Extraoral Radiography

Extraoral Radiography Imaging Quality Imaging Quality
Extraoral Extraoral Radiography Radiography

The The Extraoral Extraoral Radiography: Radiography:
Applications
Advantages
The Imaging Acquisition The Imaging Acquisition: :
Projections & Anatomical Structures
Exposure Setting
The Radiographic Image: The Radiographic Image:
The Diagnostic Value
Problems & Artifacts
Impact on Diagnosis
Test
Extraoral Radiography
Qualitative / Quantitative Imaging of anatomical structures
WHY EXTRAORAL RADIOGRAPHY??? WHY EXTRAORAL RADIOGRAPHY???
Anatomical Information that is not possible to reveal clinically
INSTRUMENTAL DIAGNOSIS INSTRUMENTAL DIAGNOSIS (preclinical and clinical phase)
PATHOLOGIES PROGRESSION PATHOLOGIES PROGRESSION
THERAPY MONITORING THERAPY MONITORING
FOLLOW FOLLOW - - UP UP
Radiograph Imaging: which application?
In particular:
CEPH Radiography
Teeth/Periodontium/Bones Condition
Growth & Development of
Dentition/Mandibulo-Facial structures
Evaluation of Implant Sites
Implants Osteointegration
Treatment analysis: pre/during/post
treatment
Dental/Skeletal Malformations
PAN Radiography
Diagnostic Value Diagnostic Value
of Radiography of Radiography

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User-friendly Acquisition
Versatility & Reproducibility of Exam
Global vision of Dentition & Maxillo-Facial Structures
Short Execution Time (vs Full Mouth)
Patient Comfort
Extraoral
Extraoral
Radiography: Advantages
Radiography: Advantages
Panoramic Radiography
Panoramic Radiography
Cephalometric
Cephalometric
Points
Points
Projection selection
Optional Exposure
setting: AEC
Methods: Panoramic Acquisition Steps
Patient
Positioning
Exposure
Arrangement
(kV / mA)
Patient size
Acquisition
Basic Panoramic Programs Basic Panoramic Programs
Standard Panoramic
Orthogonal Dentition
Half Panoramic (Left/Right)
Lateral TMJ (Open/Close Mounth)
Child Panoramic
Dento Dento- -Maxillo Maxillo- -Facial Facial Programs Programs
Frontal TMJ (Open/Close Mounth)
Frontal Maxil. Sinuses
Lateral Maxil. Sinuses (Left/Right)
Half Orthogonal (Left/Right)
Frontal Dentition
Left/Right Posteriors
(Canines, Pre-Molars, Molars)
Left/Right Anteriors (Incisors)
Transcan Transcan Programs Programs
Latero Lateral (LL)
Antero Posterior (AP)
Postero Anterior (PA)
Submento Vertex (SV)
Carpus
Cephalometric Cephalometric Programs Programs
Pan &
Pan &
Ceph
Ceph
Projections
Projections
Standard Panoramic
1. Dental Arch/Teeth
2. Mandibula & Maxilla
3. Condyles
4. Sinuses
5. Mandibular Canal
Anatomical Structures Anatomical Structures
3
4
5
1
2
2
Method: from Projections to Anatomy
Child Panoramic
3. Condyles
4. Sinuses
5. Mandibular Canal
1
2
2
3
4
5
Orthogonal Dentition 1. Dental Arch/Teeth
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
1
4
Half Panoramic (Left/Right) 1. Dental Arch/Teeth
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
4
1
2
3
5
Lateral TMJ
(Opened/Closed Mouth)
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
3. Condyles
4. Sinuses
5. Mandibular Canal
3
3
3. Condyles
4. Sinuses
5. Mandibular Canal
Frontal TMJ (Opened/Closed Mouth)
3
3. Condyles
4. Sinuses
5. Mandibular Canal
4
3. Condyles
4. Sinuses
5. Mandibular Canal
Lateral Maxil. Sinuses
(Left/Right)
4
3. Condyles
4. Sinuses
5. Mandibular Canal
1
4
5
3. Condyles
4. Sinuses
5. Mandibular Canal
Frontal Dentition
1
Dental Arcates (all teeth)
Mandibular & Maxillary Bone
Condyles
Sinuses
Mandibular Canal
Left/Right Posteriors
(Canines, Pre-Molars, Molars)
Left/Right Anteriors (Incisors)
Transcan Transcan Programs Programs
1. Enamel
2. Dentine
3. Pulp
4. Cementum
Teeth components Teeth components Basic Panoramic Programs Basic Panoramic Programs
Standard Panoramic
Orthogonal Dentition
Half Panoramic (Left/Right)
Child Panoramic
Lateral Maxil. Sinuses (Left/Right)
Frontal Dentition
Periodontium Periodontium
5. Periodontal Ligaments (CEJ)
6. Gingiva
7. Alveolar Process of Maxilla and
Mandibula
8. Cementum
Teeth Components &
Teeth Components &
Periodontium
Periodontium
1. Enamel
2. Dentine
3. Pulp
4. Alveolar Process
1
2
3
4
Teeth Components &
Teeth Components &
Periodontium
Periodontium
1. Skull Bones
3. Teeth
4. Sinuses
5. Orbits
6. Facial soft tissues
7. Pharynx
8. Cervical Vertebrae
9. Nasal Cavity
10. Bones of the hand
Latero Lateral (LL)
1. Skull Bones
3. Teeth
4. Sinuses
5. Orbits
7. Pharynx
9. Nasal Cavity
Antero Posterior (AP)
Postero Anterior (PA)
1. Skull Bones
3. Teeth
4. Sinuses
5. Orbits
7. Pharynx
9. Nasal Cavity
Submento Vertex (SV)
1. Skull Bones
3. Teeth
4. Sinuses
5. Orbits
7. Pharynx
9. Nasal Cavity
Carpus
Patient Size: Height/Weight/Face Dimension
Exposure setting (f(mA, kV
5
, s)) depends on:
Anatomical structures to investigate & sorrounding ones
( density dose to patient)
Projection Selected ( s dose to patient)
Dose
mA, kV, s mA, kV, s mA, kV, s
Method: Exposure Setting
Remarks: Remarks:
The optional Automatic Exposure Control permits to adapt
(reducing/increasing) the radiation values ( 6kV with 1kV step) to
bone mineral density
In correspondence to the Spinal Cord the emission of radiation is
automatically increased
kV
Single bite block
In case of protruded or retruded teeth,
the system is relocated to adapt to
patient
Solid and motorised head rest.
Mirror in front of the patient
In case of EDENTULOUS patient:
Chin rest
Patient Positioning: Panoramic Projections
Three laser lights for a precise positioning:
1. Sagittal plane
2. Frankfurt plane
3. Canine line
1 1 2 2
3 3
1. Three laser lights for a precise positioning
(along the major condylar axis):
Sagittal plane
Frankfurt plane
Canine line adapted to TMJ ruler
1. Cephalostat
Patient Positioning: TMJ Projections
Patient Positioning: TMJ Projections
(opened/closed mouth)
(opened/closed mouth)
Two laser lights for a precise positioning:
Sagittal plane
Frankfurt plane
Patient positioning in function of cross-sectional view
of maxillary sinuses:
Patient Positioning: Sinuses Projections
Patient Positioning: Sinuses Projections
Frontal Maxillary Sinuses
Lateral Maxillary Sinus
Positioner with proper settings is fitted
into the bite block holder on the unit.
The patient bites the mould and then is
fitted to the positioner.
Special graduated scales are provided in
order to grant better accuracy and
positioning reproducibility.
Patient Positioning:
Transcan
Transcan
Projections
Projections
Latero Lateral
Antero Posterior
Cephalometric
Cephalometric
Projections
Projections
Optional Exposure
setting: AEC
Patient
Positioning
Exposure
Arrangement
(kV / mA)
Patient size
Acquisition
Dental Arch in the focal plane
Right Dose to Patient
Artefacts Artefacts Artefacts Artefacts
No patient movement No patient movement
Blurring Blurring
Distortion Distortion
Shape of anatomical structures to investigate:
Solution: To correct Patient Positioning
Costumer Dissatisfaction Costumer Dissatisfaction
Problem: Problem: No Diagnostic Value No Diagnostic Value
False Positive False Positive
False Negative False Negative
Wrong/Difficult Interpretation Wrong/Difficult Interpretation
& Measurements: & Measurements:
Imaging Quality: Problems
Imaging Quality: Problems
Wrong patient positioning:
Frankfurt Plane
Patient Positioning: Problems
Frankfurt Plane
Mid-Sagittal Plane
Canine Line
Canine Line
Canine Laser Positioning Canine Laser Positioning
Laser on Canine Laser on Canine
Exposure setting: 76 kV; 6 mA
Laser on Premolar Laser on Premolar
Laser on Incisor Laser on Incisor
Imaging Quality: Positioning Test
Canine Laser Positioning Canine Laser Positioning
Laser on Canine Laser on Canine
Laser on Premolar Laser on Premolar
Laser on Incisor Laser on Incisor
No Image Contrast: No Image Contrast:
Shape of anatomical structures to investigate:
Too Low Exposure Values Too Low Exposure Values
Bright Bright Image Image
Exposure Setting: Problems
No Image Contrast: No Image Contrast:
Improvement (digital version):
! To process the radiography by VixWin Software ( value change)
Solution:
! To repeat the acquisition with the correct Exposure Setting
Too High Exposure Values Too High Exposure Values
Dark Dark Image Image Dark Dark Image Image
Exposure Setting Exposure Setting
66 kV
4 mA
D
o
s
e
Gray levels
W
B
76 kV
7 mA
Imaging Quality: Exposure Setting Test
mA Change: Impact on Image mA Change: Impact on Image
74 kV
8 mA
74 kV
7 mA
Gray levels
W
B
D
o
s
e
74 kV
9 mA
74 kV
7 mA
Gray levels
W
B
D
o
s
e
74 kV
8 mA
74 kV
7 mA
Gray levels
W
B
D
o
s
e
kV Change: Impact on Image kV Change: Impact on Image
76 kV
7 mA
D
o
s
e
74 kV
7 mA
Gray levels
W
B
Exposure Setting: Impact on Image Exposure Setting: Impact on Image
74 kV
9 mA
74 kV
7 mA
Gray levels
W
B
76 kV
7 mA
Presence of no anatomical structures:
Prothesis Prothesis
Metallic Objects Metallic Objects
Lead Apron Lead Apron
Artefacts: Difficult/Not Possible Interpretation
Solution: To Remove objects
Imaging Quality: Artefacts
Presence of air the oral cavity
Tongue not in contact with palate
Solutions: Tongue in contact with palate
Difficult Interpretation Difficult Interpretation
ARTEFACTS ARTEFACTS
Teeth:
Caries
Dental Abnormalities:
Position
Number
Size
Shape
Defects of Dental Components
Periodontium:
Periodontal bone loss
Periapical lesions
Sinuses
Maxilla
Cranial Structures
Instrumental Diagnosis Instrumental Diagnosis
Monitoring of Pathology Evolution Monitoring of Pathology Evolution
Monitoring of Treatments Monitoring of Treatments
Follow Follow- -up up
The Diagnostic & Clinical Value
Growth & Development of Dentition
Growth & Development of Mandibulo-Facial
structures
Instrumental Diagnosis Instrumental Diagnosis
Analysis of Treatments Analysis of Treatments
Follow Follow- -up up
Evaluation & Osteointegration of Implant Sites
Traumas
Oncologic Pathology
Caries
The Diagnostic & Clinical Value: Teeth
Hyperdontia Hyperdontia
3 3 Molars Molars
Hyperdontia Hyperdontia
Hypodontia Hypodontia
Periodontal Lesions Periodontal Lesions
Gorlyn Gorlyn Syndrome Syndrome
Osteomyelitis Osteomyelitis
Granuloma Apical Periodontitis
Cyst
Pericoronitis Pericoronitis
Treatment Planning Treatment Planning
1 1 Treatment Monitoring Treatment Monitoring
Treatment Monitoring Treatment Monitoring
Treatment Monitoring / Follow Up Treatment Monitoring / Follow Up
Treatment Monitoring / Follow Up Treatment Monitoring / Follow Up
Root Canal Therapy Root Canal Therapy
Implant Treatment Implant Treatment
TMJ Analysis TMJ Analysis
Different Projections to have different information on FRACTURES:
Infection of Deciduous Teeth Infection of Deciduous Teeth
Grow & Development of Child Dentition Grow & Development of Child Dentition
and and Maxillo Maxillo- -Facial Structures Facial Structures
The Diagnostic & Clinical Value: Child Dentition
Grow & Development of Child Dentition and Grow & Development of Child Dentition and Maxillo Maxillo- -Facial Structures Facial Structures
Analysis of Dental and Analysis of Dental and Maxillo Maxillo- -Facial Structures Facial Structures
Incorrect Exposure Setting Incorrect Exposure Setting Correct Exposure Setting Correct Exposure Setting
Imaging Quality: Impact on Diagnosis
Dental Arch/Teeth Components
Mandibula & Maxilla
Condyles
Sinuses
Mandibular Canal
Incorrect Incorrect
Exposure Exposure
Setting Setting
Incorrect Incorrect
Patient Patient
Positioning Positioning
Image with good quality Image with good quality
Dental Arch/Teeth Components
Mandibula & Maxilla
Condyles
Sinuses
Mandibular Canal
Incorrect Patient Incorrect Patient
Positioning Positioning
THANK YOU!
THANK YOU!

Extraoral Radiography

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Extraoral Radiography Imaging Quality Imaging Quality

Extraoral Extraoral Radiography Radiography

Radiograph Imaging: which application?

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