ENDODONTIC

RADIOLOGY WITH
DIGITAL
TECHNOLOGY

CONTENTS

Introduction
History
Application of radiography to endodontics
Limitations of radiographs
Technology systems
Traditional
Digital technology

Intra oral radiographs Periapical radiographs

Parallel and bisecting angle technique
Vertical and horizontal angulations
Digital imaging
Xeroradiography
Subtraction radiography
RVG
Computer tomography
MRI
Conclusion

INTRODUCTION

Radiographs eyes of the dentist while performing

many procedures

Essential for diagnosis,

treatment planning,
determining anatomy,
managing treatments,
assessing outcomes

The radiographic image is a shadow has the elusive

qualities of all shadows

Two-dimensional representation of a three-dimensional

object

It may be too light or too dark, too short or too long

HISTORY

1895 Professor William Konrad Roentgen

discovered properties of cathode rays

Within 14 days possibilities of use in dentistry

seized upon

Dr Otto Walkoff first dental radiograph in his own

mouth

Within 5 months Dr William James in US

displayed several radiographs

3 months later Dr C Edmund Kells first clinic

use of radiographs in dentistry

1899 Kells X-Ray to determine tooth length

during root canal therapy

1900 Dr. Weston A. Price attention to incomplete

root canal fillings evidenced by radiographs

Price bisecting angle technique

Kells paralleling technique

APPLICATIONS OF RADIOGRAPHY TO
ENDODONTICS

Diagnosis hard tissue alterations of teeth and

periradicular structures

Determine number, location size, shape direction

roots and root canals

Estimate and confirm length of canals

Localize hard to find or disclose unsuspected pulp

canals

Locating pulp space calcified

Determine position of structures in facial-lingual

direction

Confirm position and adaptation of master cone

Evaluate obturation

Examination soft tissues for tooth fragments and

foreign bodies following trauma

Localize hard to find apex during root end surgery

Confirm tooth fragments and excess filling

material removed before suturing in root end filling

Follow up evaluate outcome of treatment

LIMITATIONS OF RADIOGRAPHS

Two dimensional shadows on a single film

Suggestive only not singular final evidence in

judging a clinical problem

Greatest fault relates to its physical state as with

shadows dimensions easily distorted through
- improper technique,
- anatomic limitations,
- processing errors

Buccal lingual dimensions absent

Radiographs not infallible

Various states of pulpal pathosis indistinguishable

neither healthy nor necrotic pulps cast unusual image

Bacterial status not detectable

Periradicular soft tissue lesions cannot be accurately
diagnosed require histologic verification

TECHNOLOGY SYSTEMS

Basically two radiographic approaches

Traditional X-ray exposure of the film

chemically processed to produce an image

Newer digital systems electronic detection of an

X-ray generated image electronically processed and
reproduced on a computer screen
: resulting image similar traditional
radiograph

Advantages digital radiography

Reduced radiation
Speed of obtaining image
Enhancement of image
Computer storage
Transmissibility
Does not require chemical processing

Disadvantages of digital technology

Cost
Placement of the sensor

TRADITIONAL MACHINES

Two basic types X-ray machines

One type range of kilovoltage and two

milliamperage long cone (16 inch) superior for
diagnostic radiographs

Other type range of kilovoltage and one

milliamperage short cone (8 inch) treatment or
working radiographs

Long cone clarity of detail and minimum distortion

inherent in long cone parellel technique

Preferred for diagnostic, final and follow up

radiographs

Short cone small easily manipulated head saves

time energy and frustration in case of working
radiographs taken in course of endodontic therapy

INTRA ORAL FILMS

(PERIAPICAL RADIOGRAPHY)

Periapical radiography intraoral techniques

designed to show individual teeth and the tissues
around the apices.

Each film shows two to four teeth

Provides detailed information about the teeth and the

surrounding alveolar bone

Ideal positioning requirements

The ideal requirements for the position of the film packet
and the X-ray beam, relative to a tooth include:

Tooth under investigation and the film packet should

be in contact or, if not feasible, as close together as
possible

The tooth and the film packet parallel to one

another

The film packet positoned with its long axis

vertically for incisors and canines, and horizontally for
premolars and molars sufficient film beyond the
apices

The X-ray tube head positioned so that the beam

meets the tooth and the film at right angles in both the
vertical and the horizontal planes

The positioning should be reproducible

Radiographic techniques
The anatomy of the oral cavity does not always allow
all these ideal positioning requirements
To overcome the problems, two techniques for
periapical radiography have been developed:
- The paralleling technique
- The bisected angle technique

Paralleling technique
The film packet is placed in a holder and positioned in
the mouth parallel to the long axis of the tooth under
investigation

The X-ray tubehead aimed at right angles

(vertically and horizontally) to both the tooth and the
film packet

By using a film holder with fixed film packet and Xray tubehead positions, the technique is reproducible

This positioning has the potential to satisfy four of the

five ideal requirements

Anatomy of the palate and the shape of the arches

tooth and the film packet cannot be both parallel and in
contact
Film packet has to be positioned some distance from
the tooth
To prevent the magnification of the image
separation would cause, a parallel, non diverging, Xray beam is required
Achieved by having a large focal spot to skin
distance, by having a long spacer cone or beamindicating device (BID) on the X-ray set

Film packet holders

Variety of holders for this technique

The choice of holder is a matter of personal preference

ex the Rinn XCP holders

The holders vary in cost and design but consist of three

basic components:

A mechanism for holding the film packet parallel to the

teeth that also prevents bending of the packet

A bite block or platform

An X-ray beam-aiming device

Positioning techniques

The appropriate holder and size of film packet

selected

Incisors and canines anterior holder used and a

small film packet (22 35 mm) with its long axis
vertical

Premolars and molars posterior holder and a large

film packet (31 41 mm) with its long axis horizontal

The smooth, white surface of the film packet must face

towards the X-ray tube head

The end of the film packet with the embossed

orientation dot is placed opposite the crowns of the
teeth (to avoid subsequent superimposition of the dot
over an apex)

The patient is positioned with the head supported and

with the occlusal plane horizontal

The holder and film packet are placed as follows:

Maxillary incisors and canines the film packet is

positioned sufficiently posteriorly to enable its height
to be accommodated in the vault of the palate

Mandibular incisors and canines the film packet is

positioned in the floor of the mouth, approximately in
line with the lower canines or first premolars

Maxillary premolars and molars the film packet is

placed in the midline of the palate

Mandibular premolars and molars the film packet is

placed in the lingual sulcus next to the appropriate
teeth

A cottonwool roll is placed on the reverse side of the

bite block helps to keep the tooth and film packet
parallel

The patient bite gently together, to stabilize the

holder in position.

The locator ring is moved down the indicator rod until

it is just in contact with the patients face ensures
correct focal spot to film distance

The spacer cone or BID is aligned with the locator

ring This sets the vertical and horizontal angles and
centres the X-ray beam on the film packet

The exposure is made

Bisected angle technique

The theoretical basis of the bisected angle summarized
as follows:

The film packet is placed as close to the tooth as

possible without bending the packet

The angle formed between the long axis of the tooth

and the long axis of the film packet is assessed and
mentally bisected

The X-ray tubehead is positioned at right angles to this

bisecting line with the central ray of the X-ray beam
aimed through the tooth apex

Using the geometrical principle of similar triangles, the

actual length of the tooth in the mouth will be equal to
the length of the image of the tooth on the film

A straight hemostat good film holder

Positioning techniques
The bisected angle technique either by using a film
holder or by asking the patient to support the film
packet gently using either an index finger or thumb
Film holder recommended technique however, using
the finger is still widely used

The specific positioning for different areas of the mouth,

using both simple holders and the patients finger to
support the film packet, is shown in Figures 8.188.25.

Difficulty in root canal therapy

Clumsy, aggravating methods treatment radiographs
when rubber dam in place

Rubber dam frame should not be removed saliva

contamination

Radiolucent N-O (Nygaard-Ostby) frame, Lexicon

hinge dam frame Star VisiFrame can be used

With rubber dam hemostat held film certain

advantages
Film placement easier

Patient may close somewhat with the film in place

advantage mandibular posterior area

Handle of hemostat guide to align cone proper

vertical and horizontal angulations

Less distortion caused by too much finger pressure

bending the film

Patient can hold hemostat handle more securely

Any movement detected by shift in handle

Vertical angulations of the X-ray tubehead

The angle formed by continuing the line of the central
ray until it meets the occlusal plane determines the
vertical angulation of the X-ray beam to the occlusal
plane

Elongation of image corrected increasing

vertical angle

Foreshortening corrected by decreasing vertical

angle

Horizontal angulations of the X-ray tube head

In the horizontal plane, the central ray should be aimed
through the interproximal contact areas avoid
overlapping the teeth
The horizontal angulation determined by the shape
of the arch and the position of the teeth

Clarks rule applied to identify seperated canals

when horizontal angulation is used most distant
object from the cone moves towards the direction of
the cone

SLOB rule same lingual opposite buccal

Ingles rule MBD always shoot from the mesial and

the buccal root will be to the distal

Horizontal angulations for:

Maxillary anterior teeth straight facial
Maxillary premolars and molars mesial angle
Mandibular incisors distal angle
Mandibular premolars mesial
Mandibular molars - distal

Mandibular molars central beam 20 30 degrees

mesially superimposed canals separated

Mandibular premolars horizontal angulations help

detect bifurcations that may be present in the root canal

Maxillary molars most difficult radiograph because

complicated root and pulp anatomy
superimposiotioning of roots and by bony structures

Horizontal angulation 20 degrees mesial

zygomatic process moved distal and distobuccal root
cleared of palatal root

Diatal angulation isolates mesiobuccal root

Maxillary premolars horizontal angulation great

value

Generally two roots and canals, sometimes 3

Angulation by 20 two canals are separated

Mandibular anterior teeth varying horizontal

angulations separate superimposed canals

Maxillary anterior teeth root curvatures can be

detected

Bisecting Angle Technique Central Ray

Is Directed At The Apices Of The Teeth

Paralleling Technique
Central Ray Is Directed At Center &
Perpendicular To The Tooth

EXTRA ORAL FILM

PLACEMENT

Useful for patients cannot accommodate or tolerate

intra oral films

Gagging or trismus

Special positioning of cone and film

Processing
Ingle processing temperature 92 degree F less
than 1 min most acceptable radiographs

92 degree F fixer mixed to company specifications

development 30 sec and fixation 25-30 sec

Rapid processing solutions

Concentrated chemicals like kodaks rapid access
solution popular in endodontic practice

More expensive, but requires only 15 sec for

developing and 15 sec fixation

Table Top developing

For quick turn around and ease of procesing
combine rapid speed solutions with table top
processing hood

Hoods used right in the operatory

Film placed through light proof cuffs hand

movement seen through red plexiglass cover

Solutions in small cups

ERRORS

Wet Readings
Developed For Proper Time But Fixed For Only Few Minutes.
Cause
1. Brown stain will occur if not returned to fixing solution.
2. Brown stain is temporary if film is returned to fixing solution.
3. Brown stain becomes permanent after several hours.
Correction
Return films to fixer promptly. Then wash and dry.

DIGITAL RADIOGRAPHY

Endodontic therapy relies on series of radiographic

images made at different stages of treatment

Radiographs helpful determination of

- hard and soft tissues,
estimation of working length
Tooth fractures and foreign bodies
Post treatment healing

Digital imaging advance conventional

radiographs

Used to record radiographic images where no film

or processing chemistry used

1983 Mouyen solid state imaging using indirect

exposure of a charged coupled device (CCD)

Uses electronic sensor, computerized imaging

system produces images almost instantly

Terminologies used:
Analog image radiographic image produced by
conventional film

Charge- coupled device (CCD) solid state detector ,

image detector in intraoral sensor

Direct digital imaging obtaining digital image

intraoral sensor exposed to x-rays to capture an image
viewed on a computer

Indirect digital imaging existing image scanned and

converted to digital image

Pixel a discrete unit of information

Sensor small detector placed intraorally to

capture an image

Storage phosphor imaging image recorded on a

phosphor coated plate placed into an electronic
processor laser scans the plate image produced
on a computer

Use of digital radiography

Detect lesions, diseases and conditions of teeth and
suurrounding structures

Classify suspected diseases

Provide information during dental procedures

Document conditions of a patient at a specific point in

time

Fundamentals
Sensor used to capture images

Sensor receives analog information converts it to

digital image

Digital image is an array of picture elements

pixels

The pixels range of shades of grey depending on the

exposure

Each pixel represented by number corresponding to

the grey scale

Arranged in grids and rows on the sensor

X- ray beam strike the sensor electronic charge

produced on surface of sensor

Electric signal converted into digital form

Sensor transmits information to computer

Data acquired by sensor transmitted to computer in

analog form which is converted to digital form by
analog-to-digital converter (ADC)

Software used to store image

Image displayed within seconds to minutes

Radiation exposure
Less radiation exposure as typical sensor more
sensitive to x-rays

Exposure time 50-80% less than conventional

radiograph

Equipment x- radiation source, intraoral sensor and

computer

Radiation source
conventional dental x-ray unit source
Timer adapted to allow exposures in a time frame
1/100 of a sec
Intra oral sensor
Small detector placed in the mouth
Used to capture image
Thick, bulky and rigid
Wired or unwired

Wired linked by fibro-optic cable 8-35feet

Three types of direct sensor technologies

charge- coupled device CCD
Complementary metal oxide semiconductor/active
pixel sensor CMOS/APS
Charge injection device

Charge coupled device CCD

Most common image receptor

First developed 1960s

Used in fax machines, home video cameras,

microscopes and telescopes

Solid state detector contains silicon chip with an

electronic circuit embedded in it

Silicon chip sensitive to x-rays or light

Electrons that make up the silicon CCD arranged in

elements pixels which are structured in ordered
arrangement

Pixel small box or well into which electrons

produced

Pixel digital equivalent of silver crystal

Each pixel represented numerically in the computer by

location and level of color of grey

Range of numbers 0-255

X-ray photons contact CCD electrons released from

silicon produce electronic charge electronic latent
image formed

Image transmitted and stored in a computer

Complementary metal oxide semiconductor/active pixel

sensor CMOS/APS

Similar to CCD but use active pixel technology that

is active transistor built into each pixel provides
reduction by a factor of upto 100

Advantages design integrstion and relatively low

cost manufacture

Noise level greater with CMOS sensors than with

CCD because of electronic "crosstalk" between the
elements

Multiple components on the same chip less sensor

area available for image capture

Charge injection device

Another sensor silicon based solid state imaging
reseptor

Similar CCD

TYPES OF DIGITAL IMAGING

Two types
Direct digital imaging
Indirect digital imaging

Direct digital imaging

Components x-ray machine, sensor and computer

monitor

Sensor placed in the mouth exposed to x-rays

Sensor captures image transmits to computer

Within seconds image appears

Software used enhance and store image

Indirect digital imaging

Components CCD camera and computer

Existing x-ray film digitalized using CCD camera

CCD camera scans image, digitalizes image and

displays it on the computer monitor

Inferior to direct digital imaging

Digitalization using secondary capture of analogue film

images
Conventional X-ray films polyester sheet covered
both sides by thin layer of silver halide emulsion
absorbs X- ray photons latent image

Once visible film based image has been produced

possible to use flat bed scanner with a transparency
adaptor digitalize image by secondary capture

Flat bed scanner preferred to cameras cameras

optical distortion and added noise from light reflected
from surface of radiographic film

Scanning parameters set at high definition gray

scale images

Scanned at 300 dots/inch

Acquisition software parameters set to transparency

Storage phosphor imaging

 Image plates available same sizes as conventional film and

come with disposable plastic barriers.
No wires attached
Reusable image plate coated with phosphors
Plates flexible

Diagnostic data recorded on plate after exposure to xrays

High speed scanner used to convert information into

electronic files

After exposure plate removed placed into

electronic processor laser scan image produced
transferred to computer

Although the plate can store energy for a number of days,

information starts to be lost within minutes after exposure and it is
advised to scan the plates quite quickly to optimize the image
recovered

Advantages of digital imaging

Dose reduction- up to 90 percent compared to E-speed film

Image manipulation - greatest diagnostic value and
suppressing the rest
Contrast enhancement - compensate for over or under
exposure
Measurements - Digital calipers, rulers and protractors

3-D reconstruction - to visualizing facial fractures in all

three dimensions.

Time - displayed at the chair side

Storage - hold over 30,000 images

Teleradiology - compression techniques and sent via email

Environment friendly -capable of being reused for many

times

Disadvantages of digital imaging

Cost
Sensor dimensions - bulky for the CCD system and
awkward
Medico-legal - ability to manipulate the images
Cross-infection control many times usage

Features of digital imaging

contrast

Figure 3a. This image was

underexposed.

Figure 3b. A simple change

of contrast and brightness
produces an image that is of
diagnostic quality.

magnification

The rectangle in the main image identifies the region of interest. The
inset "picture-in-picture" is a 2x magnification of the region. In reality,
this image would be at least the size of this journal page, rather than
the small format shown.

Colorize

A combination of the "invet" and colorize" features

accentuates trabeculation and provides an almost 3-D
appearance.

measurement

Figure 6b. The apical region is spot enhanced to

better locate the tip.

The apical region is spot

to better locate the tip.
enhanced

Figure 6c. The remaining

distance from the tip of the file
to the apical foramen is
determined.

The remaining distance

from the tip of the file to the
apical foramen is
determined.

RVG system (radio visualography)

Four main components

An X-ray set with special timer

An intra oral sensor

A display processing unit

A printer

X-ray system
Special electronic timer to give the accurately
controlled, short exposure times required

The Intraoral sensor

The primary image receptor in the sensor is a rare-earth

intensifying screen 25mm16mm housed in a rigid plastic
casing 40.6mm long 22.8mm wide14mm thick

Behind the screen is an array of optical fibers

The intensity screen fluoresces when X-rays are

incident upon it and the light is then conducted by the
optical fibers to a CCD

The CCD detects the pattern of light and translates it

into an electrical signal which is received by the
display unit

Display processing unit

Exposure is made image 100mm*64mm immediately

on the left hand side of screen

Four fold magnification of the primary image on the

intensity screen in the sensor

Image from second exposure displayed on the right

hand side of the screen, without the loss of the first image

The display processing unit number of controls

allows manipulation of the image

This image can then be changed in two way:

The grey scale of the image reversed so that black

becomes white and vice versa

Image enhanced by increasing the contrast while

decreasing the latitude of the system

Original image remains stored in the unit and can be

returned to the screen at any time

Zoom feature produce an enlarged image of the

periapical region

Advantages
The radiation dose is 41% of E speed film, or only
23% of the D speed film

In zoom mode a radiation dose similar to that of the D

speed film was required. The range of exposures that
can be imaged by the RVG system in the normal mode
is less than conventional film.

Disadvantages
Small size of the sensor

Can accommodate only one molar tooth or two

incisors

The resolution is comparable to that of a medium

speed rare earth film/ screen combination

Cost of the equipment

Subtraction Radiography

When two radiographs are recorded with controlled

projection angles, the information from the most recent
one may be digitally subtracted from that of the former

All unchanged anatomical background structures will

cancel and unchanged areas will be displayed in a
neutral grey shade

Areas with mineral loss displayed in darker shades

of gray, while areas of gain appear lighter than the
background

A subtraction image is a two dimensional display of 3D structures

Subtraction image between two digital bitewing radiographs taken two years
apart in the same individual. Due to a non-optimal standardization of the
recordings, the teeth in each jaw are subtracted separately, here the upper jaw.
The box illustrates a new filling, the white circle a new deep proximal caries
lesion, and the black circle progression of a former enamel lesion into the dentin.

Xeroradiography
X-ray images recorded on electrostatically charged
plates
The most significant characteristic feature EDGE
ENHANCEMENT facilitates the visualization of very
small structures and areas of minor difference

Advantages

Reduce both radiation exposures and total absorbed dose

Total absorbed dose with intraoral xeroradiograhy

40% less than that with conventional D- speed film
techniques

Wide exposure latitude

No dark room facilities needed

Rapid process < 25 seconds

Viewing of the image by reflected light rather than

transmitted light.

The presentation of images sandwiched between two

layers of tough protective plastic

The compatibility of the system with a wide range of Xray equipment

Automatic processing

Silver free image receptors

The use of premixed processing solutions considered

to be less hazardous then those necessary for
conventional film systems

Superior to conventional intra oral radiography for the

assessment of intraoral structures and the diagnosis of all
hard tissue lesions

Disadvantages

Xero cassettes not always fit comfortably in the mouth

Positioning difficulties
Image artifacts (discharge effects) are more

Computer tomography
Is a radiographic technique that blends the concepts of
thin Laser radiography with the computed image.
Techibana has reported about the use of C.T. in
endodontics
a. Determining the bucco - lingual and Mesio-distal widths
of teeth
b. Presence and absence of root canal filling materials and
metal posts
c. Carious lesion
d. Extension of the maxillary sinus and its proximity to root
apices

Advantages:
a. Observation of structures difficult to visualize in
conventional radiograph
b. Provides images for 3-D reconstruction of roots, root
canals and teeth

Disadvantages

a.

Expensive

b.

Skin dose large

c.

Time consuming

Consists radiographic tube emits finely

collimated fan shaped x-ray beam directed to series
of scintillation detectors

Radiographic tube and detectors may rotate

synchronously about patient or detector may form a
continuous ring about the patient and x-ray tube
moves in circli within the ring

Most recently scanners developed that acquire

image data in spiral or helical fashion

Spiral scanners improved multiplanner image

reconstructions, reduced examination time and
radiation dose

Image digital image reconstructed by computer

which mathematically manipulates the transmission
data

TACT (Tuned aperture computed Tomography).

Relatively new type of imaging device that may have
advantages over current radiographic modalities in viewing an
object while decreasing the superimposition of overlying
anatomical structures
TACT uses digital radiographic images and the tact software
correlates the individual image of a subject into a layering of
images that can be viewed into slices.

"TACT image " composed of a series of a digital

radiographs assimilated into one reconstructed TACT
image
Preliminary studies TACT has advantages over
conventional film in the visualization of canals in the
human molars

MAGNETIC RESONANCE
IMAGING

Uses non ionizing radiation

Patient placed inside large magnet induces

strong external magnetic field

Nuclei of many atoms in the body align with the

magnetic field

Energy released from the body, detected and used to

construct image by computer

Advantages of MRI

It offers the best resolution of tissues of low inherent

contrast

No ionizing radiation is involved with MRI

Direct multiplanar image is possible without

reorienting the patient

Disadvantages

Long imaging time

Potential hazard imposed by the presence of

ferromagnetic metals in the vicinity of the
imaging magnet

SUMMARY

Radiographs Essential for diagnosis,

treatment planning,
determining anatomy,
managing treatments,
assessing outcomes

APPLICATIONS OF RADIOGRAPHY TO
ENDODONTICS

Diagnosis hard tissue alterations of teeth and

periradicular structures

Determine number, location size, shape direction

roots and root canals

Estimate and confirm length of canals

Localize hard to find or disclose unsuspected pulp

canals

Locating pulp space calcified

Determine position of structures in facial-lingual

direction

Confirm position and adaptation of master cone

Evaluate obturation

Examination soft tissues for tooth fragments and

foreign bodies following trauma

Localize hard to find apex during root end surgery

Confirm tooth fragments and excess filling

material removed before suturing in root end filling

Follow up evaluate outcome of treatment

Basically two radiographic approaches

Traditional X-ray exposure of the film

chemically processed to produce an image

Newer digital systems electronic detection of an

X-ray generated image electronically processed and
reproduced on a computer screen
: resulting image similar traditional
radiograph

Two basic types X-ray machines

One type range of kilovoltage and two

milliamperage long cone (16 inch) superior for
diagnostic radiographs

Other type range of kilovoltage and one

milliamperage short cone (8 inch) treatment or
working radiographs

Long cone diagnostic, final and follow up

radiographs

Short cone working radiographs taken in course of

endodontic therapy

INTRA ORAL FILMS

(PERIAPICAL RADIOGRAPHY)

Periapical radiography intraoral techniques

designed to show individual teeth and the tissues
around the apices.

Each film shows two to four teeth

Provides detailed information about the teeth and the

surrounding alveolar bone

Radiographic techniques
Two techniques for periapical radiography have been
developed:
- The paralleling technique
- The bisected angle technique

Paralleling technique
The film packet is placed in a holder and positioned in
the mouth parallel to the long axis of the tooth under
investigation

The X-ray tubehead aimed at right angles

(vertically and horizontally) to both the tooth and the
film packet

By using a film holder with fixed film packet and Xray tubehead positions, the technique is reproducible

This positioning has the potential to satisfy four of the

five ideal requirements

Bisected angle technique

The theoretical basis of the bisected angle summarized
as follows:

The film packet is placed as close to the tooth as

possible without bending the packet

The angle formed between the long axis of the tooth

and the long axis of the film packet is assessed and
mentally bisected

The X-ray tubehead is positioned at right angles to this

bisecting line with the central ray of the X-ray beam
aimed through the tooth apex

Using the geometrical principle of similar triangles, the

actual length of the tooth in the mouth will be equal to
the length of the image of the tooth on the film

Digital imaging
Uses electronic sensor, computerized imaging
system produces images almost instantly

Use of digital radiography

Detect lesions, diseases and conditions of teeth and
suurrounding structures

Classify suspected diseases

Provide information during dental procedures

Document conditions of a patient at a specific point in

time

Fundamentals
Sensor used to capture images

Sensor receives analog information converts it to

digital image

Digital image is an array of picture elements

pixels

The pixels range of shades of grey depending on the

exposure

Each pixel represented by number corresponding to

the grey scale

Arranged in grids and rows on the sensor

X- ray beam strike the sensor electronic charge

produced on surface of sensor

Electric signal converted into digital form

Sensor transmits information to computer

Data acquired by sensor transmitted to computer in

analog form which is converted to digital form by
analog-to-digital converter (ADC)

Software used to store image

Image displayed within seconds to minutes

Three types of direct sensor technologies

charge- coupled device CCD
Complementary metal oxide semiconductor/active
pixel sensor CMOS/APS
Charge injection device

TYPES OF DIGITAL IMAGING

Two types
Direct digital imaging
Indirect digital imaging

The Intraoral sensor

The primary image receptor in the sensor is a rare-earth

intensifying screen 25mm16mm housed in a rigid plastic
casing 40.6mm long 22.8mm wide14mm thick

Behind the screen is an array of optical fibers

Subtraction Radiography

When two radiographs are recorded with controlled

projection angles, the information from the most recent
one may be digitally subtracted from that of the former

All unchanged anatomical background structures will

cancel and unchanged areas will be displayed in a
neutral grey shade

Xeroradiography
X-ray images recorded on electrostatically charged
plates
The most significant characteristic feature EDGE
ENHANCEMENT facilitates the visualization of very
small structures and areas of minor difference

Endodontics Ingle 5th and 6th edition

Pathways of pulpCohen
A guide to dental radiographyRita and Bourne
Oral radiologyWhite and Pharoah
Radiologic differential diagnosisWood and Goaz
Journal of dental research 2004, 83, spl issu C 80-94
Journal of Endodontics 2003: 29: 419
Journal of Endodontics 2007

Thank you