RADIOGRAPHS IN PROSTHODONTICS

Introduction
Dental radiographs are a necessary component of comprehensive patient
careIn dentistry! radiographs ena"le the dental professional to identify many
condition that may other#ise go $ndetected clinically. Detection is one of
the most important $ses of dentistry $sed radiographs %any dental diseases
and conditions prod$ce no clinical signs or symptoms and are typically
discovered only thro$gh $se of dental radiographs
Uses of dental radiographs&
' To detect lesions! disease and conditions of teeth and s$rro$nding
str$ct$res that cannot "e identified clinically
( To confirm and classify or foreign o")ects
* To locali+e lesions or foreign o")ects
, To provide information d$ring dental proced$res
- T o eval$ate gro#th and development
. To ill$strate changes secondary to caries! periodontal disease and
tra$ma
/ To doc$ment the condition of patient at a specific point of time
The history of dental radiography "egins #ith discovery of 01rays
WILHELM CONRAD ROEN!EN 2prono$nced 3ren14en56! a
7avarian physicst discovered 01ray on Nov 8!'89-This mon$mental
discovery revol$tioni+ed the diagnostic capa"ilities of medical and
dental profession and a res$lt! forever changed the practice of medicine
and dentistry
Roentgen named his discovery 01rays! the :0; referring to $n4no#n
nat$re and properties of s$ch raysHe p$"lished a total of three scientific
papers detailing the discovery! properties and characteristics of 01rays
D$ring his life time! Roentgen #as a#arded many hono$rs and
distinctions incl$ding first no"le pri+e ever a#arded in Physics <or a
n$m"er of years after discovery! 01rays #ere referred to as Roentgen
rays! Radiology as Roentgenology and Radiographs #ere named
Roentgenography
"ioneers in dental #$ra% radiation&
<ollo#ing the discovery of 01rays in '89-! a n$m"er of pioneers helped
to shape the history of dental radiography After anno$ncement of
discovery of 01rays in '98-! a German dentist OO WAL'HO((
made first dental radiograph
C.Ed)und 'ells! a ne# Orleans dentist is credited #ith the $se of
radiographs dentistry in '89. =ells dedicated to the development of 01
rays $ltimately cost him his fingers ! later his hand and his arm
Other pioneer in dental radiography incl$de Willia) H.Rollins! a
7oston dentist #ho first developed 0 ray $nit
(ran* +an Woert! a dentist from Ne#yor4 city #as the first to $se film
in intraoral radiography
Ho,arth Rile% Raper! an I ndiana $iversity professor esta"lished the
first college co$rse of radiography for dental st$dents >i4e#ise dental
?1ray film! dental radiographic techni@$es #ere developed
Present day diagnosis! treatment planning and eval$ation of prognosis in
the field of medicine and dentistry depends a lot on radiographic
imaging and prosthodontics is no #ay e?ception to his principle Tho$gh
$se of vario$s radiographs #as limited for eval$ation and to reach a
concl$sion regarding diagnosis and treatment planning previo$sly in
Prosthodontics! present day radiographs are $sed to analyse even the
prognosis or treatment o$tcome especially after advent of advanced
Prosthodontic care "y Implants and %a?illofacial prosthesis
COM"LEE DENURE-
Radiographic e.aluation
Radiographs are important aids in the eval$ation of s$"m$cosal conditions
in patients see4ing prosthodontic care The presence of a"normalities in
edent$lo$s )a#s may "e $ns$spected "eca$se of a"sence of any clinical
signs or symptoms they sho# the relative thic4ness of alveolar ridge and the
m$coperioste$m! the @$ality of the "one
E/traoral radiographs can provide s$rvey of the patient5s dent$re
fo$ndation and s$rro$nding str$ct$res Panoramic dental radiograph are
readily availa"le for convenient e?amination of edent$lo$s patients
=no#ledge of location of the anatomic str$ct$res is an essential pre1
re@$isite in the eval$ation of the radiographs
Intraoral radiographs have limited role in edent$lo$s patients They can
$sed in locating any locali+ed a"normality or the e?amination of
t$"erosities
The transition from em$lsion "ased film radiography to photostim$a"le
phosphor "ased films CCD 2charge co$ple devices6 and C%OS
2complementary metal o?ide semicond$ctor6 are #ell $nder #ay This is
limiting the e?pos$re of patients to radiations
Other investigations tools these incl$de Tomography! Aonography!
Comp$ted Tomography! %agnetic Resonance! Radion$clide Imaging and
Bltraso$nds
Radiographs in complete dent$res sho$ld r$le o$t foreign "odies! retained
root tips! $ner$pted teeth or vario$s pathoses of developmental!
inflammatory or neoplastic origin
Cephalometric and temporomandi"$lar )oint radiography are
performed to r$le o$t relevant a"normalities for complete
dent$re prosthesis f$nctioning and maintenance
Radiographs are $s$ally ta4en to find o$t the presence of
hidden a"normalities! to note the str$ct$re of cortical "one
and tra"ec$lae! sharp pro)ections! thic4ness of soft tiss$e etc!
Retained roots #ith no apparent pathology can often "e left
alone provided the patient is informed of their presence and
01rayed periodically
The interpretation of panoromic radiographs follo# a - step
analysis as o$tlined "y Che)en*o
The panoromic is also an aid in doc$menting the amo$nt of
ridge resorption A very $sef$l system of classifying the
amo$nt of ridge resorption #as descri"ed "y WICAL C
-WOO"E . They fo$nd that the lo#er edge of mental
foramena divides the mandi"le into thirds in normal dent$lo$s
panaromic radiograph If the distance is meas$red from
inferior "order of mandi"le to inferior margin of mental
foramina and then m$ltiplied "y * ! the res$ltant prod$ct is a
relia"le estimate of original alveolar ridge crest height
Amo$nt of ridge resorption can "e calc$lated an classified as
Class I 2%I>D RDSORPTION6>oss $pto 'E* of original
vertical height
Class II 0%ODDRATD RDSORPTION6 >oss $pto 'E* to (E* of vertical
height
Class III 2SDFDRD RDSOPTION6 >oss of (E* or more of vertical
height
To concl$de periapical s$rvey of edent$lo$s )a#s are accepta"le "$t
Panaromic radiographs are faster red$ce patient e?pos$re to radiation
and image the entire ma?illa and mandi"le
REMO+A1LE "ARIAL DENURE-
"lanning
A panoramic radiograph is of great diagnostic val$e and
sho$ld "e made #herever possi"le
Periapical radiographs of the remaining teeth may also "e
re@$ired is order to s$pplement the OPG
teeth #ith @$estiona"le prognosis
Re@$iring s$rgical C Dndodontic restoration
In case OPG not there then a f$ll month service of IOPAS have
to "e there
The diagnostic factors or criteria )$dged are
2i6 Cario$s lesion
initial cario$s lesions
Rec$rrent caries ad)acent to e?isting restorations
Deep lesions or e?tensive restorations on potential a"$tment
teeth
O"vio$s indications for endodontic therapy cast restorations
are noted
2ii6 Root >ength! Si+e C <orm
>arge! longer roots are more favora"le a"$tment teeth
<orm of the root is e@$ally important tapered or conical roots
are $nfavora"le "eca$se ever a small loss of "one height can
greatly diminish the attachment area
%$ltirooted teeth #ith divergent and c$rved roots are "etter
than single rooted or %$ltirooted #ith f$sed roots
Position of roots of ad)acent tooth is also important! in case
the roots are close #ith little interpro?imal "one separating
them even a moderate irritation of force may "e destr$ctive
Cro,n root ratio
The relationship of the length of the clinical area and the
amo$nt of root em"edded is "one is a very critical factor If the
cro#n root ratio is greater than '&' then the tooth has a poor
prognosis as an a"$tment It is also poor #hen there is f$rcation
involvement of a m$lti rooted teeth is present
La)ina dura or periodontal space
The #idth of the periodontal ligament space is of significance
in eval$ating the sta"ility of the teeth A thin $niform
ligament space and an $ninterr$pted >amina d$ra is a more
favora"le sign compared to a more #idened or irreg$lar space
A thic4ening of the lamina d$ra may occ$r if the tooth is
mo"ile! has occl$sal tra$ma or is $nder heavy f$nctions
occl$sal tra$ma can ca$se partial or total loss of the lamina
d$ra
Partial or total a"sence of the lamina d$ra may "e fo$nd in
systemic disorders s$ch as Hyperparathyroid and Paget5s
disease
Systemic disease m$st "e considered #henever this
condition is notedG Destr$ction forces or the disease processes
ca$sing changes in the lamina d$ra m$st "e correlated or the
a"$tment tooth #ill have a poor prognosis
Bone quality & quantity
7ones #hich has small closely gro$ped tra"ec$lar and small
inter tra"ec$lar spaces is considered #ell minerali+edG hence
strong C healthy
This is portrayed in the radiograph as relatively radiopa@$e!
altho$gh a certain amo$nt of variation is si+e of the tra"ec$lae is
normal and to "e e?pected
Bone height of quantity
In this eval$ation care m$st "e ta4en to avoid any
interpretation errors res$lting from ang$lations factors #ith is
normally $sed in the short cone or 7isecting angle techni@$e
As a res$lt of the central ray $sing shot at an angle res$lts
in the "$ccal "one to "e pro)ected higher on the cro#n than the
ling$al or palatal "one
Therefore #hen interpreting "one height it is imperative to
follo# the line of the lamina d$ra from the ape? to#ards the
cro#n of the tooth $ntil the opacity of the lamina materially
decreases
At this point of opacity charge! a less dense "one e?tends
f$rther to#ards the tooth cro#n
This additional amo$nt of "one represents false "one
height Th$s the tr$e height of the "one is ordinarily #here the
lamina shines a mar4 decrease in opacity
At this point the tra"ec$lar pattern of the "one
s$perimposed on the tooth root is lost And the portion of the
root "E# the CDH and the tr$e "one height has the appearance
"eing "ase as devoid of covering
1ONE INDE# AREA-
Inde? areas are those areas of alveolar s$pport that disclose
the reaction of "one to additional stress
There might "e a positive 7one factor or a Negative 7one
factor depending on the response of the alveolar "one to
additional loading
A position or a fa.ora2le response
A decrease in the tra"ec$lar pattern 2"one condensation66
A heavy cortical layer
Dense lamina d$ra
Normal "one height
Normal periodontal ligament space
Retrograde or negati.e response
loss of lamina d$ra
decrease "one height
#idening of periodontal ligament space
apical and f$rcation radiol$scency
Teeth that have been subjected to greater than normal stress and
provide good index information are:-
2i6 A"$tment teeth of an <PD or RPD
2ii6 Teeth involved in occl$sal interferences
2iii6 Teeth receiving greater occl$sal stress d$e to
loss of ad)acent teeth
2iv6 Tipped teeth #ith occl$sal contact
Radioluscent or radioopa3ue lesions.
The presence of cysts! accesses! em"edded teeth or roots or
foreign "odies m$st "e noted
A s$rgical diagnosis and treatment m$st "e planned so that a
conditions does not flare $p later on )eopardi+ing the
prognosis of the prosthesis
7$ried root tips or impacted teeth that sho# no signs of any
pathosis and are encaps$lated "y normal appearing "one need
not "e s$rgically removed tho$gh it m$st "e noted in the
diagnosis
It sho$ld "e chec4ed for any imparted *
r d
molars
Roentgenographic interpretation
Radiographic interpretation most pertinent to partial dent$re
constr$ction are those relative to prognosis of remaining teeth that may "e
$sed as a"$tments
The @$ality of the alveolar s$pport of an a"$tment tooth is of prime
importance "eca$se the tooth #ill have to #ithstand greater stress loads
#hen s$pporting a dental prosthesis! especially greater hori+ontal forces
A"$tment teeth ad)acent to distal e?tension "ases are s$")ected not only to
vertical and hori+ontal forces "$t to tor@$e as #ell
(I#ED "ARIAL DENURE-
A #ell defined! complete mo$th radiographic series is essential
T%H radiographs may "e indicated for patients #ith )oint
dysf$nction and a panoramic radiograph can also "e helpf$l
Radiographs provide information that cannot "e determined
clinically! they are an ad)$nct! ho#ever! and not the sole or
primary so$rce of diagnostic information
The radiographic interpretation is com"ined #ith all other
availa"le findings #hen ma4ing a definitive diagnosis and
developing a treatment plan
Radiographs used in FPD are
' <$ll mo$th intra1oral periapical radiographs
( Panoramic radiographs
* T%H radiographs
Full mouth intra oral radiographs
An intra oral radiographic e?amination reveals
1. Remaining bone support
After hori+ontal "one loss from periodontal disease the
PD> s$pported root s$rface area can "e dramatically
red$ced Ihen one third of the root length has "een
e?posed half the s$pporting area is lost
( Root n$m"er and morphology 2short! long! slender! "road!
"if$rcated! f$sed dilacerated etc6 and root pro?imity %olar
#ith divergent roots provide "etter s$pport than a molar
#ith little or no inter radic$lar "one
* J$ality of s$pporting "one tra"ac$lar patterns and reaction
to f$nctional charges
, Iidth of the periodontal ligament spaces and evidence of
tra$m from occl$sion
- Areas of vertical and hori+ontal osseo$s resorption and
f$rcation invasions
. A?ial inclination of teeth 2degree of non parallelism if
present6 A #ell aligned tooth #ill provide "etter s$pport
than a tilted one
/ Contin$ity and integrity of the lamina d$ra
8 P$lpal morphology and previo$s endodontic treatment #ith
or #itho$t post and cores
9 Presence of apical diseases! root resorption or root
fract$res
'K Retained root fragments! radiol$cent areas! calcification!
foreign "odies! or impacted teeth
'' Presence of cario$s lesions and restorations to the p$lp and
alveolar crest
'( Pro?imity of cario$s lesions and restorations to the p$lp
and alveolar crest
'* Calc$l$s deposits
', Oral roentgenographic manifestation of systemic disease
15. Edentulous areas
Presence of retained root tips or other pathosis in the
edent$lo$s area sho$ld "e noted In many radiographs it is
possi"le to trace the o$tline of the soft tiss$e in edent$lo$s
areas so that the thic4ness of the soft tiss$e overlying ridge
can "e determined
16. ro!n " root ratio. #$nte%s &a!'
This ratio is a meas$re of the length of tooth occl$sal to the
alveolar crest of "one compared #ith the length of root
em"edded in the "one As the level of the alveolar "one
moves apically! the level arm of that portion o$t of the "one
increases and the chance for harmf$l lateral forces is
increased The optim$m cro#n root ratio for a tooth to "e
$sed as a fi?ed partial dent$re a"$tment is (&* A ratio of
'&' is the minim$m ratio that is accepta"le for a prospective
a"$tment $nder normal circ$mstances
1(. )i*e and position of the pulp
This is one of the most important factors to "e assessed
"efore preparing a tooth and may #ell determine the correct
choice of retainer Ihere the p$lp is large partic$larly in
the yo$ng patient! it may "e impossi"le to o"tain s$fficient
red$ction of tooth tiss$e for ade@$ate retainers #itho$t
devitali+ation This is especially tr$e of the "onded
porcelain restorations! #here @$ite drastic red$ction of
tooth tiss$e is essential if a good esthetic res$lt is to "e
o"tained
On occasions #here devitali+ation is re@$ired it is far "etter
if this is elective rather than follo#ing an e?pos$re In the
posterior region a "ite#ing 01ray is the "est method of
assessing the correct position of the p$lp Iith anterior
teeth an 01ray ta4en #ith the ray at right angles to the
cro#n of the tooth is to "e preferred to the $s$al apical
vie#
Panoramic radiographs
Panoramic films provide $sef$l information as to the
presence or a"sence of teeth They give an overall vie# a"o$t the
dentition Ho#ever they do not provide detailed vie# for
assessing "one s$pport! root morphology! or caries
Special radiographs
There are needed for the assessment of T%H disorders A
trans1cranial e?pos$re #ith the help of a positioning device ! #ill
reveal the lateral third of the mandi"$lar condyle and can "e $sed
to detect str$ct$ral and positional changes
Ho#ever interpretation may "e diffic$lt %ore information
can "e o"tained from serial tomography! arthrography! CT
scanning or magnetic resonance imaging of the )oints
IM"LAN IMA!IN!
Radiographic vis$ali+ation of potential implant sites is an
important e?tension of clinical e?amination and assessment
Radiographs help the clinician to vis$ali+e the alveolar ridges
and ad)acent str$ct$res in all three dimensions and g$ide the
choice of site! n$m"er! si+e and a?ial orientation of the implants
Site selection incl$des consideration of ad)acent anatomic
str$ct$res Pathologic conditions! that co$ld compromise the
o$tcome m$st "e identified C located relative to the site of the
proposed implant A variety of radiographic techni@$es are
availa"le to assist the clinicians
Radiographs are $sef$l in the Implant dentistry mainly at
three levels
'6 Preprosthetic implant imaging
(6 S$rgical and interventional implant imaging
*6 Post prosthetic implant imaging
I%AGING O7HDCTIFDS
I Preprosthetic imaging
O")ectives incl$des Information a"o$t
' J$ality! @$antity and ang$lation of "one
( The relationship of critical str$ct$res to the prospective
implant sites
* Presence or a"sence of disease at the proposed s$rgery
sites
II S$rgical and Interventional imaging
The o")ectives of this phase are
' To eval$ate the s$rgery sites d$ring and immediately
after s$rgery
( Assist in optimal position and orientation of dental
implants
* Dval$ate the healing and integration phase of implant
s$rgery
, Dns$re a"$tment position C prosthesis fa"rication are
correct
III Post prosthetic imaging
The o")ectives of this phase are
' To eval$ate the long1term maintenance of implant
rigid fi?ation and f$nction! incl$ding the crestal "one levels
aro$nd each implant
( To eval$ate the implant comple?
+,$-+.- ,/0$&+T+E)
The imaging modalities can "e descri"ed as either analog or
digital and t#o dimensional or three dimensional
a4 Analog I)aging )odalities
Periapical radiography
Panoramic radiography
Occl$sal radiography
Cephalometric radiography
24 hree di)ensional i)aging )odalities
Comp$ted tomography
%agnetic resonance imaging
Interactive comp$ted tomography
c4 5uasi 6 three di)ensional i)aging )odalities
01ray tomography
Some cross L sectional panoramic imaging techni@$es
Periapical radiograph
Peri1apical radiography provides high resol$tion planar
images of a limited region of the )a#s They provide a lateral
vie# of the )a#s and no cross sectional information Dven #ith
ad)acent peri1apical radiographs made #ith limited o"li@$e
orientations! third dimensional information is of little $se for the
implant imaging
Periapical radiographs may s$ffer from "oth distortion C
magnification The long cone paralleling techni@$e #ill
eliminate distortion and limit magnification less than 'KM In
order to vis$ali+e opposing cortical pate! the image most often
m$st "e foreshortened As a res$lt! the act$al availa"le "one
height may "e diffic$lt to determine
In terms of the o")ectives of preprosthetic imaging!
periapical radiography is
' A $sef$l high L yield modality for r$ling o$t local
"one or dental diseases
( Of limited val$e in determining @$ality "eca$se the
image is magnified! may "e distorted and does not depict
the third dimension of "one #idth
* Of limited val$e in determining "one density or
minerali+ation
, Of val$e in identifying critical str$ct$res! "$t of little
$se in depicting the spatial relationship "et#een the
str$ct$res at the proposed implant site
In preprosthetic phase! these films are most often $sed for
single tooth implants in regions of a"$ndant "one #idth
Occlusal radiograph
Occl$sal radiographs prod$ce high resol$tion planar images
of the "ody of the mandi"le or ma?illa %a?illary occl$sal
radiographs are inherently o"li@$e and so distorted they are of no
@$antitative $se for implant dentistry for either determining the
geometry or the degree of minerali+ation of the implant site
%andi"$lar occl$sal radiograph is an orthogonal pro)ection
It is a less distorted pro)ection than the ma?illary occl$sal
radiograph 7$t! the mandi"$lar alveol$s flares anteriorly and
demonstrates a ling$al inclination posteriorly! prod$cing an
o"li@$e and distorted image of the mandi"$lar alveol$s! #hich is
of little $se in implant dentistry In addition it sho#s the #idest
#idth at the crest! #hich is #here the diagnostic information is
needed most
As a res$lt occl$sal radiographs are rarely indicated for
diagnostic preprosthetic phase in implant dentistry
Cephalometric radiographs
The geometry of cephalometric imaging devices res$lts in a 'KM
magnification to the image #ith a .K inch focal o")ect and a .
inch o")ect to film distance
The primary advantages of cephalometric radiographs in
implantology are&
a A cross sectional image of the alveol$s of "oth the
mandi"le and the ma?illa in the mid sagittal plane is
demonstrated "y this radiograph
" Iith slight rotation of the cephalometer! a cross
sectional image of the mandi"le or ma?illa can "e
demonstrated in the lateral incisor or in the canine region
as #ell
c It demonstrates the spatial relationship "et#een
occl$sion and esthetics #ith the length! #idth! ang$lation!
and geometry of the alveol$s
d It is more acc$rate for "one @$ality determination!
$nli4e panoramic or periapical images
e It demonstrates the geometry of the alveol$s in the
anterior region and the relationship of the ling$al plate to
the patients5 s4eletal anatomy
f Together #ith regional periapical radiographs!
@$antitative spatial information is availa"le to demonstrate
the geometry of the implant site relationship #ith that of
the critical str$ct$res
Panoromic radiography
This modality is pro"a"ly the most $tili+ed diagnostic
modality in implant dentistry Ho#ever for @$antitative pre1
prosthetic implant imaging! it is not the most diagnostic This
radiograph prod$ces an image of a section of the )a#s of varia"le
thic4ness and magnification
Panoramic radiography is characteri+ed "y an image of the
)a#s that demonstrates "oth vertical and hori+ontal
magnification! along #ith a tomographic section thic4ness that
varies according to the anatomic position It prod$ces a
relatively constant vertical magnification of appro?imately 'KM
The hori+ontal magnification of appro?imately (KM
The non$niform magnification of str$ct$res prod$ces
images #ith distortion that cannot "e compensated for in
treatment planning The posterior )a/illar% regions are
generally the least distorted regions of a panoramic radiograph
"anora)ic i)ages offer the follo,ing ad.antages
' Opposing landmar4s are easily identified
( Fertical height of "one initially can "e assessed
* The proced$re is performed #ith convenience! ease! and
speed in most dental offices
, Gross anatomy of the )a#s and any related pathologic
findings can "e eval$ated
Disad.antages are
' It does not demonstrate "one @$ality E minerali+ation
( It is misleading @$antitatively "eca$se of
magnification and "eca$se of the third dimension cross
sectional vie# is not demonstrated
* It is only of some $se in demonstrating critical
str$ct$res "$t of little $se in depicting the spatial
relationship "et#een the str$ct$res and dimensional
@$anti+ation of implant site
Diagnostic templates that have - mm "all "earing or #ires
incorporated aro$nd the c$rvat$re of the dental arch and #orn "y
patient d$ring the panoramic 01ray e?amination ena"le the
clinician to determine the amo$nts of magnification in the
radiograph
A techni@$e for eval$ating the panoramic radiograph for
mandi"$lar posterior implants and comparing this to the clinical
eval$ation d$ring s$rgery #as developed "y identifying the
mental foramen and the posterior e?tent of the inferior alveolar
canal :-under Dhar)ar; proposed that appro?imately - degree
do#n#ard tilt of the patient head #ith reference to the <ran4fort
hori+ontal reference plane! sho#ed mandi"$lar foramen!
mandi"$lar canal and mental foramen in 9'M of the radiographs
7onograph%
Recently a modification of the panoramic 01ray machine
has "een developed that has the capa"ility of ma4ing a cross
sectional image of the )a#s These devices employ limited angle
linear tomography 2Aonography6 and means of positioning the
patient The tomographic layer is of appro?imately - mm This
techni@$e ena"les the appreciation of spatial relationship
"et#een the critical str$ct$res and the implant site and
@$antification of the geometry of the implant site The
tomographic layers are relatively thic4 and have ad)acent
str$ct$res that are "l$rred and s$per imposed on the image!
limiting the $sef$lness of this techni@$e for individ$al sites!
especially in the anterior regions
Tomography
The diagnostic @$ality of the res$lting tomographic image
is determined "y the type of tomographic motion! the section
thic4ness and the degree of magnification The type of
tomographic motion is pro"a"ly the most important factor in
tomographic @$ality Hypocycloidal motion is generally
accepted as the most effective "l$rring motion >arge amplit$de
t$"e travel and ' mm sections are preferred for high contrast
anatomic o")ects #hose geometry changes in a relatively short
distance! s$ch as the alveol$s of the )a#s %agnification varies
from appro?imately 'K L *KM #ith higher magnification
generally prod$cing higher @$ality images Dense str$ct$res may
persist in the tomographic image ever tho$gh they are * L , times
the tomographic layer thic4ness and distant from the tomographic
section
The $se of tomography prosthetic implant imaging are
' Dna"les @$antification of the geometry of the alveol$s
( Dna"les determination of the spatial relationship "et#een
the critical str$ct$res and the implant site
* Dna"les appreciation of the @$asi three dimensional
appearance of the alveol$s
, The @$antity of alveolar "one availa"le for implant
placement can "e determined "y compensating for
magnification
- Post imaging digiti+ation of tomographic implant images
ena"les $se of a digital r$ler aid in the determination of
alveolar "one for implant placement
. Image enhancement can aid in identifying critical
str$ct$res s$ch as the inferior alveolar canal
&imitations
Not $sed in determining "one @$ality or identifying dental
and "one disease
Linear Tomography
It has "een sho#n to "e accepta"le for the eval$ation of
single implant sites or m$ltiple sites #ithin a single @$adrant
<or the assessment of a greater n$m"er of sites! this techni@$e
#as fo$nd to "e too time cons$ming "eca$se of the additional
calc$lations re@$ired to locate the patients5 position relative to
the central ray of the 01ray "eam S$"mento verte? radiograph
is $sed to determine the correct ang$lation of the 01ray "eam
location of the cross L sectional plane of the image
$dvantages
>inear tomography is capa"le of prod$cing tomograms
#ith layer thic4ness of appro?imately * mm and a range of
magnification from . L 'KM Acc$racy in this range #as fo$nd to
"e ade@$ate as confirmed s$rgically
ultidirectional or Polydirectional Tomography
This incl$des hypocycloidal and spiral In theory it sho$ld
provide images of s$perior @$ality to linear tomography "eca$se
of more $niform "l$rring Ho#ever no direct comparison of the
efficacy of linear tomography and comple? motion tomography
has "een reported
$dvantages
Compared to panoramic radiography! they have sho#n to "e
more precise in meas$ring the distance "et#een the alveolar crest
and the mandi"$lar canal
D!"!T#L R#D!O"R#P$%
Intra Oral Radiograph%
Direct digital intra oral imaging is a techni@$e emerging as
an alternative to film radiography
$dvantages +ncludes
' Red$ced patients5 e?pos$re to radiation
( Increased patient comfort #hile the radiographic image
is ta4en
* Instant res$lts and eliminates the inconvenience
associated #ith developing film
, The images prod$ced "y digital technology can "e
manip$lated The contrast can "e enhanced to facilitate
immediate diagnosis
- Fideo conversion improves vis$ali+ation "y allo#ing for
s#itching "et#een negative and positive or from "lac4 and
#hile to #hite and "lac4 image
. Color also can "e enhanced
/ The images can "e inverted and rotated to 9K degrees
8 The distance meas$rement icon allo#s for doc$mentation
of distance "et#een different points of an image in K' mm
increments This is most $sef$l in implants
Co)puted o)ograph%
Comp$ted tomography has "een #idely advocated for
implant site assessment especially in the posterior regions of the
)a#s and for comple? cases CT st$dies are planned on a lateral
sco$t image of the selected )a# #ith alignment corrections made
as needed Direct a?ial image are ac@$ired as thin! overlapping
a?ial scans #ith appro?imately *K a?ial sections per )a# These
images are $s$ally ac@$ired perpendic$lar to the long a?is of
"ody The se@$ential a?ial images s$"se@$ently are manip$lated
to prod$ce m$ltiple t#o dimensional images in vario$s planes!
$sing a comp$ter "ased process called m$ltiplanar reformatting
2%PR6
In general three "asic images are reformatted
' A?ial images #ith a s$perimposed c$rve
( Cross sectional images
* Panoramic li4e c$rved linear images
An a?ial scan incl$ding the f$ll conto$r of the mandi"le 2or
ma?illa6 at a level corresponding to the dental roots is selected
as a reference for the reformatting process The comp$ter places
a series of dots on the selected scan and connects them to
develop a c$stomi+ed arch or c$rve $ni@$e for each )a# The
comp$ter program then generates a series of lines perpendic$lar
to "e c$rves
These lines are made at constant intervals Bs$ally ' to (
mm and n$m"ered se@$entially on the a?ial image to indicate the
position at #hich each cross sectional slice #ill "e reconstr$cted
Cross sectional reconstr$ctions are made perpendic$lar to the
c$rve and panoramic 2c$rved liner6 reconstr$ctions are made
parallel #ith the c$rve Three dimensional representations may
also "e constr$cted in vario$s orientations
Uses In "reprosthetic I)plant I)aging
These reformatted images provide the clinician #ith t#o
dimensional diagnostic information in all the three dimensions
Reformatted CT st$dies provide diagnostic information in all
availa"le implant sites #ithin a dental arch The reformatted
images typically are presented life si+e on photographic prints or
radiographic film
It provides information of the contin$ity of the cortical
"one plates! resid$al "one in the mandi"le and ma?illa! the
relative location of soft tiss$es covering the osseo$s str$ct$res
St$dies have reported that 9,M of CT meas$rements
"et#een the alveolar crest and #all of the mandi"$lar canal #ere
acc$rate #ithin 'mm hree di)ensional refor)ations are
particularl% useful in the planning of angu)entation
procedures such as a sinus lift.
The density of str$ct$res #ithin the image is a"sol$te and
@$antitative and can "e $sed to differentiate tiss$es in the region
and characteri+e "one @$ality
Misch 7one density classification
D' 1 Dense cortical "one
D( 1 Thic4 dense to poro$s cortical "one on crest and
coarse tra"ac$lar "one #ithin
D* 1 Thin poro$s cortical "one on crest and fine
tra"ac$lar "one #ithin
D, 1 <ine tra"ac$lar "one
D- 1 Immat$re! non minerali+ed "one
C Deter)ination of 2one densit%
D
'
& N '(-K Ho$nsfield Bnits
D
(
& 8-K L '(-K Ho$nsfield Bnits
D
*
& *-K L 8-K Ho$nsfield Bnits
D
,
& O '-K Ho$nsfield Bnits
Th$s CT is capa"le of determining all the radiologic o")ectives
of preprosthetic implant imaging
Interacti.e co)puted to)ograph%& 8IC9
2SI% E Plant Soft#are! col$m"ia scientific! Inc!6
This addresses many of the limitations of CT This
techni@$e ena"les the radiologist to transfer the imaging st$dy to
the clinician as a comp$ter file and ena"les clinician to vie# and
interact #ith imaging st$dy on their o#n comp$ter
The clinicians5 comp$ter "ecomes a diagnostic radiologic
#or4 station #ith tools to meas$re the length and the #idth of
the alveol$sG meas$re "one @$ality! the change the #indo# and
level of the grey scale of the st$dy to enhance the perception of
critical str$ct$res A?ial! cross sectional! and panoramic images
are displayed and referenced so that the clinician can appreciate
the same position or region #ithin the patients anatomy in each
of the images
As important feat$res of ICT is that the clinician and
radiologist can perform :electronic L s$rgery; 2DS6 "y selecting
and placing ar"itrary si+e cylinders that sim$late root form
implants in the images Iith an appropriately designed
diagnostic template! DS can "e performed to electronically
develop the patients5 treatment plan in three dimensions
DS C ICT ena"le the development of a three dimensional
treatment plan that is integrated #ith the patients anatomy and
can "e vis$ali+ed "efore s$rgery "y the mem"ers of the implant
team and the patient for approval or modification
Li)itations
' Refinement and e?act relative orientation of
the implant position is diffic$lt and c$m"ersome
( Parallelism is diffic$lt to appreciate in ICT
$sing orthogonal rather than three dimensional images
Magnetic Resonance I)aging& 0MRI4
%R $sed in implant imaging as a secondary imaging
techni@$e #hen primary imaging techni@$es s$ch as comple?
tomography! CT or ICT fail
<ail$re to differentiate the inferior alveolar canal may "e
ca$sed "y osteoporotic tra"ac$lar "one and poorly corticated
inferior alveolar canal
The $ses of %R are
' %R vis$ali+es the fat in tra"ac$lar "one and differentiates
the inferior alveolar canal and ne$rovasc$lar "$ndle from
the ad)acent tra"ac$lar "one
( Do$"le sco$t %R imaging protocols #ith vol$me and
oriented cross Sectional imaging of the mandi"le prod$ce
orthogonal @$antitative contig$o$s images of the proposed
implant sites
Li)itations
%R is not $sef$l in characteri+ing "one minerali+ation or a
high L yield techni@$e for identifying "one or dental disease
DIA!NO-IC EM"LAE-
A diagnostic radiographic template is $sed to incorporate
the patient5s proposed treatment plan into the radiographic
e?amination This information can then "e $sed to alter implant
ang$lation and position! achieving optimal implant "ody
placement #ithin the availa"le "one C preserving vital
str$ct$res The end res$lt of this process is the fa"rication of a
s$rgical implant that #ill ena"le the s$rgeon to place the
implants in their proper positions
The preprosthetic imaging proced$res ena"le eval$ation of
the proposed implant site at the ideal position and orientation
identified "y radiographic mar4ers incorporated into the
template
The radiopa@$e mar4ers $sed are
' 7ari$m s$lphate
( >ead foil
* G$tta percha
, %etal sleeves 2set $p dis4s6
Of this lead foil is of limited $se 7eca$se of larger lead
atom ca$ses distortion of the image at the locali+ed site occ$rs
Diagnostic templates used in computed tomography&
The precision of CT ena"les the $se of comple? and precise
diagnostic templates Altho$gh CT scan can acc$rately identify
the availa"le "one height and #idth for a dental implant at a
proposed implant site! the e?act position and orientation of
implant! #hich many times determines the act$al length and
diameter of the implant! is often dictated "y the prosthesis
The s$rfaces of the proposed restorations and e?act position
and orientation of each dental implant sho$ld "e incorporated
into the diagnostic CT template %any designs have "een
proposed for diagnostic CT templates
They are "asically t#o forms
' Prod$ced from a vac$$mform reprod$ction
( Prod$ced from a processed acrylic reprod$ction of the
diagnostic #a? $p
'acuumform Template
A n$m"er of variations have "een proposed
' Coating the proposed restoration #ith a thin film of
"ari$m s$lfate Altho$gh the proposed restoration "ecomes
evident in the CT e?amination! the ideal position C
orientation of the proposed implant is not identified "y this
design
( The proposed restoration sites are filled in the vac$form
of the diagnostic #a? $p #ith a "lend of 'KM "ari$m
s$lfate and 9KM cold c$re acrylic this res$lts in radiopa@$e
tooth appearance of the proposed restorations in the CT
e?amination #hich matches the density of enamel and
dentin of nat$ral teeth "$t does not identify the e?act
position and orientation of the proposed implant site
* %odification of previo$s design "y drilling a ( mm hole
thro$gh the occl$sal s$rface of the proposed restoration at
the ideal position and orientation of the proposed implant
site #ith t#ist drill This res$lts in a nat$ral tooth li4e
appearance to the proposed restoration in the CT
e?amination #here all the s$rfaces of the restoration are
evident along #ith a ( mm radiol$cent channel thro$gh the
restoration! #hich precisely identifies the position and
orientation of the proposed implant
Processed acrylic template
The processed acrylic template is modified "y coating the
proposed restoration #ith a thin film of "ari$m s$lfate and filling
a hole drilled thro$gh the occl$sal s$rface of the restoration #ith
g$tta percha The s$rfaces of the proposed restoration then
"ecome radiopa@$e in the CT e?amination and the position and
orientation of the proposed implant is identified "y the
radiopa@$e pl$g of g$tta1percha #ithin the proposed restoration
Diagnostic Templates used for Tomography
Diagnostic templates for tomography e?aminations are
generally less precise than those re@$ired in CT e?aminations
The diagnostic information availa"le from tomography
e?aminations is not as detailed or as precise as that availa"le
from CT e?aminations
' The simplest tomography template is prod$ced "y
o"taining a vac$form of the patient5s diagnostic cast #ith *
mm "all "earing placed at the proposed implant positions
A n$m"er of tomograms of the implant region are prod$ced
#ith the implant site identified "y the one in #hich the "all
"earing is in sharp foc$s The "all "earing can additionally
serve as a meas$re of the magnification of most
tomographic imaging system
( Templates that incorporate metal cylinders or t$"es at
the proposed implant sites also ena"le eval$ation of
tomograms for the orientation along #ith the position of the
proposed implant
* The diagnostic template $sed in CT e?amination! #hich
is prod$ced from a vac$form of the patients diagnostic cast
#ith "ari$m coating of the proposed restoration and
orthodontic #ires to indicate the position and orientation of
the proposed implant! can also "e $sed for tomography and
provide the most diagnostic information of templates
descri"ed
Dual purpose templates
Diagnostic templates can "e modified and $sed as s$rgical
templates If metamorphosis from diagnostic template to s$rgical
template is the o")ective of the s$rgeon! the diagnostic template
sho$ld "e selected and fa"ricated #ith that in mind Typically
"ench modification of a diagnostic template to prod$ce a s$rgical
template does not incorporate the precision of the res$lts of ICT
or DS
C#D(C# Stereo Tactic Surgical Templates
Anatomically acc$rate three dimensional models of the
patients5 alveolar anatomy can "e prod$ced "y a n$m"er of CADE
CA% and rapid prototyping proced$res CADE CA% s$rgical
stereotactic templates can "e prod$ced from CT e?aminations
that have $sed interactive CT to develop a three dimensional
treatment plan for the patient of the position and orientation of
dental implants
:. -urgical and Inter.entional I)aging
S$rgical and interventional imaging involves imaging the
patient d$ring and immediately after s$rgery and d$ring the
placement of the prosthesis
Purpose
' To eval$ate the depth of implant placement
( To eval$ate the position and orientation of implants E
osteotomies
* To eval$ate donor or graft sites
Modalities used
' periapical radiographs
( panoramic radiographs
Film )ased intra*oral radiography
The patient can "e generally imaged at chair side #ith
periapical radiography to determine implantEosteotomy depth!
position and orientation Corrections for magnification similar to
those employed in endodontics are necessary to @$antify the
depth of osteotomy The disadvantage of periapical radiography
is that a dar4 room and appro?imately - min$tes radiography for
film processing is generally re@$ired
Digital periapical radiography
Digital periapical image receptors ena"le virt$ally
instantaneo$s image ac@$isition! prod$ce image @$ality similar to
that of dental film and ena"le the s$rgical proced$re to proceed
#itho$t $nd$e delay
Additional feat$res of digital imaging s$ch as image
enhancement and $se of digital meas$ring techni@$es can help
the s$rgeon in esta"lishing the optim$m depth and orientation of
the implants
Panoramic radiography
<or e?tensive implant proced$res that may involve the
entire )a#! "oth )a#s! large donor graft sites! or sin$s
arg$mentation! panoramic radiography #ill provide a more
glo"al vie# of the patients5 anatomy

The disadvantage of panoramic radiography is that the
patient m$st generally leave the s$rgical s$ite and stand or sit for
the panoramic proced$re A panoramic radiography has less
resol$tion than the periapical radiography
Clinical assessment
Periapical or digital periapical radiography is $sef$l
modality to determine if the implants components and prosthesis
are seated or fitted appropriately The anti rotation device of the
implant "ody may prevent the a"$tment from seating in the
correct position This may "e diffic$lt to ascertain "eca$se the
implant crest mod$le is often at the "one crest and the tiss$e is
several millimeter thic4 An ?1ray e?amination is also performed
to determine of the metal frame #or4 and E or final restoration is
completely seated! and the margins are accepta"le aro$nd the
implants andEor teeth
The important portion to image is the crestal aspect of the
implant not the ape?
;. "ost "rosthetic I)aging
The p$rpose of post prosthetic implant imaging is to
eval$ate the stat$s and prognosis of the dental implant The "one
aro$nd to the dental implant sho$ld "e eval$ated on a ro$tine
"asis for changes in minerali+ation or "one vol$me Changes in
"one minerali+ation in the region of "one ad)acent to the dental
implant may indicate s$ccessf$l integration! fi"ro$s tiss$e
interfaces! inflammation or infection! loss of crestal "one vol$me
ad)acent to the dental implant! e?cessive f$nctional loading or
Para1f$nctional loading
"eriapical Radiograph%
The implants "one interface is depicted only at mesial!
distal! inferior or crestal aspect or #here the central ray of the ?1
ray so$rce is tangent to the implant s$rface! eval$ating the dental
implant for changes in "one minerali+ation or "one vol$me in
alveolar "one ad)acent to the implant re@$ires eval$ation of
temporally ac@$ired periapical radiographs
The ang$lation of the ?1ray "eam m$st "e #ithin a degree
of the long a?is of the fi?t$re to open the threads on the image
on most threaded fi?t$res Ang$lar deviations of '* degrees or
more res$lt in complete overlap of the threads In general
periapical radiographs are appropriate for longit$dinal
assessments
%esial C distal marginal "one height is meas$red $sing
4no#n inter thread meas$rements and comparing that #ith the
"one level in previo$s periapical radiographs St$dies s$ggest
that the rate of marginal "one loss after s$ccessf$l implantation
is appro?imately '(mm in the first year! s$"se@$ently tapering
of to a"o$t K'mm in s$cceeding years Occasionally areas of
marginal "one gain also may "e noted
1ite ,ing radiograph%
The short and long term eval$ation of crestal "one loss
aro$nd implants is "est eval$ated #ith intra oral radiographs A
vertical "ite #ing radiography is often ideal and m$ch easier to
position once the prosthesis is in place
%ost threaded implants have a smooth crestal region that
meas$re K8 L (mm depending $pon the man$fact$rers There is
constant distance "et#een the threads As a res$lt! the amo$nt of
crestal "one loss can "e determined #hen compared to the
original implant insertion
The image is optimal #hen the implant "ody threads can "e
seen clearly on "oth sides
J$ality periapical or "ite #ing radiographs placed parallel
to the implant "ody #ith the central ray of so$rce oriented
perpendic$lar to the film #ill ena"les se@$ential radiographs for
crestal and peri implant "one loss Radiographs prod$ced in this
manner sho$ld res$lt in a relatively $ndistorted image of the
"ody of the implant! the implant a"$tment connection and E or
threads
Radiographic signs associated ,ith failing endosseous
i)plants&
Radiographic Appearance Clinical I)plications
Thin radiol$cent area that
closely follo#s the entire
o$tline of the implant
<ail$re of the implant to
integrate #ith ad)oining "one
Radiol$cent area aro$nd the
coronal portion of the implant
Peri implantitis res$lting from
poor plag$e control! adverse
loading or "oth
Apical migration of alveolar
"one on one side of the
implant
Non a?ial loading res$lting
from improper ang$lation of the
implant
Iidening of periodontal
ligament space of the nearest
nat$ral a"$tment
Poor stress distri"$tion
res$lting from "io mechanically
inade@$ate prosthesis implant
system
<ract$re of the fi?t$re Bnfavora"le stress distri"$tion
d$ring f$nction
e)poral digital su2traction radiograph% 0-R4
It is a radiographic techni@$e that ena"les t#o radiography
made at different points of time of the same anatomic region to
"e s$"tracted res$lting in an image of the difference "et#een the
t#o original radiographs SR re@$ires the same orientation
"et#een the ?1ray so$rce patient and film for each radiograph
#hich can "e accomplished "y the $se of registration templates
Additionally! SR re@$ires the radiography to "e standardi+ed to
acco$nt for changes in e?pos$re and processing "et#een each
radiograph Then the radiographs can "e digiti+ed! registered and
s$"tracted #ith a res$lting s$"traction image that simply depicts
the changes in the patient anatomy d$ring the time period
"et#een the radiographic e?pos$res
$dvantages
' SR has "een sho#n to "e considera"ly more acc$rate
at depicting changes in "one minerali+ation and "one
vol$me than simply vie#ing the original periapical
radiographs
( In addition to identifying mesial and distal changes in
alveolar "one! SR can also depict "$ccal and ling$al
changes in alveolar "one
* SR has "een the modality of choice for depicting
temporal changes of alveolar "one for clinical and research
st$dies
0isadvantages
' SR has had limited $tili+ation in clinical practice
"eca$se of the diffic$lty in o"taining reprod$ci"le
periapical radiographs
( 7oth periapical and SR techni@$es have limitation in
determining "$ccal and ling$al changes in alveolar "one
* A"sol$te @$anti+ation of tra"ac$lar "one! and
, Depiction of the three dimensional relationship
"et#een the dental implant and s$rro$nding tra"ac$lar and
cortical "one
Co)puted to)ograph%
The advantages of CT are
' The resol$tion
( The @$antitative gray scale eval$ation
* Three dimensional characteristics of CT ena"le
eval$ation of the "one implant interface in all orientations
, <ailing implants characteri+ed "y tra"ac$lar and
crestal deminerali+ation! resorption of the "one implant
interface! cortical plate fenestrations and perforation of the
inferior alveolar canal cortical plates and nasal cavity or
ma?illary sin$s floor can "e identified #ith CT
- CT also demonstrates the res$lts of sin$s
a$gmentation s$rgery
. Bnli4e conventional imaging techni@$es s$ch as
periapical or panoramic anatomy! the resol$tion! spatial
discrimination! and the three dimensional imaging
capa"ilities of CT ena"le precise eval$ation of the position
of dental implants relative to critical str$ct$res s$ch as the
inferior alveolar canal! the mental foramen! ma?illary sin$s!
nasal cavity! incisive foramen! anterior loop ad)acent teeth!
"$ccal or ling$al cortical plates and so on And s$ffers
from magnification and distortion
MA#ILLO(ACIAL "RO-HODONIC-
Radiographs play ma)or role in ma?illofacial reha"ilitation of intra and
e?tra oral facial str$ct$res #hich have "een congenitally malformed or
lost d$e to tra$ma
Main Indications for %a?illofacial radiographing are
' <ract$re of ma?illofacial s4eleton
( Dm"royonic a"normalities of ma?illofacial region
* fract$re of s4$ll
, investigations of antra
- diseases effecting s4$ll "ase and va$lt
. T%H disorders
The e?tent of damage to tiss$es needed to "e reha"ilitated and e?tent
of $nderneath s$pporting tiss$es vital for receiving ma?illofacial
prosthesis to "e analysed "y vario$s radiographic vie#s of
ma?illofacial prosthesis and treatment plan is e?ec$ted
Radiographs of ma?illofacial region are
' I ntraoral radiographs L IOPA! "ite#ing etc
( D?traoral radiographs L most commonly $sed ma?illofacial
imaging
D? P1A Pro)ection 2Granger pro)ection 6
Inclined P1A 2Cald#ell pro)ection6
%ost ma?illofacial reha"ilitations in Prosthodontics incl$de clos$re
of developmental defects li4e clefts and eye ! ear! nose and cranial
prosthesis lost d$e to tra$ma #hich go "est #ith radiographic
evidence
<or "est vis$ali+ation of clefts most preffered radiographs are
' Occl$sal radiographs
( >ateral Cephalogram
* CT scan
, Bltraso$nd
Radiographs in )a/illofacial sinuses
' Standard occipeto mental pro)ection2 K degress6
( %odified method 2*K degrees mental pro)ection6
* P1A Iaters vie#
, 7regma menton vie#
Radiographs of )andi2le
' P1A mandi"le
( Rotated P1A mandi"le
* >ateral o"li@$e
a Anterior "ody of mandi"le
" Posterior "ody of mandi"le
c Ram$s of mandi"le
Radiographs of 7%go)atic arches
' H$ghandle vie#
Radiographs of 2ase of s*ull
' S$"mentoverte? pro)ection
Radiographs of s*ull
' >ateral cephalogram
( Tr$e lateral cephalogram
* P1A cephalogram
, P1A s4$ll
- TOINDS pro)ection
Radiographs of M< i)aging
' Panoromic radiography
( Transcranial pro)ection
* Tomography
, Arthromography
- Arthromography #ith videofloroscopy
. %RI
/ Comp$ted tomography
M< interpretation
Roentgenograms are of val$e for differential diagnosis in that other
pathologic condition having signs and symptoms similar to tra$matic
T%H arthritis may "e disting$ished "y roentgenographic changes
Roentgenographic changes associated #ith Osteoarthritis of T%H are
' >ac4 of definition of anterior aspect of condyle
( Peripheral lipping of "one of condyle #ith flattening of artic$lar
s$rface
*resorption of "one at posterior aspect of artic$lar t$"ercle to#ards
glenoid fossa
, <ragmentation of menisc$s
- Dystrophic calcification
Presence of t$mor ! cyst and fract$re sho$ld "e r$led o$t "efore a
final diagnosis is made on tm) and occl$sal related pro"lems
Bs$ally s$ch pro"lems can "e detected from panore/ radiograph
Panore? radiographs presents the entire )oint region and ascending
ram$s in clarity and completeness! they are most practical for $se in
differential diagnosis of T%H
Radiographic e?amination proced$res for T%H sho$ld al#ays incl$de
periapical films
Radiographs are important third step in ma4ing differential diagnosis
<o$r 2asic radiographic techni@$es can "e $sed in most dental
offices for eval$ating the T%H
' panoramic vie#
( >ateral transcranial
* Transpharangeal
, Transma?illary or A1P vie#
%ore sophisticated techni@$es incl$de
' Tomography
( Arthrography
* %RI
, 7one scanning
Alternate and speciali=ed i)aging )odalities
Research and development have foc$sed on man$plating and altering
all three "asic re@$irements of image prod$ction ie the patient! image
generating e@$ipment and image receptor
Ne# soft#ares are "eing developed to man$plate the image itself
once it has "een capt$red
%any of imaging modalities are playing increasing role in dentistry
%any of imaging modalities are playing increasing role in dentistry
Main speciali=ed i)aging )odalities are
' Contrast st$dies
( Radioisotope imaging
* Comp$ted tomography
, Cone "eam CT 2C7CT6
- Bltraso$nd
. %agnetic resonance
Conclusion
Proper modality of radiographic interpretation! good technical s4ill in
ta4ing radiograph! thoro$gh radiographic st$dy! proper interpretation
help to reach a perfect diagnosis and optim$m treatment Arriving at
definite diagnosis and treatment plan is challenging tas4 in
Prosthodontics #hich is made easy "y radiographic interpretation
%any of a"normalities "oth intraoral and facial #hich remain
$ndetected "y inspection for a s$ccessf$l prosthetic reha"ilitation
can "e detected "y radiographs So 3eye misses "$t 01ray catches5
Radiographs are an ad)$nct and not the sole or primary so$rce of
diagnostic information
Good $nderstanding and so$nd 4no#ledge of vario$s radiographic
modalities and their specificity help to eliminate $nnecessary
radiation ha+ards and control e?pense of treatment Radiographs form
final aspect of diagnostic proced$re and provide Prosthodontist
correlate all the facts that have "een collected listening to the patient !
e?amining the mo$th and eval$ating the diagnostic cast

Reference

Imaging in Implantology! 7hatS! ShettyS! Shenoy ==!(KK-!FO>
-!HIPS!Iss$e '!page 'K1',
7asic Implant S$rgery! RPalmer! PPalmer! <loyd! Fol '8/!No
8!OCT (*!'999!7DH
Prosthetic treatment of edent$lo$s patients!Aar"17olender!'(th
edition!(KK,
Dssentials of complete dent$re prosthodontics! Sheldon Irin4ler!(nd
edition!(KK,
Sylla"$s of Complete dent$res!Charles %Heart#ell )r! ,th edi!'98,
%cCrac4ens Remova"le partial Posthodontics! ''th edi!Alan 7
Care!Glen P%c Givney!David T7ro#n!(KK-
Clinical remova"le partial Prosthodontics!(nd
edi!Ste#ard!R$dd!=$e"4er!(KK*
Contemporary <i?ed prosthodontics!Stefen < Rosential!(KK'
Tylmans theory and practice of <i?ed Prosthodontics!8th edi!
I<P%alone!D> =oth!(KK,
<$ndamentals of <i?ed Prosthodontics!*rd ediHer"ert T
Shilling"erg!'99/
<$nctional occl$sion <rom T%H to S%I>D DDSIGN!Peter
DDa#son!'989
%anagement of T% disorders and occl$ysion!-th edi!Heffrey P
O4eson!'998
Clinical ma?illofacial prosthesis!Thomas D Taylor!(KK,
Dental implant prosthetics!Carl< %isch!'st edi!(KK,
Dssentials of dental radiology and radiography!,th edi!Dric
Ihaites!(KK/
Te?t "oo4 of Dental and %a?illofacial Radiology!<reny R
=ARHOD=AR!(KK.
Oral Radiology principles and interpretations!-th edi!(KK,s
Contents
Introd$ction
Pioneers in dental radiography
Radiographs in CD prosthesis
Radiographs in RPD prosthesis
Radiographs in <PD prosthesis
Implant imaging
Radiographs in ma?illofacial prosthodontics
T%H interpretation
Alternate and speciali+ed imaging
Concl$sion
Reference
A Seminar on
RADIOGRAPHS IN
PROSTHODONTICS
"resented 2%
Dr.!.MANMOHAN>
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