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Imaging Modalities in Dental Implant
The document outlines the evolution and techniques of imaging modalities in dental implants, emphasizing the need for accurate imaging in successful implant rehabilitation. It details various imaging techniques, classification, and principles for optimal image quality, including conventional and advanced methods like CBCT and MRI. The importance of imaging phases from presurgical to postsurgical evaluations, along with specifics on each imaging technique's advantages and limitations, is also discussed.
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Imaging Modalities in Dental Implant
- 1. WWW.ASSEMWAD.COM Founder of XscanDental Digital Solutions
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- 3. CONTENT INTRODUCTION HISTORY CLASSIFICATION OF IMAGINGTECHNIQUES ALARA PRINCIPLES IMPROVING IMAGE QUALITY IMAGING PHASES IN DENTAL IMPLANT IMAGING MODALITIES WORKSHOP
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- 5. INTRODUCTION • Successful rehabilitationwith 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.
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- 7. OBJECTIVES OF IMAGINGIN 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 RAYIS ?
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- 11. THE MAGICIAN THE MAGICALLAMP Wilhelm Röntgen Crookes Tube
- 12. THE MAGIC Hand withRings Print of Wilhelm Röntgen's first medical X-ray, of his wife's hand, taken on 22 December 1895
- 13. HISTORICAL PERSPECTIVE 1895 RoentgenDiscovered 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 documentedextra-oral panoramic radiograph made by dr. Yrjo V. Paatero1949 - 1950
- 17. This is thefirst panoramic configuration 1951
- 18. NewTom 3G. Thissupine was one of the first commercially available CBCT scanner units in North America.
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- 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
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- 24. ALARA PRINCIPLES Source Reduction. Controlling AndContaining 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?
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- 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.
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- 29. CONTROLLING IMAGE QUALITY WhenTaking 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 DENTALIMPLANT
- 31. IMAGING PHASES INDENTAL 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
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- 33. IMAGING MODALITIES • Thedecision 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.
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- 35. PERIAPICAL RADIOGRAPHY • Usedto 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.
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- 37. PERIAPICAL RADIOGRAPHY • INDICATIONSOF PERIAPICAL RADIOGRAPHS: • Evaluation of a small area. • Alignment and orientation during surgery. • For recall and maintenance therapy.
- 38. PERIAPICAL RADIOGRAPHY ADVANTAGES • Lowradiation 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 YOURDIGITAL XRAY SENSOR?
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- 41. OCCLUSAL RADIOGRAPHY • High-resolutionplanar 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.
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- 45. CEPHALOMETRIC RADIOGRAPHY Cephalometric radiographis 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.
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- 47. CEPHALOMETRIC RADIOGRAPHY • Lateralcephalometric 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/widthin 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 • Usedin combination with other techniques for anterior implants. • Symphysis bone graft evaluation.
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- 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.
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- 55. PANORAMIC RADIOGRAPHY ADVANTAGES • Easyidentification 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.
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- 61. COMPUTED TOMOGRAPHY • Tomographyis 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.
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- 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.
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- 66. ADVANTAGES OF CONEBEAM 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 CONEBEAM COMPUTED TOMOGRAPHY • Moderate cost and radiation risk as compared to other imaging techniques. • Some metallic image artifacts. • Special training for interpretation.
- 68. USES OF CONEBEAM 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 CONEBEAM COMPUTED TOMOGRAPHY IN DENTAL IMPLANT
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- 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.
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- 73. MAGNETIC RESONANCE IMAGING ADVANTAGES • Non-invasiveand 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.
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- 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 • HounsfieldUnit (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 • TheSAGITTAL 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 OFA CBCT VOLUME
- 80. HOW TO CHOSE AND COMMUNICATE WITHYOUR 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
Editor's Notes
- #3 Radiology is complicated and important field of science. It is important to know the fundamentals of that field to keep up with the new technologies. lecture will cover some basic information about dental radiology and imaging modalities in dental implant. Workshop will cover the basic information about interactive imaging.
- #6 Successful rehabilitation – accurate imaging – skillful interpretation.
- #9 An X-ray, or X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz (30×1015Hz to 30×1018 Hz) and energies in the range 124 eV to 124 keV.
- #11 It is simply a lamp but special lamp that produce special light.
- #12 On November 8, 1895, German physics professor Wilhelm Röntgen stumbled on X-rays while experimenting with Lenard tubes and Crookes tubes and began studying them. He wrote an initial report "On a new kind of ray: A preliminary communication" and on December 28, 1895 submitted it to Würzburg's Physical-Medical Society journal.
- #13 Hand with Rings Print of Wilhelm Röntgen's first medical X-ray, of his wife's hand, taken on 22 December 1895
- #19 NewTom 3G. This supine CBCT scanner was one of the first commercially available units in North America. It was replaced by units that scanned patients seated with the head in an upright position.
- #20 Simpler. More Accurate. Safer.
- #24 ALARA is an acronym used in radiation safety for “As Low As Reasonably Achievable.” The ALARA radiation safety principle is based on the minimization of radiation doses and limiting the release of radioactive materials into the environment by employing all “reasonable methods”.
- #25 Justification for each case
- #26 Lead aprons are no longer recommended for routine dental radiography since the use of such techniques with modern, high kilovolt equipment, rectangular collimation and fast films produce less scatter towards the body and are more effective at reducing dose. DIRECT SCINCE With well-designed and optimized equipment and procedures there is no need for routine use of lead aprons for the patient in dental radiology.IAEA Film should not be handheld by a member of the dental practice staff. IAEA
- #30 KVp – Penetration – Contrast mAs – Quantity - Intense
- #40 Manufactured Water resistance Drop resistance Pixels LPMM