Intraoral Dental Radiographs Research Articles

Tooth Resorption in Spanish Domestic Cats: Preliminary Data

The objective of this study was to collect preliminary data about tooth resorption (TR) from cats treated at the Odontology Service (September 2016-June 2018), part of a University Veterinary Hospital in Spain, with specific emphasis on TR distribution per tooth. Diagnosis was based on visual/tactile inspection and intraoral dental radiographs. This cross-sectional study was carried out on 59 adult cats (27 females, 32 males). TR occurred in 39/59 cats (66.1%; 95% CI: 54.0%-78.2%). The median number of lesioned teeth per TR-affected animal was 3. A highly significant but weak correlation was found for age and number of TR-affected teeth per individual (Spearman´s correlation ρ = 0.381, P = .003, power = 0.853; N = 59). No TR cases were detected in incisors (0/708, 0%) but TR occurred in canines (21/236, 8.9%; 95% CI: 5.4%-12.4%), premolars (78/590, 13.2%; 95% CI: 10.5%-15.9%), and molars (33/236, 14%; 95% CI: 9.7%-18.3%). A significant age influence on TR was found. The greatest TR occurrence corresponded to 307 (21/59; 35.6%; 95% CI: 23.4%-47.8%) followed by 409 (17/59; 28.8%; 95% CI: 17.2%-40.3%), 407 (16/59; 27.1%; 95% CI: 15.7%-38.4%), and 309 (16/59; 27.1%; 95% CI: 15.7%-38.4%). These teeth would be considered as TR-sentinels in the studied population. These findings are relevant for veterinarians working in dental clinics, where the TR prevalence may be high especially in older cats.

Skull pathology in 10 cats with patellar fracture and dental anomaly syndrome.

The aim of this case series is to describe the clinical and radiological features of mandibular and maxillary abnormalities in cats diagnosed with patellar fractures and dental anomalies, a condition that we have named 'patellar fracture and dental anomaly syndrome' (PADS), also known previously as 'knees and teeth syndrome'. Where available, clinical records, skull and/or intraoral dental radiographs, head CT images, microbiology and histopathology reports were collected, and follow-up was obtained. Ten cats with mandibular or maxillary abnormalities were identified. Common clinical features included multiple persistent deciduous teeth, gingivitis and swellings of the jaw. Skull radiographs were available for 7/10 cats and head CT images were available for one cat. Findings included marked bony and periosteal proliferation, hypodontia, root resorption, root malformation and unerupted permanent teeth. Where available, microbiology and histopathology results were consistent with osteomyelitis. Mandibular and maxillary abnormalities are an additional unreported clinical feature of the rare condition that we have termed PADS. Radiologically, these lesions can have an aggressive appearance, which can mimic neoplasia. Medical management with antibiotic and anti-inflammatory therapy improves clinical signs in the short term; however, surgical extraction of persistent deciduous and unerupted permanent teeth, and debridement of proliferative and necrotic bone appear to be necessary for an improved outcome. Additional information on long-term outcome is required.

RADIATION DOSE FROM DENTAL RADIOGRAPHY IN INDONESIA: A FIVE-YEAR SURVEY.

Dose metrics on intraoral and panoramic dental radiography were analyzed to preliminarily indicate dose trend of dental radiology equipment in Indonesia. Measurements were performed in 71 healthcare institutions involving a total of 92 dental X-ray devices. Imaging modes are categorized into 'low dose' and 'high dose' based on the task. The 75th percentile for intraoral IAK was 2.8 and 4.3 mGy for 'low' and 'high' dose modes, respectively while for panoramic devices the 75th percentile of the KAP for 'low' and 'high' dose modes were 85.2 and 192.4 mGy cm2, respectively. Results compared with local regulatory recommendation for intraoral units indicated that 38.8 and 6.3% of measured dose modes on analogue and digital devices, respectively, were above the recommended range. The dose trend can be used as reference for local regulations concerning patient dose in dental radiography and preliminary value prior to the establishment of national diagnostic reference level.

P054] Absorbed and effective doses from the intraoral dental X-ray radiography

Purpose Evaluation of the doses to patients obtained during intraoral dental X-ray radiography procedure. Methods Gafchromic films were used for dose measurements in homemade PMMA head phantom reconstructed from CT scans of real patients. The absorbed doses to organs were evaluated at distinguished locations corresponding to the locations of certain organs in the head phantom. For the recalculation of the effective doses tissue weighting factors were applied. Results It was found, that the doses were ∼60% lower applying digital image detectors as compared to the analogue dental X-ray equipment. Absorbed doses measured using analogue technique was noticeable higher for the salivary glands and oral mucosa. Recalculated effective dose varied from the 0.5 to 5.5 μSv depending on the technical irradiation parameters and field size/collimation. Conclusions Performed investigation has shown statistically significant dose variations during intraoral dental X-ray procedure, that were related to the technical parameters of irradiation. This indicated an important issue of possible patient’s dose reduction in intraoral dental X-ray radiography, which could be managed when selecting appropriate set of technical parameters for the examination. Some recommendations regarding patient’s dose reduction are also provided.

Image Quality Assessment and Radiation exposure in Intra Oral Dental Radiography

In this study, an intra oral dental unit (Siemens-70) at King Abdul Aziz University (KAU) Dental Hospital was selected and investigated for visual image quality assessment and radiation protection purposes. Radiation dosimetry for determining the optimum image quality with the lowest radiation exposure to the patient was carried out. A DXTTR dental radiography trainer phantom head and neck, portable survey meter Model RAD EYE-B20, and radiation dosimetry system RADCAL Acuu-pro were used in this study. RADCAL Accu-pro is a non-invasive kV system, reliable instruments to measure and diagnose all X-ray machines including dental units. The radiation exposure to patients in (mGy) was measured using RADCAL ionization chamber Model 10×6-6. The best image quality with the lowest exposure dose was assessed for conventional intraoral X-ray film (Kodak type E) and the digital processing sensor (RVG 5200). Radiation survey level was done during this study for safety and protection purposes.

Definition, classification and retrospective analysis of photostimulable phosphor image artefacts and errors in intraoral dental radiography.

To detect and determine image error and artefact types in intraoral radiographs obtained with photostimulable phosphor (PSP) technology, place them in an appropriate classification and retrospectively analyze the PSP-specific image errors and artefacts. The causes and solutions of PSP-specific errors and artefacts have also been discussed. The radiographic database of Ondokuz Mayis University, Faculty of Dentistry, Department of Dentomaxillofacial Radiology, was used for this study. Different types of image errors and artefacts observed on intraoral radiographs during 2014-15 were detected and defined. A total of 2100 intraoral radiographs were individually evaluated for the distribution of PSP-specific image artefacts. There were 34 image error and artefact types detected and classified into 4 groups according to the causative factors. The most common PSP-specific image artefacts were found in fading with a ratio of 44.1% for the ambient light-related group, peeling of the plate borders with a ratio of 53.4% for the PSP plate-related group and straight line with a ratio of 42.2% for the scanner-related group. The determination and definition of the image errors and artefacts with clarification of their causes and solutions are important for the improvement of radiographic quality and the reduction of the retake ratio.

Local diagnostic reference levels for intraoral dental radiography in the public hospitals of Cyprus

PurposeThe purpose of this study was to determine local DRLs for children and adults undergoing intraoral dental examinations at the intraoral radiology units of the public hospitals in Cyprus. MethodsMeasurements were made on all the twenty intraoral X-ray units of the public hospitals in Cyprus with the intention to establish the local DRLs for all the possible intraoral X-ray examinations for children and adults. All units are film based. The measurements were made by a Dose Area Product (DAP) meter (GAMMEX RMI 841-RD) placed at the surface of the dental unit’s X-ray shaping cone (FSD 20cm). A diagnostic radiology dosimeter (Dosimax Plus A) was also placed at an FSD of 100cm to compare the dose reading between the two dosimeters. ResultsDRLs were established at the 3rd quartile for 7 exposure settings corresponding to 12 types of teeth (Adult and children mandibular and maxillary incisor, premolar and molar) with values of 197, 163, 128, 102, 81, 65 and 49mGycm−2 and 7.23, 5.94, 4.75, 3.68, 3.10, 2.41 and 1.88mGy for benchmark nominal exposure times of 1000, 800, 640, 500, 400, 320 and 250ms respectively, at a nominal exposure voltage of 70kVp. ConclusionsThe local DRLs of the present study compare well with other similar published DRLs.

Diagnostic reference levels of intraoral dental radiography in the public hospitals of cyprus

Diagnostic reference levels of intraoral dental radiography in the public hospitals of cyprus

COMPUTED TOMOGRAPHY OF TOOTH RESORPTION IN CATS.

Tooth resorption is the most common dental disease in cats and can be a source of oral pain. The current clinical gold standard for diagnosis includes a combination of oral exam and dental radiography, however early lesions are not always detected. Computed tomography (CT) of the skull, including the dental arches, is a commonly performed diagnostic procedure, however the appearance of tooth resorption on CT and the diagnostic ability of CT to detect tooth resorption have not been evaluated. The purpose of this prospective, descriptive, diagnostic accuracy study was to characterize the CT appearance of tooth resorption in a sample of affected cats and to evaluate the sensitivity and specificity of CT for tooth resorption compared to the clinical gold standard of oral exam and intraoral dental radiography. Twenty-eight cat cadaver specimens were recruited for inclusion. Each specimen was evaluated using oral exam, intraoral dental radiography, and computed tomography (four different slice thicknesses). Each tooth was evaluated for the presence or absence of tooth resorption. Teeth with lesions and a subset of normal teeth were evaluated with histopathology. On CT, tooth resorption appeared as irregularly marginated hypoattenuating defects in the mineral attenuating tooth components, most commonly involving the root or cementoenamel junction. Sensitivity for CT detection of tooth resorption was fair to poor (42.2-57.7%) and specificity was good to excellent (92.8-96.3%). Findings from this study indicated that CT has high specificity but low sensitivity for detection of tooth resorption in cats.

Dose measurements in intraoral radiography using thermoluminescent dosimeters

The use of X-ray in medicine demands to expose the patient and the professional to the lowest radiation doses available in agreement with ALARA philosophy. The reference level for intraoral dental radiography is 7 mGy and, in Mexico, a number of examinations of this type are performed annually. It is considered that approximately 25% of all the X-rays examinations carried out in our country correspond to intraoral radiographies. In other hand, most of the intraoral X-ray equipment correspond to conventional radiological systems using film, which are developed as much manual as automatically.In this work the results of determining the doses received by the patients in intraoral radiological examinations made with different radiological systems using LiF:Mg,Cu,P+PTFE thermoluminescent dosimeters are presented.In some conventional radiological systems using film, when films are developed manual or automatically, incident kerma up to 10.61 ± 0.74 mGv were determined. These values exceed that reference level suggested by the IAEA and in the Mexican standards for intraoral examinations.

Feline dental radiography and radiology: A primer.

Information crucial to the diagnosis and treatment of feline oral diseases can be ascertained using dental radiography and the inclusion of this technology has been shown to be the best way to improve a dental practice. Becoming familar with the techniques required for dental radiology and radiography can, therefore, be greatly beneficial. Novices to dental radiography may need some time to adjust and become comfortable with the techniques. If using dental radiographic film, the generally recommended 'E' or 'F' speeds may be frustrating at first, due to their more specific exposure and image development requirements. Although interpreting dental radiographs is similar to interpreting a standard bony radiograph, there are pathologic states that are unique to the oral cavity and several normal anatomic structures that may mimic pathologic changes. Determining which teeth have been imaged also requires a firm knowledge of oral anatomy as well as the architecture of dental films/digital systems. This article draws on a range of dental radiography and radiology resources, and the benefit of the author's own experience, to review the basics of taking and interpreting intraoral dental radiographs. A simplified method for positioning the tubehead is explained and classic examples of some common oral pathologies are provided.

Odontogenic Keratocyst in a Cat

Odontogenic cysts are derived from odontogenic epithelium, can be locally invasive and destructive and have been reported rarely in cats. A 16-year-old, male domestic shorthair cat had a 3-year history of a slowly progressive, right mandibular swelling. Intraoral dental radiographs revealed a multilocular, radiolucent, cystic mass within the right mandible that extended from the distal aspect of the canine tooth to the mesial aspect of the fourth premolar tooth. Radiographically, the mass was associated with distortion and regional destruction of the right mandibular bone and resorption of regional tooth roots. Histological examination of an incisional biopsy sample revealed multiple ruptured cysts lined by stratified squamous epithelium of odontogenic origin with luminal parakeratinization and a prominent palisading basal cell layer. The cyst contained abundant orthokeratotic and parakeratotic keratin. The clinical, radiographical and histological features were consistent with a diagnosis of odontogenic keratocyst, as seen in man. This is the first report of an odontogenic keratocyst in a cat.

Bilateral Dentigerous Cysts in a Dog

Dentigerous cysts are infrequently seen in veterinary medicine, but the consequences of an undiagnosed dentigerous cyst can be severe. Dentigerous cysts, that can be sub-classified as eruption or follicular, are a type of benign odontogenic cyst. They can cause significant bony and dental destruction associated with expansion if they remain undiagnosed for a period of time. Dentigerous cysts are secondary to embedded or impacted teeth, however not every impacted tooth subsequently forms a dentigerous cyst. Intraoral dental radiographs are necessary to differentiate a missing tooth from an impacted tooth. This case demonstrates the successful surgical management of a dog with bilateral impacted mandibular canine teeth, with secondary dentigerous cyst formation.

Diagnostic reference levels in intraoral dental radiography in Korea

PurposeThe objectives of this study were to survey the radiographic exposure parameters, to measure the patient doses for intraoral dental radiography nationwide, and thus to establish the diagnostic reference levels (DRLs) in intraoral dental X-ray examination in Korea.Materials and MethodsOne hundred two intraoral dental radiographic machines from all regions of South Korea were selected for this study. Radiographic exposure parameters, size of hospital, type of image receptor system, installation duration of machine, and type of dental X-ray machine were documented. Patient entrance doses (PED) and dose-area products (DAP) were measured three times at the end of the exit cone of the X-ray unit with a DAP meter (DIAMENTOR M4-KDK, PTW, Freiburg, Germany) for adult mandibular molar intraoral dental radiography, and corrections were made for room temperature and pressure. Measured PED and DAP were averaged and compared according to the size of hospital, type of image receptor system, installation duration, and type of dental X-ray machine.ResultsThe mean exposure parameters were 62.6 kVp, 7.9 mA, and 0.5 second for adult mandibular molar intraoral dental radiography. The mean patient dose was 2.11 mGy (PED) and 59.4 mGycm2 (DAP) and the third quartile one 3.07 mGy (PED) and 87.4 mGycm2 (DAP). Doses at university dental hospitals were lower than those at dental clinics (p<0.05). Doses of digital radiography (DR) type were lower than those of film-based type (p<0.05).ConclusionWe recommend 3.1 mGy (PED), 87.4 mGycm2 (DAP) as the DRLs in adult mandibular molar intraoral dental radiography in Korea.

Lip Avulsion and Mandibular Symphyseal Separation Repair in an Immature Cat

A 12-week-old kitten was presented for symphyseal separation, comminuted rostral fractures of the mandibles, avulsion of the mandibular lip, andfractured teeth. Oral examination and intraoral dental radiographs demonstrated a mandibular symphyseal separation and the presence of developing tooth buds. Cerclage wire was placed circumferentially around the mandibles for 2-weeks to provide stabilization of the mandibular symphyseal separation. Clinical examination 9.5-months following surgery demonstrated normal occlusion with enamel hypoplasia affecting the mandibular canine teeth. Intraoral dental radiographs showed a partial bony union of the mandibular symphysis and vital, developing mandibular canine teeth.

Mandibular Periostitis Ossificans in Immature Large Breed Dogs: 5 Cases (1999–2006)

This case series describes clinical, radiographic, and histopathological features of mandibular swellings in 5 immature, large breed dogs. The dogs originated from different regions of the United States. In each case, intraoral dental radiography of the jaw swelling revealed a two-layered (double) ventral mandibular cortex. Biopsy was performed in 4 of the 5 puppies, revealing periosteal new bone formation. Resolution of the mandibular swelling was spontaneous in the 4 dogs available for follow-up examination. The authors postulate that the clinical, radiographic, and histopathological presentation of mandibular swelling in these 5 dogs is a distinct pathological entity consistent with an inflammatory condition of the maturing human mandible known as periostitis ossificans.

Operator Exposure to Scatter Radiation from a Portable Hand‐held Dental Radiation Emitting Device (Aribex™ NOMAD™) While Making 915 Intraoral Dental Radiographs*

Operator exposure to backscatter radiation while using an Aribex NOMAD radiation emitting device (a portable, self-contained, cordless, hand-held dental X-ray unit) was determined while the operator employed various typical and atypical use scenarios during the exposure of 715 digital and/or film-based dental radiographs and 200 study control exposures. Study data was compared to the radiation safety occupational exposure annual Maximum Permissive Dose (MPD) of 50 mSv (5000 mrem) to determine the possible exposure risk to an unprotected operator using this device. The results showed the reproductive organs received the highest dose and the thyroid the least. The average operator whole body dose for the study was determined to be 0.047 mSv (4.47 mrem) or 0.09% of the annual MPD. Extrapolating the data as an expression of averaged annual operator exposure resulted in a whole body dose of 0.4536 mSv (45.36 mrem) or 0.9% of the annual MPD, These results are well below established occupation exposure limits and are compatible with those published by the manufacturer.

医用画像部門における品質維持の評価及び日常試験方法―第 ２‐７ 部：不変性試験―口内法撮影用Ｘ線装置 ＪＩＳ Ｚ ４７５２−２−７

医用画像部門における品質維持の評価及び日常試験方法―第 ２‐７ 部：不変性試験―口内法撮影用Ｘ線装置 ＪＩＳ Ｚ ４７５２−２−７

Intra- and interobserver error of the Greulich–Pyle method as used on a Danish forensic sample

The Section of Forensic Medicine at the University of Copenhagen performs age evaluations of the living at the request of the police. The established procedure in these cases involves: (1) a physical examination; (2) an odontological examination based on evaluation of an orthopantomogram and intraoral dental radiographs. Different methods are used depending on the maturity of the individual examined; and (3) a carpal X-ray examination, using the Greulich and Pyle Atlas (GPA) method. We present the results of intra- and interobserver tests of carpal X-rays in blind trials, and a comparison of the age estimations by carpal X-rays and odontological age estimation. We retrieved 159 cases from the years 2000–2002 (inclusive). The intra- and interobserver errors are overall small. We found full agreement in 126/159 cases, and this was between experienced users and novices. Overall, the mean difference was 0.053 years, with a standard deviation of ±0.567 years. Our results show that the direct and naïve use of the GPA is simple and reproducible, even when applied by non-experienced users. This is probably also why the method is still widely applied, even though other authors have stated that atlas-based techniques are obsolete and ought to be replaced by other methods. Specifically, the GPA test sample consisted of American “white” children “above average in economic and educational status”, leading to the question as to how comparable subjects being scored by the GPA method today are to this original sample. Indeed, we found a minor difference in the age estimations for older juveniles between odontologists and radiologists, which may indicate that more studies on comparative dental and skeletal aging for geographically different populations would be beneficial. Finally, if using the GPA method in legal cases, we would advise that one should closely adhere to the standard deviations given, and intermediary scores should be noted and not just a resultant age. The final age statement should also address the problems of reference populations.

Dose reduction of intraoral dental radiography in Spain

To assess the influence of new European Union (EU) legislation on radiation doses in intraoral dental radiography in Spain. A total of 10 109 official reports from Spanish dental offices covering the period 1996-2003 were analysed. The results point to a dose reduction of 19% in 7 years, with a mean dose of 3.11 mGy being administered in 2003. The third quartile value in 2002 was 4.8 mGy. Taking the EU recommended dose of 4 mGy as standard, 73.3% (2002) and 77.3% (2003) of installations are in compliance with the EU recommendations in Spain. However, there has been no further reduction in the last 3 years. The results showed that Ultraspeed dental X-ray film was used by 77.6% of the dentists in 1996-1997 and 82.3 in 2003. There was infrequent use of E-speed films (0.6%) and F-speed films (9.6%) in 2003. Statistical analysis pointed to significant differences between the doses administered and the type of processing used, the lowest exposures being measured in digital systems, which used significantly lower doses than both manual and automatic development, and when conventional radiographic films were used. The introduction of new legislation has resulted in a gradual reduction in the dose administered in intraoral dental radiology in Spain.