Radiography and radiology for dental care professionals

Radiography and Radiology for

Dental Care Professionals

THIRD EDITION

To our families

Content Strategist: Alison Taylor

Content Development Specialist: Barbara Simmons

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Radiography and

Radiology for Dental

Care Professionals

MSc BDS(Hons) FDSRCS(Edin) FDSRCS(Eng) FRCR DDRRCR

Senior Lecturer and Honorary Consultant in Dental and Maxillofacial Radiology,

Head of the Unit of Dental and Maxillofacial Radiological Imaging, Kings College

London Dental Institute at Guy’s, King’s College and St Thomas’ Hospitals,

London, UK

Nicholas Drage

BDS(Hons) FDSRCS(Eng) FDSRCPS(Glas) DDRRCR

Consultant and Honorary Senior Lecturer in Dental and Maxillofacial Radiolog)',

University Dental Hospital, Cardiff and Vale University Health Board, Cardiff, UK

Third edition

W R IT T E N AND ILLU STR A T ED RY

Eric Whaites

Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2013

CHURCHILL

LIVINGSTONE

ELSEVIER

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(other than as may be noted herein).

First edition 2005

Second edition 2009

Third edition 2013

ISBN 9780702045981

eBook ISBN 9780702051678

British Library Cataloguing in Publication D ata

A catalogue record for this book is available from the British Library

Library of Congress Cataloging in Publication Data

A catalog record for this book is available from the Library o f Congress

N otices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden

our understanding, changes in research methods, professional practices, or medical treatment may become

necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and

using any information, methods, compounds, or experiments described herein. In using such information or

methods they should be mindful o f their own safety and the safety o f others, including parties for whom they

have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check the most

current information provided (i) on procedures featured or (ii) by the manufacturer o f each product to be

administered, to verify the recommended dose or formula, the method and duration o f administration, and

contraindications. It is the responsibility o f practitioners, relying on their own experience and knowledge of

their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient,

and to take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume

any liability for any injury and/or damage to persons or property as a matter of products liability, negligence

or otherwise, or from any use or operation o f any methods, products, instructions, or ideas contained in the

material herein.

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Contents

Preface vii

Acknowledgements ix

List of colour plates xi

PART 1

Introduction

1. The radiographic image 3

PART 2

Radiation physics, equipment and

radiation protection

2. The production, properties and

interactions of X-rays 15

3. Dental X-ray equipment, image receptors

and image processing 25

4. Radiation dose, dosimetry and dose

limitation 51

5. The biological effects associated with

X-rays, risk and practical radiation

protection 59

PART 3

Radiography

6. Dental radiography - general patient

considerations including control of

infection 73

7. Periapical radiography 79

8. Bitewing radiography 113

9. Occlusal radiography 123

10. Oblique lateral radiography 129

11. Cephalometric radiography 137

12. Tomography and panoramic

radiography 147

13. Cone beam computed tomographv

(CBCT) 169

14. The quality of radiographic images and

quality assurance 183

15. Radiographic assessment and localization

of unerupted maxillary canines 205

PART 4

Radiology

16. Introduction to radiological

interpretation 215

17. Dental caries and the assessment of

restorations 221

18. The periapical tissues 235

19. The periodontal tissues and periodontal

disease 247

20. Implant assessment 259

21. Atlas of diseases and abnormalities

affecting the jaws 269

Bibliography and suggested reading 281

Index 285

Preface

It is now 20 years since the first edition of Essen￾tials was published and 7 years since the first

edition of this slimmed down, condensed version

for Dental Nurses and other Dental Care Profes￾sionals, so I felt that the time was right for the

injection of new ideas and to bring on board a co￾author. I am delighted that my friend and col￾league for many years, Nicholas Drage, accepted

both the offer and the challenge.

Together we have gone through, revised and

updated every chapter. Now that Cone Beam CT

is established as the imaging modality of choice in

certain clinical situations, this section has been

expanded and numerous new examples of

advanced imaging have been added . We have also

replaced some of the conventional images with

new and better examples.

A major change has been the establishment of

a website linked to the book. This has allowed us

the opportunity to remove from the book the

detailed UK legislative details (only relevant to

UK Dentists and Dental Care Professionals). We

can now update this information as and when

necessary and readers from outside the UK are

spared unnecessary and irrelevant details. More

importantly the linked website has given us the

opportunity to include on-line self-assessment

questions based on each chapter. We hope this

innovation will provide a useful additional teach￾ing and learning resource for Dental Care

Professionals.

The aims and objectives of this book remain the

same, namely to provide a basic and practical

account of what we consider to be the essential

subject matter of both dental radiography and

radiology required bv Dental Care Professionals.

As in previous editions some things have inevita￾bly had to be omitted, or sometimes, over-simpli￾fied. It therefore remains first and foremost a

teaching manual, rather than a comprehensive

reference book. We hope the content remains suf￾ficiently broad, detailed and up-to-date to satisfy

the requirements of most post-qualification

examinations.

We hope that the result is a clear, logical and

easily understandable text, that continues to make

a positive contribution to the challenging task

facing Dental Care Professionals as they embark

on broadening their skills to include dental

radiography.

EW

London 2013

Acknowledgements

As with previous editions, this edition has only

been possible thanks to the enormous amount of

help and encouragement that we have received

from our families, friends and colleagues (now too

numerous to mention them all by name) in both

London and Cardiff.

Over the years many people have contributed

their help and advice for which we are very grate￾ful, but none more so than Professor Rod Cawson

who died in the summer of 2007. Without his help

and involvement the first Essentials manuscript

would never have been completed and, as a con￾sequence, this spin-off book would never have

been written. His unfailing support and encour￾agement will never be forgotten.

For this edition we would like to thank in par￾ticular Chris Greenall and Tim Huckstep from the

Dental Radiology Department in Cardiff Dental

Hospital and Christie Lennox from the Dental

Illustration Unit in Cardiff University for their

help in producing many of the new radiographic

images. We would also like to thank Wil Evans for

his help with the section on radiation dose and

Arnold Rust for his help with the section on

dosemeters.

We are also grateful to the Health Protection

Agency (formerly the National Radiological

Protection Board) for their permission to again

reproduce parts of the 2001 Guidance Notes (that

now appear in the on-line section on the book)

and to reproduce parts of their specific guidance

on the use of CBCT. We are also grateful to Pro￾fessor Keith Homer and the Faculty of General

Dental Practice (UK) for their permission to

reproduce sections from their 2013 Selection Cri￾teria booklet and to Professor Homer and SED￾ENTEX CT project for their permission to

reproduce some material from their 2011 guide￾lines on the clinical use of CBCT.

Special thanks to the team at Elsevier including

Alison Taylor, Caroline Jones, Barbara Simmons

and Jim Chiazzese for all their help and advice

with project - both the book itself and the on-line

resource.

Finally, the most special thanks of all to our

wives Catriona and Anji and our children Stuart,

Felicity and Claudia, and Karisma and Jaimini for

their love, encouragement and understanding

throughout the production of this edition.

EW

London 2013

ND

Cardiff 2013

List of colour plates

Fig. 3.31 Examples of digital image enhance￾ment. G and H Pseudocoloured. (See p. 46)

Fig. 7.6 A A selection of film packet and digital

phosphor plate holders designed for the parallel￾ing technique. B Holders incorporating additional

rectangular collimation — the Masel Precision all￾in-one metal holder and the Rinn XCP holder

with the metal collimator attached to the locator

ring. C Blue anterior and yellow posterior Rinn

XCP-DS solid-state digital sensor holders. D

Green/yellow anterior and red/yellow posterior

Hawe-Neos holders suitable for film packets and

digital phosphor plates (shown here). (See p. 82)

Fig. 7.7 A The anterior Rinn XCP holder suitable

for imaging the maxillary incisors and canines. B

Diagram showing the four small image receptors

required to image the right and left maxillary inci￾sors and canines. C The same anterior Rinn XCP

holder suitable for imaging the mandibular inci￾sors and canines. D Diagram showing the three

small image receptors required to image the right

and left mandibular incisors and canines. (See

p. 82)

Fig. 7.8 A The posterior Rinn XCP holder

assembled for imaging the RIGHT maxillary

premolars and molars. B The posterior Rinn

XCP holder assembled for imaging the LEFT

maxillary premolars and molars. C Diagram

showing the two large image receptors required

to image the right and left premolars and molars

in each quadrant. D The posterior Rinn XCP

holder assembled for imaging the RIGHT man￾dibular premolars and molars. E The posterior

Rinn XCP holder assembled for imaging the

L E FT mandibular premolars and molars. (See

p. 83)

Fig. 7.38 Specially designed image receptor

holders and beam-aiming devices for use during

endodontics. A Rinn Endoray® suitable for film

packets and digital phosphor plates (green) and

solid-state digital sensors (white). B Anterior

Planmeca solid-state digital sensor holder. Colour

coding of holders by some manufacturers is now

used to facilitate clinical use. (See p. 106)

Fig. 8.5 Bitewing image receptor holders with

beam-aiming devices. A A selection of horizontal

bitewing holders set-up using a film packet as the

image receptor — note the red colour coding for

the Rinn XCP System. B The Hawe-Neos Kwik￾bite horizontal holder set-up using a digital phos￾phor plate. C Vertical bitewing holders — the red

Rinn XCP holder and the yellow Hawe-Neos

Parobite holder set-up using film packets. D The

red Rinn XCP-DS horizontal bitewing solid-state

digital sensor holder. E The Planmeca horizontal

bitewing holder designed specifically for use with

their dixi2 solid-state digital sensors. (See p. 115)

Fig. 20.4 Examples of pre-implant assessment

CBCT images of the mandible. A Axial, pano￾ramic and a series of cross-sectional images (or

transaxial) images. B Example of an implant plan￾ning software program being used to plan the

placement of implants in the lower right and left

canine regions. Using the software the ideal posi￾tion of the implants can be planned in three

dimensions. The software is then used to design a

drill guide, so the implant fixtures can be placed at

the proposed sites (© Materialise Dental

NV-SimPlant®). C The tooth-borne drill guide

constructed to place implants in the lower canine

regions. (Kindly provided by Dr Matthew

Thomas.) (See p. 263)

Additional online material

Besides the wealth of information found within

Radiography and Radiology fo r Dental Care Pro￾fessionals 3E, the authors have created a unique

website - www.whaitesessentialsdentalradiography,

com - to accompany the volume. This site contains

two separate sections:

1. A summary of the UK ionising radiation legislation

and guidance on good practice for all dental prac￾titioners and dental care professionals

2. Self assessment questions and answers. Questions

have been specially prepared for each of the 21

chapters to enable DCPs to assess their own

knowledge and understanding. These include a

mixture of multiple choice questions and multiple

response questions, drag and drop identification of

radiological anatomy as well as new examples of

various pathological conditions to enable practice

of diagnostic skills.

To access the site, go to www.whaitesessentialsdentalradiography.com and follow the simple log-on

instructions shown.

Colour plates

Fig. 3 .3 1 Examples o f digital image enhancement. C and H Pseudocoloured. (See p. 46)

Fig. 7 .6 A A selection o f film packet and digital phosphor plate holders designed for the paralleling technique. Note how some

manufacturers use colour coding to identify holders for different parts of the mouth. B Holders incorporating additional rectangular

collimation — the Masel Precision all-in-one metal holder and the Rinn XCP holder with the metal collimator attached to the locator

ring. C Blue anterior and yellow posterior Rinn XCP-D S solid-state digital sensor holders. D Green/yellow anterior and red/yellow

posterior Hawe-Neos holders suitable for film packets and digital phosphor plates (shown here). (See p. 82)

1