Radiographic assessment in paediatric dentistry

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Radiographic assessment in paediatric dentistry, a seminar prepared mainly to explain the radiography in paediatric dentistry. it includes the uses, indications, and contraindications of the most common views in paediatric dentistry. prepared by undergraduate students form International Islamic University Malaysia.

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  • Intraoral dental film is made up of a semiflexible, clear cellulose acetate film base that is coated on both sides with an emulsion of silver bromide, silver halide, and silver iodide that are sensitive to radiation.
  • The purpose of the developer is to chemically reduce the exposed silver halide crystals into black metallic silver.The acidic fixing solution removes the unexposed silver halide crystals from the film emulsion.
  • Radiographic assessment in paediatric dentistry

    1. 1. Radiographic Assessment in Paediatric Dentistry Presented By: Sayfaldeen Muhannad Ali Kashmoola Nur Alia Bt. Che Mohd Din Supervised By: Dr. Nur Asilah Bt. Harun
    2. 2. Histroy of X-rays  Wilhelm Röntgen Dec. 1895
    3. 3. Radiography in Medicine
    4. 4. Radiography in Dentistry
    5. 5. 3 1 2 4 5 Digital Radiography Device: 1- The Patient 2- X-Ray Generator 3- Sensor 4- Wireless connector between sensor and PC 5- PC to view the Radiograph
    6. 6. Dental X-Ray Film clear cellulose acetate film base is coated on both sides with silver bromide, silver halide, and silver iodide.
    7. 7. Processing the Film
    8. 8. Rationale in taking X-Ray  Should not be performed in a routine manner  using the same practice for all individuals.  Should only be performed when the patient history and/or objective findings and symptoms lead to the conclusion that further useful information might be obtained.  If a radiograph is not expected to change diagnosis or treatment or add other useful information, it should not be taken.
    9. 9. Criteria to take a radiograph  Based on objective findings/symptoms.  Based on anamnestic information. EAPD guidelines for use of radiographs in children 2003
    10. 10. Based on objective findings/symptoms 1. Caries 2. Pulpal and periapical pathology 3. Traumatic injuries 4. Problems of eruption 5. Developmental anomalies 6. Unexplained discolouration of teeth 7. Orthodontic treatment planning and evaluation 8. Evidence of swelling 9. Unexplained tooth mobility 10. Unexplained bleeding
    11. 11. Based on objective findings/symptoms 11. Deep periodontal pocketing 12. Fistula formation 13. Unexplained sensitivity of teeth 14. Unusual spacing or migration of teeth 15. Lack of response to conventional dental treatment 16. Unusual tooth morphology, 17. Evaluation of growth abnormalities 18. Altered occlusal relationship 19. Aid in diagnosis of systemic disease
    12. 12. Based on anamnestic information  History of pain  History of trauma to teeth  Postoperative evaluation  Familial history of dental anomalies
    13. 13. General Indications for Radiographs  Detection of caries;  Dental injuries;  Disturbances in tooth development,  Examination of pathological conditions other than caries.  Orthodontic treatment planning.
    14. 14. Techniques of Dental radiographic views in Paediatric Dentistry Dental Radiographs Extraoral Intraoral •PanoramicView •Lateral oblique/bi-molarView •CBCT •Bitewing view •Periapical view •Occlusal view
    15. 15. Bite-Wing Radiograph horizontal Bitewing and vertical bitewing
    16. 16. Indication for Bite-Wing Radiograph  Detect proximal caries that cannot be detected clinically,  Estimate the extent of lesions,  Monitor lesion progression,  Determine pulp chamber configuration,  Suspected secondary caries under old restorations.
    17. 17. Baseline bitewing These factors should be considered for base line of radiograph for caries  relevant epidemiological data on the caries prevalence and rate of progression in the population;  caries experience;  oral hygiene and dietary habits;  exposure to fluorides;  socioeconomic status. Based on this knowledge, an individual risk assessment is carried out.
    18. 18. intervals to the next bitewing examination in children. Baseline bitewing examination Interval to next bitewing examination At age: Low caries risk High caries risk 5 years 3 years 1 year 8 or 9 years 3-4 years 1 year 12 to 16 years 2 years 1 year 16 years 3 years 1 year
    19. 19. Limitation of BW  Active vs non-active lesions;  Cavitated vs non-cavitated surfaces;  Radiographic depth vs clinical depth.
    20. 20. Periapical Radiograph
    21. 21. Periapical techniques Paralleling technique Bisecting technique  Based on Cieszynski’s rule of isometry.
    22. 22. Indications for Periapical Radiograph  Detection of pathologic changes associated with primary teeth (such as apical infection/inflammation or internal resorption)  After trauma to the teeth and associated alveolar bone,  Detect developmental abnormalities,  Assessment of the presence and position of unerupted teeth,  Assessment of the periodontal status,  Assessment of root morphology before extractions,  Detailed evaluation of apical cysts and other lesions within the alveolar bone,  In endodontic/pulp treatment (Preoperative,Working length estimation, Post condensation, Review).
    23. 23. Occlusal Radiograph  The occlusal view is indicated when there is a desire to reveal the skeletal or pathologic anatomy of either the floor of the mouth or the palate.  The occlusal view taken with a large film (3X2.3 inches) and the patient is asked to bite on it.  It has two types which are:  maxillary occlusal view ( Standard, oblique, andVertex)  mandibular occlusal view (90°, 45°, oblique)
    24. 24. Maxillary standard occlusal - clinical indications  Periapical assessment of the upper anterior teeth in patients unable to tolerate periapical films  Detecting the presence of unerupted canines, supernumeraries and odontomes  As the midline view, when using the parallax method for determining the bucco/palatal position of unerupted canines  Evaluation of the size and extent of lesions such as cysts or tumors in the anterior maxilla  Assessment of fractures of the anterior teeth and alveolar bone, especially useful for children
    25. 25. Mandibular – true occlusal indication  Detection of the presence and position of calculi in the submandibular salivary ducts  Assessment of the bucco/lingual position of unerupted mandibular teeth by parallax technique  Evaluation of the bucco/lingual expansion of lesions in the body of the mandible like cysts, tumours or osteodystrophies  Assessment of displacement fractures of the anterior body of the mandible in the horizontal plane
    26. 26. Upper standard occlusal view Diagram showing the position of the film packet in relation to the lower arch. B Positioning from the front; note the use of the protective thyroid shield. C Positioning from the side. D Diagram showing the positioning from the side
    27. 27. Upper oblique occlusal Diagram showing the position of the film packet in relation to the lower arch for a left upper oblique occlusal. B Positioning for the left upper oblique occlusal from the front; note the use of the protective thyroid shield. C Diagram showing the positioning from the front.
    28. 28. Vertex occlusal Diagram showing the position of the cassette in relation to the lower arch. B Positioning for the vertex occlusal from the front; note the use of the protective thyroid shield. C Positioning from the side. D Diagram showing the positioning from the side.
    29. 29. Lower 90° (true) occlusal
    30. 30. Lower 45° (standard) occlusal
    31. 31. Lower oblique occlusal
    32. 32. Lateral oblique/bimolar radiograph  Radiograph of molars and premolars using film/sensor positioned beside the face  Useful in  difficult and uncooperative patient  small children, mentally/physically disable patient  Can tolerate with extraoral radiograph better than intraoral radiographs  Beneficial in having a short exposure time  Limitation – distortion of teeth  Indication : 1. To Examine the posterior region of the mandible. 2. Patients who have fractures or swelling. 3. It evaluate the condition of the bone and to locate impacted teeth or large lesions.
    33. 33. LATERAL OBLIQUE  Cassette positioned against cheek and centered over the mandibular first molar area.  •The patient presses the tube side of the cassette firmly against the cheek with the palm of one hand and the thumb is placed under the lower edge of the cassette.  •Head position tilted 10 to 20 toward the side to be examined and the chin is protruded.  •The central ray directed toward the first molar region of the mandible from a point slight underneath the opposite side of the mandible and directed as perpendicular to the horizontal plane as possible
    34. 34. LATERAL OBLIQUE
    35. 35. Panoramic Radiograph (OPG)
    36. 36. What can we gain from OPG  Presence or absence of permanent teeth and their Positions in relation to the primary teeth.  Evaluation of bony lesions and the TMJ  Bone loss  Estimate the age of the patient
    37. 37. Indications for Panoramic Radiograph  Diagnose missing and supernumerary teeth,  Detect gross pathoses,  Asses development of the dentition,  Estimate the dental age of the patient,  Detect bone fractures, traumatic cysts,  Detect anomalies,  In some patients with disabilities (if the patient can sit in a chair and hold head in position).
    38. 38. Parallax Technique  Two types: 1. Horizontal parallax involves taking either:  Two periapicals with different angulations and follow the (SLOB)rule1-4 or  An upper occlusal and a periapical views. 2.Vertical parallax involves taking either:  An upper occlusal (Standard) view and an orthopantomogram (OPG)  A periapical view and an orthopantomogram (OPG).  http://www.midemos.com/demos/elsevier/haring/SlobRule.html
    39. 39. Indication for Parallax technique  Over-retention of the primary canine.  Delayed eruption of the permanent canine.  Absence of a upper labial canine bulge in a 10- or 11- year-old patient.  Presence of a palatal bulge.  Distal crown tipping of the lateral incisor.
    40. 40. Adverse effects of X-ray  X rays are carcinogenic.  Chest x-ray vs background radiation  Dental x-ray vs background radiation.  Patient’s age and radiation  The x-rays can cause damage by two mechanisms: 1. Direct damage.  Somatic: It happens when X-ray photon or a high-energy ejected electron cause breakage of weak bonds between nucleic acids in RNA or DNA.This can cause inability to pass information, abnormal replication, or cell death. Or it might be resolved and the damage is repaired.  Genetic : Radiation-induced congenital abnormalities. 2. Indirect damage.  Indirect damage occurs due to formation of free radicals inside the cells.
    41. 41. Radiation protection  Protection of staff  a.Position  b.Workload  c.Local rules  d.Good practice guidelines
    42. 42. Radiation protection  Protection of patient -  a. justification  b.dose limitation  c.quality assurance
    43. 43. Justification  Don’t take x-rays for fun
    44. 44. Dose limitation
    45. 45. Quality assurance  DON’T BY X-RAY MACHINE BECAUSE IT IS CHEAP.  A yearly maintenance and periodic check up with the manufacturer.  Request for extended warranty.  Quality assurance certification every two years.
    46. 46. A Good quality x-ray Area Improving methods Radiographic technique Use film-holding/beam aiming device Careful positioning for OPG Careful selection and instruction of patients X-rays set Regular maintenance and service Film and cassettes Use film before expiry date After care Mount, name and date radiograph
    47. 47. Radiographic assessment
    48. 48. Errors in radiographs
    49. 49.  http://www.dentalcare.com/en-US/dental-education/continuing- education/ce137/ce137.aspx?ModuleName=testpreview&PartID=-1&SectionID=-1
    50. 50. Thanks for listening and participating

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