Roentgen Discovered X-ray
1896 First Intra Oral Radiograph C. Edmond Kells. New Orleans.
1922 Cephalometric Was Introduced By Pacini & Carera.
1967 Godfrey Hounsfield Developed First Ct Scanner.
1971 CT Scanning Was Introduced Into Medical Scanning.
1972
Walker, Savara &Ricketts Made An Attempt In The Development Of Dentofacial
Imaging In 3-D Individually & Together With & Without Computerization.
1990 Tachibana And Matsumoto First Reported Use Of CT In Endodontics.
1997
Quantative Radiology Produced The First CBCT, The New Tom 9000, For Dental
Use After The Pioneering Work Of Both Arai In Japan And Mozzo In Italy.
2001 First CBCT Licensed For Use In USA.

14. Dr Otto Walkhoff, a German scientist, is credited with creating
the first dental radiograph in 1896. It required a 25-minute
exposure time, but thankfully, he used himself as the subject. C.
Edmond Kells, a dentist from New Orleans, created some of the
first practical applications.

15. Hisatugu Neumata
1933
Yrjo V. Paatero
1946
Yrjo V. Paatero
1949

16. The first documented extra-oral panoramic radiograph made by dr. Yrjo V.
Paatero1949 - 1950

17. This is the first panoramic
configuration 1951

18. NewTom 3G. This supine was one of the first commercially
available CBCT scanner units in North America.

19. NOW

20. CLASSIFICATION
OF IMAGING
TECHNIQUES

21. CONVENTIONAL
TECHNIQUES
• Periapical Radiography.
• Digital Radiography.
• Occlusal Radiography.
• Cephalometric Radiography.
• Panoramic Radiography.
ADVANCED
TECHNIQUES
• Tomography.
• Computed Tomography.
• CBCT.
• Magnetic Resonance Imaging.
• Interactive Computed Tomography.
CLASSIFICATION OF IMAGING TECHNIQUES

22. ALARA PRINCIPLES

23. A
L
A
R
A
AS
LOW
AS
REASONABLY
ACHIEVABLE

24. ALARA
PRINCIPLES
Source Reduction.
Controlling And Containing The Radioactivity.
Minimizing TIME In Radiation Field.
Maximizing The DISTANCE From Radiation Source.
Using Proper SHIELDING.
Optimization of Radiation Protection.

25. HOW TO PROTECT
YOURSELF, YOUR
TEAM ANF YOUR
PATIENTS?

26. IMPROVING
IMAGE QUALITY

27. IMPROVING IMAGE QUALITY
• Use Small Focal Size "Smaller Focal Spot Increases The
Sharpness Of The Image” This Is Controlled By The
Manufacturer.
• Increase The Distance Between The X-ray Source And The
Film.
• Place The Film As Close As Possible To The Object.
• Make The Path Of The X-rays Perpendicular To The Film.
• Position The Film As Parallel As Possible To The Object.

28. CONTROLLING
IMAGE QUALITY

29. CONTROLLING IMAGE QUALITY
When Taking A Radiograph,
You Have Control Over These
Three Parameters:
• Kilovoltage: Speed at which the
electrons move between the
cathode and anode of an x-ray
machine.
• Milliamperes: Quantity of
“electrons” radiation produced
over a set amount of time via an x-
ray tube.
• Exposure Time: How long x-rays
are produced or how long the
patient is exposed to them.

30. IMAGING PHASES IN
DENTAL IMPLANT

31. IMAGING PHASES IN DENTAL IMPLANT
• Determine the quantity, quality, and angulation of bone.
• Determine relationship of critical structures to the implant site.
• Determine presence of any disease at the implant site.
PRESURGICAL
PHASE
• Evaluate surgical site during and after surgery.
• Assist the optimal position and orientation of dental implants.
• Evaluate the healing and integration phase of implant surgery.
INTERVENTIONAL
PHASE
• Evaluate the long-term success of implant osseointegration, crestal
bone levels and to evaluate the implant component in function.
• Evaluate the bone adjacent to the implant.
POSTSURGICAL
PHASE

32. IMAGING MODALITIES

33. IMAGING MODALITIES
• The decision to image the patient is based on the patient’s clinical
needs. To obtain a radiologic survey of a particular area of interest,
the imaging modality is selected that yields the necessary diagnostic
information related to the patient’s surgical and prosthetic needs.
• Maximizing the ratio of benefit to risk for acquiring information from
imaging examinations is a fundamental tenet of radiology.

34. PERIAPICAL RADIOGRAPHY

35. PERIAPICAL RADIOGRAPHY
• Used to find the presence of pathosis and location of anatomic
structures around the implant site and evaluate implants
postoperatively.
• Used to determine vertical height of the edentulous region,
architecture, and bone quality.

36. PERIAPICAL RADIOGRAPHY

37. PERIAPICAL RADIOGRAPHY
• INDICATIONS OF PERIAPICAL RADIOGRAPHS:
• Evaluation of a small area.
• Alignment and orientation during surgery.
• For recall and maintenance therapy.

38. PERIAPICAL RADIOGRAPHY
ADVANTAGES
• Low radiation dose.
• Minimal magnification with
proper alignment and
positioning.
• High resolution.
• Inexpensive.
LIMITATIONS
• Distortion and magnification.
• Minimal site evaluation.
• Difficulty in film placement.
• Technique sensitive.

39. HOW TO CHOOSE
YOUR DIGITAL
XRAY SENSOR?

40. OCCLUSAL RADIOGRAPHY

41. OCCLUSAL RADIOGRAPHY
• High-resolution planar images of the mandible or the maxilla
are produced by occlusal radiography.
• Structures like maxillary sinus, nasal cavity, and nasopalatine
canal can be assessed through occlusal radiography.
• Mandibular occlusal radiograph projection is less distorted than
the maxillary occlusal radiograph.

42. OCCLUSAL RADIOGRAPHY

43. OCCLUSAL RADIOGRAPHY

44. CEPHALOMETRIC RADIOGRAPHY

45. CEPHALOMETRIC RADIOGRAPHY
Cephalometric radiograph is a radiograph of the head taken in a
Cephalometer (Cephalostat) that is a head-holding device introduced in
1931 by Holly Broadbent Sr. in USA. The Cephalometer is used to obtain
standardized and comparable craniofacial images on radiographic films.

46. CEPHALOMETRIC RADIOGRAPHY

47. CEPHALOMETRIC RADIOGRAPHY
• Lateral cephalometric radiography helps in:
• Analysis of the quality of the bony site (ratio of compact to cancellous bone),
especially in the anterior region of the mandible.
• Evaluation of relationship between the buccal cortex and the roots of the
anterior teeth.
• Evaluation the loss of vertical dimension.
• Evaluation of skeletal arch interrelationship.
• Evaluation anterior crown-implant ratio.
• Evaluation anterior tooth position in the prosthesis.

48. CEPHALOMETRIC RADIOGRAPHY
ADVANTAGES
• Height/width in anterior region.
• Low magnification.
• Skeletal relationship.
• Evaluation of quantity of bone in
anterior region.
LIMITATIONS
• Reduced resolution and
magnification.
• Technique sensitive.
• Image information is limited to
anterior region.

49. CEPHALOMETRIC RADIOGRAPHY
• Used in combination with other techniques for anterior implants.
• Symphysis bone graft evaluation.

50. PANORAMIC RADIOGRAPHY

51. PANORAMIC RADIOGRAPHY
Two-dimensional (2-D) dental x-ray examination that captures the
entire mouth in a single image, including the teeth, upper and
lower jaws, surrounding structures and tissues.
It is narrow beam rotational tomographs, which use two or more
centers of rotation with a predefined focal trough.

52. PANORAMIC RADIOGRAPHY

53. PANORAMIC RADIOGRAPHY

54. PANORAMIC RADIOGRAPHY

55. PANORAMIC RADIOGRAPHY
ADVANTAGES
• Easy identification of opposing
landmarks.
• Initial assessment of vertical
height of bone.
• Convenience, ease, and speed
in performance in most dental
offices.
• Evaluation of gross anatomy of
the jaws and any related
pathological findings.
LIMITATIONS
• Distortions inherent in the
panoramic system.
• Errors in patient positioning.
• Does not demonstrate bone
quality.
• Misleading quantitate because
of magnification and no third
dimension.
• No spatial relationship between
structures.

56. PANORAMIC RADIOGRAPHY

57. PANORAMIC RADIOGRAPHY

58. PANORAMIC RADIOGRAPHY

59. PANORAMIC RADIOGRAPHY

60. COMPUTED TOMOGRAPHY

61. COMPUTED TOMOGRAPHY
• Tomography is a generic term formed from the Greek words
“tomo”: slice and “graph”: picture.
• The x-ray tube moves in one direction with the film plane
moving in the opposite direction.
• CT is based on the fundamental principle that the density of the
tissue passed by the x-ray beam can be measured from the
calculation of the attenuation coefficient.
• The individual element of the CT image is called a voxel, which
has a value, referred to in Hounsfield units.

62. COMPUTED TOMOGRAPHY

63. CONE BEAM COMPUTED
TOMOGRAPHY

64. CONE BEAM COMPUTED
TOMOGRAPHY
• It is a variant type of computed tomography (CT).
• Used particularly in dental and extremity imaging.
• Differs from conventional CT in that it uses cone-shaped x-ray
beam and two-dimensional detectors instead of fan-shaped x-
ray beam and one-dimensional detectors.

65. CONE BEAM COMPUTED
TOMOGRAPHY

66. ADVANTAGES OF CONE BEAM
COMPUTED TOMOGRAPHY
• Evaluates all possible sites and anatomical structures.
• No superimposition.
• Uniform magnification.
• Measurements accurate withing about 1 mm.
• Simulates implant placement with implant planning software.
• CBCT dose of radiation exposure is less than that produced by CT scanning.
• Can limit radiation exposure according to field of view chosen (FOV): small, medium, or
large.
• Provides precise information about pathology.
• Less expensive than CT scanning.
• Allows for the 3D evaluation of an arch.

67. LIMITATIONS OF CONE BEAM
COMPUTED TOMOGRAPHY
• Moderate cost and radiation risk as compared to other imaging
techniques.
• Some metallic image artifacts.
• Special training for interpretation.

68. USES OF CONE BEAM COMPUTED
TOMOGRAPHY IN DENTAL IMPLANT
• Quantitative evaluation of bone availability: Height and width.
• Qualitative evaluation of bone availability: Bone quality.
• Evaluation of edentulous saddle length.
• Evaluation of the residual alveolar ridge.
• Evaluation of anatomical and pathological conditions that cab
restrict implant placement.
• Facilitate prosthetic treatment planning.

69. USES OF CONE BEAM COMPUTED
TOMOGRAPHY IN DENTAL IMPLANT

70. MAGNETIC
RESONANCE IMAGING

71. MAGNETIC RESONANCE IMAGING
• It is a staging technique used to image the protons of the body
by employing magnetic fields, radio frequencies,
electromagnetic detectors, and computers.
• Magnetic resonance images are the opposite of ct images, with
cortical bone appearing dark or black and fat or water
appearing bright or white.

72. MAGNETIC RESONANCE
IMAGING

73. MAGNETIC RESONANCE
IMAGING
ADVANTAGES
• Non-invasive and does not use
radiation.
• Does not involve radiation.
• Gives extremely clear, detailed
images of soft tissue structures
that other imaging techniques
cannot achieve.
LIMITATIONS
• Expensive.
• Patient must remain still in an
enclosed machine, which may be a
problem for claustrophobic
patients.
• Undetected metal implant or
electronic medical devices
“pacemakers” in a patient’s body
may be affected by the strong
magnet of the MRI unit.

74. ARE TITANIUM
IMPLANTS MRI
FRIENDLY?

75. WORKSHOP

76. TALK CBCT
• VOXEL: Volume element (volumetric and pixel) representing a
value in the three-dimensional space, corresponding to a pixel
for a given slice thickness.
• ATTENUATION: Reduction of the intensity of an x-ray beam as
it traverses matter.
• IMAGE RECONSTRUCTION: Mathematical process that
generates tomographic images from X-ray projection data
acquired at many different angles around the patient.

77. TALK CBCT
• Hounsfield Unit (HU) Scale: linear transformation of the
original linear attenuation coefficient measurement into one in
which the radiodensity of distilled water at standard pressure
and temperature (STP) is defined as zero Hounsfield units
(HU), while the radiodensity of air at STP is defined as -1000
HU.
• DICOM: Digital Imaging and Communications in Medicine
(DICOM) is the standard for the communication and
management of medical imaging information and related data.

78. TALK CBCT
• The SAGITTAL Plane Or Lateral
Plane (Longitudinal,
Anteroposterior):Is a plane parallel to
the sagittal suture. It divides the body
into left and right.
• The CORONAL Plane Or Frontal
Plane (Vertical):Divides the body into
dorsal and ventral (back and front, or
posterior and anterior) portions.
• The Transverse Plane Or AXIAL
Plane (Horizontal): Divides the body
into cranial and caudal (head and tail)
portions.

79. STRUCTURED REVIEW OF A
CBCT VOLUME

80. HOW TO CHOSE
AND
COMMUNICATE
WITH YOUR
IMAGING
CENTER?

81. DR. ASSEM AWAD
CONTACT
Dr. Assem Awad
BDS,
Dentist and Entrepreneur
Founder of Xscan Dental Digital Solutions.
Founder of Xprint Medical 3D Printing Solutions.
Email: assem.awad93@gmail.com
Telephone: 03 580 2800
Mobile: 0111 115 163
Facebook: /assem.awad93
Instagram: @assemawad93
THANK
YOU