Dental Decks Radiology 2011-2012

RADIOLOGY
Digital Rad
Which tlTe of digital image receptor is most common at tlris time?
. CID (Charge Injection
Device)
. CMOS/APS (Complementarv Metal Oxide Seniconductor/Atiive Pixel Sensor)
. CCD
(Charge-Coupled Device)
Copyright t) 20ll-2011 - Denhl Decks
A number ofcomponenls are required lbr direct digital image producrion. These components include an x-ray source, an elecffonic snsor, a digitil interface card, a computer with an analog-to-digilal con\efter lADC). a screen monitor, sofhvarc, and a printer Tlpically, systcms are PC based *ith a 486 or higher proccssor, 640 KB intemal memory cquipped .|.t'ith an SVCA graphics card, and a high-resolution monitor /1024 X 768 pi* e/j.). Direci digital senso$ are eilher a charge-cotlplcd device /Ca'D) or complemenlary metal oxide semiconductor active pixel sensot (CMOS-APS). The CCD is thc most common device used today.The CCD is a solid-state detcctor composed ofan anay of x-ray or light sensitive pixels on a pure silicon chip. A pixel or picture element consisN of a small electron well into which thc x-ray or light energy is deposited upon exposure. The individual CCD pixel size is approxirnately 40I wilh thc latest versious in the 20F range. Thc rows ofpixels are rrranged in a matrix of 5I2 x 512 pixels. Charge coupling is a process whereby the numbcr ofclcctrons deposited in cach pixel are transferred from one well 1{) thc next in a sequential manner to r rcad-out amplifier filr imagc display on the monitor. There are tuo typcs ofdigital sensor array designs: area and linar. Arr arrays are used tbr intraorll radiography, while linear arrays are used in extraor|l imsging. Area arrays are available iD sizes comparablc to size 0, size l, and size 2 film. but the sensors are rigid and thickcr than radiographic film and have a smaller sensitive area for image capture. The sensor communicates with the computcr through all electrical
cable. The complementary metal oxide smiconductor active pixl sensor fa'ryo.t-.4PS/ is the latest development in direct digiral sensor technology. Externally. CMOS sertsors appcar idcntical to CCD dctectors but lhey use an aclive pixel technology and are lss expensive to manufacturc. Thc APS technology rsduces by a factor of 100 the system power required to process the image conpared with the CCD. In addition. rhe APS system eliminates the nccd for charge transf'er and may improvc the reliabilify and lifespan ofthe sensor. In summary, CMOS sensors have scvcral advantages including design integration, low power requrremenls. mimu_ facturabiliry, and low cost. Horvever, CMOS scnsors have more fired pattern noise and a smaller rctive
area for image acquisition. The charge injection device or CID is another sensor technology used in dental digital radiograph). A CID is a silicon-bascd solid-state imaging rcceptor much like the CCD. Structurally, howevcr, the CID differs from the CCD. No computer is required to process lhe images. This system features a CID x-ray sensor. cord, and plug that are insc(cd into the light source on a camera platform; digital images are seen on the system monitor within seconds.
Superior gray-scale resolution
. Reduced patient exposure to x-radiation . Increased speed of image viewing
. Lower equipment .
Sensor size
and
film costs
. Increased efficiency
. Effective patient education tool . Enhancement ofdiagnostic image

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. Indirect digital imaging

. Direct digital imaging
Storage phosphor imaging
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has bccn availablc lbr morc lhan a dccadc. lt is cslinatcd that l0-207o ofdcntal practitioncrs usc digital imaging tcchnology in thcir dcntal practicc. It is anticipatcd thcsc numbers will steadily increasc ovcr thc ncxt fivc to tcn ycars as dcntistry continucs to movc from film bascd to digital inraging. Film-based imaging consists ofx-ray inieraction with clcctrons in thc lilm cmulsion. production ofa lalcnl inragc, and chcnrical proccssing that transfoffns thc latcnt imagc into a visible onc.
Digital or electronic imaging
As such, radiographic fi1m providcs a mcdium for rccording. displayiDg, and sloring diaeirrosiic infbrmation. Filmbascd inragcs arc dcscribcd as analog images. Analog imagcs arc charactcrizcd by continuous shadcs ofgray liom onc arca to the next betwccn thc cxtrcmcs ofblack and \lhitc. Each shadc ofgray has an optical dcltrsity klarknet, rclatcd to lhe amount oflight that can pass through thc imagc ai a spccific silc. Film displays higher resolution than digilal rcccpfors wilh a rcsolving powcr ofabout l6lplmm (lnrcs puirs/nil/td"/"r'l. However, tilm is a rclativcly ineflicicnt radiation deiector ard, thus, rcquircs rclatively high radiation cxposurc.Thc usc oircctangular collimation and thc highest speed lilm arc mcthods thal rcducc rudiation cxposurc. Chcmicals ar(} nccded to process the image and arc olicn drc sourcc of crrors and rctakcs. Thc finalresult is a fixcd nnagc that is dillicult lo manipulalc oncc capis thc rcsult of x-ray intcrrction *ith clectrons in clectronic sensor pirels fpi./ru e ?l?nents), cotrvcrsion ofanalog data to digital data, computcr proccssing, and display ofihc visiblc imagc on a computcr scrccn. Data acquircd by thc scnsor is communicatcd to the conputcr in analog tbmr. Computcrs opcraic on thc binary number systcm in which hvo digits /0 dr./ // arc uscd to rcprcscnt data. Thcsc two charactcrs arc callcd bits (bi ar) digit), and thcy form words eight or morc bits in lcngth c^llcd bytes. Thc total nunrbcr ofpossible bylcs for 8-bit languagc is 28 = 256. Thc analog-tc.digital converter translbrms analog data into numcrical dala bascd on thc binary numbcr systcm. Thc vohagc of thc output signal is nrcasurcd and assigncd a numbcr trom 0 fbld.t/ to 255 (\'hit?) according to thc intcnsity ofthc voltagc. Thcsc numcrical assignmcnts translatc into 256 shades of gra!. Thc human eyc is ablc to detect approximatcly 32 gray lcvcls.
Digital imaging
Dircct digital imaging has dislinct advantagcs ovcr lilnt in Icrms ofcxposurc rcduclion, climlnation ofprocessing chcmicals, inslanr or rcal timc imagc production and display. imagc cnhanccmcnt, paticnt educatjon utility, and con\ cnicnt sloragc. Thc actual amount ofcxposurc rcduction is dcpcndent on a numbcr offactors including film spccd. s.nsor arca. collimation. and relakcs. Thc primary disadvantages includc drc rigidily and thickncss ofthc sensor, dccr.as.d rcsolution. highcr inilial systcm cost, unknown scnsor lifcspan. and pcrfccl scm iconduc tor chargc Iransfir. \ote: Infection controlprcscnts anolhcr chal lcngc forclinicians using dircct digitalimaging. CCD scnsors cannol bc :t.ri1i/cd. Carc nccds to bc tak.n to propcrly prcparc, covcr, and cnsurc thc barrier is nol damagcd during paticnt imaging proccdurcs. Dircct saliva contact with thc rcccptor and clcctrical cablc must bc avoidcd to p.cvcnt crossconta-
Three methods of obtaining a digital image currently exist: direct digital imaging, indirect digital imaging, and storage phosphor imaging. . To produce a direct digital x-ray image, three components are necessary: an x-ray machine,
sensor, and a computer monitor The images are captured using a solid-state detector or sensor such as a charge-coupled device {CCDJ, a complementary metal oxide semiconductor/active pixel sensor (CMOS / AP.S/. or a charge injection device /C/Dl. The sensor then transmits the image to a computer monitor Within seconds of exposing the sensor to an
intraonl
x-rays. an image appears on the computer screen. Software is then used to enhance and
store the image.
. The essential components ofan indirect digital imaging system include a CCD camera and computer. In this method, an existing x-my film is "digitized" using a CCD camera. The
CCD camera scans the image, digitizcs or converts the image, and then displays it on the
computer momtor
. A third method ofobtaining a digital image is storage phosphor imaging, a wireless digital radiography system. In this system, a reusable imaging plate coated with phosphors is used instead of a sensor with a fiber optic cable. The plates are described as "wireless" because they are not connected via cable or wire to the computer. The plates are similar in every way to conventional intraorul film, including size, thickness, rigidity and placement. These plates store the energy from incoming x-rays, and are then placed in a scanning device. The scanner stimulates the stored x-ray infonnation by subjecting the plate to a laser light. When the light strikes the phosphor material, energy is released as a light signal in an electronic waveform and is converted to a digital image by the computer. The image can not instantaneously be viewed on the monitor, but takes from 30 seconds to 5.5 ninutes depending upon the system and certain variables.
RADIOLOGY
Dig Rad
You have a patient who is extrmly concerned about the radiation erposure he will receive when he gets intraoral pictures taken. You let him know that if he wants the least exposure then you will use:
. Digital radiography
. .
E-speed films F-speed films
. Panoramic instead ofa full mouth series
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RADIOLOGY
Image Char
A radiograph that exhibits areas of black and white is termed high contrast and is said to have a short contrast scalei a radiograph that exhibits many shads of gray is termed low contrast and is said to hiye a long contrast scale.
To
limit image rnagnification, th longest target-film distance and shortcst object-Iilm distance are used.
. The first statement
is true; the second statement is false
. The first statement is false; the second statement is true . Both statements are true . Both statements are false
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One ofthe positive features ofdigital radiography is that it requires less radiation than conventional radiography, because the sensor is more sensitive to x-rays than dental frlm. Exposure times for digital radiography are from 507o to 80%o shorter than those lor E-speed film and about 50% shoter than those of F-sneed hlm. This translates into less radiation
exposure for the patient.
.. L All direct and PSP digital radiography systems use a conventional dental xliotce:' ray unit. The literature emphasizes that the x-ray unit must have the ability to ; ;;;ra:,,t: reduce exposure times to 0.01 seconds to reduce the likelihood of oversaturating the sensor. 2. In digital radiography, a sensoq or small detector is placed inside the mouth ofthe patient to capture the radiographic image. The sensor is used instead of intraolal film. As in conventional radiography the x-ray beam is aimed to strike the sensor An electronic charge is produced on the surface of the sensori this electronic signal is digitized, or converted into "digital" fom.r. 3. Digital radiography systems are not limited to intraoral images; panoramic and cephalometric images rray also be obtained.
\lagnificationretirstoarar1iographicimagcthatappearsr",g"'@
ir::j The intase magnification on a dental x_ray is influenced bv the: ' TarqeFfifm dist^nce (a!ro La\etl sorrLel,-/irm distdn.e) is thc distance
bctween the source or-r-rays Uo.al \pot on the tungsten target) and the film lr is dercrmincd by the length ofrhe posirion_indicating dc_ ,. :c rtl:o ttlletl ptD). When a longer pID is used, more parallei ra1,s ir; rhc middle ofrhe x-ray
bicanr i:-r.h :he object rather than thc diverging x_rays from the pcriphcry plI) olthe beam. As a resuft, ::i :ir{eafilm distance result in less image magnillcetion. ond a shortcr pID and target-tiloa tonger distance re_ j.i.: l: more image magnification.
'
:i
object-film distanc: is the distance berween_the object bcing rrdiographed /r7 r.ro1[/
Thc closer rhe proximiry ofrhe toorh 10 rhc film. fie less ima-ge enligcml;t thcre decrease In objecl_frrn' distance rcsurts in a decrease in magnitication,
an_d
and rhc x-ray
_;tt bc on the film.

objec!firm dis_
:.::r:c:esulti ln an increas in imagc magnification.
an increase in
dirrortion ofa radiographic image is influenced by:

a\ is
djstorted image does not have the same size and shape as the object being radiographed. A dimensional
'object-film alignment:10 minimize dimensionaldistortion
gles to the tooth but not to thc film. ' \-rai besm: to minimiTe dimensional disro(ion, the x-ray beam musr be directed perpendicurar !o rhe :oo:h and rhe film. :he appearance :rast results
ofthc rooth. Foreshortening rcsultsfrom excessive verti{:al angulation when the x-ray bcarn is perl ac:rdtcular to rhe film but not thc toorh. Elongation resolrs \rhen the x-ray bearn is oricnred at
the
film
and should be parallel to the long
righl
an_
scales ofcontrast: is rhe range ot'usefur densitics secn on ofan x-ray:
a dentar
radiograph.Tu,o rcrms arc usd ro dcscribe
is an x-ray that shows only tno densities. areds olblack and white. short_scale con_ lionl the usc ofa lor{,er kilovoltage range. . Long-scrle contrast: is an x-ray that shows many densities, or nany shades ot gray. Long_scale con_
' short-scal contrast:
rrast results from the usc
ofa higher kilovotage
range.
bct*een adiacsnt areas on an x-ray. Low contrast describes 3r r-rav ofblack and white. High contra;t describcs an x_ray with man! black and white areas and ferv shades ofqray.
contrsst
is thc difrercnce in degrccs ofbrackncss wrth many shades ofgray and few areas
. Amalgam
. Enamel
. Dentin
. Bone . Maxillary sinus space
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. The patient . The dentist . The state . None ofthe above
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Radiopaque structures/materials:
Less radiation penetrates the structure and reaches the film
. Radiopaque structures appear white on the processed film . Dense materials such as metals. enamel. dentin. and bone Radiolucent structures/materials:
. Allow radiation to pass through, absorbing very little . More radiation penetrates the structure and reaches the film . Radiolucent structures appear gray to black on processed filfir . Less dense materials, including soft tissue and air space
Note: Radiographs show shading from black to white fr?os/ radiolucent to most radiopoque). Example: Least to most radiopaque: periodontal ligament space, dentin,
enamel. ZOE. amalsam.
**+ Dental radiographs should be kept indefinitel"v.

The dental record must include documentation of informed consent and the exposure of radiographs (e.g., the number and type of .filn.s, the rationale./or exposure and the interpreto tiotl). Legally, dental radiographs are the property of the dntist. Patients do, however, have a right to reasonable access to the dental radiographs, which includes having a copy ofthe radiographs forwarded to another dentist.
Note: Patients may refuse dental x-rays, howeveq the dentist must decide whether an accurate diagnosis can be provided and whether treatment can providec.
Remember: No document can be signed by the patient that releases the dentist from liability.
Important: Based on the orientation ofthe embossed d,ot (i(lenti/ication dot), there are two methods ofmounting radiographs: labial mounting fi, ilh the raised or convex side oJ the dot;facing the vieu'erl and lingual m o.|[]'ting (with the depressed or concave tide oJ the dot Jacing the vielr,er/. The labial mounting method is recommended by the American Dental Association. Note: With the labial mounting method, the radiographs are viewed as ifthe viewer is looking directly at the patient; that is, with the right quadrants in the left side of the film mount and those ofthe left quadrants in the risht side ofthe film mount.
Your dental hygienht has a patient who states that she needs bite.wing x-rays because it has been six months since the last nlms were taken. Your hygienist should respond in which manner listed below?
. Agree with the patient
. Tell the patient that bite-wing x-rays should be taken once
a year
. Tell the patient that dental x-rays are taken only when needed as judged by each patient's needs
. None ofthe above
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Identify the structure below that the arnows are pointing to:
Reprirted fronHaring. Joenlannucc' andLauraJansen: Dentrl Rrdiography: Principles and Techniqles:Thnd Edilion. O:000, wirh permission fron Elsevier.
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Decisions about the number, t)?e and frequency ofdental x-rays are determind by the dentist based on each patient's needs. Every patient has a different dental condition and thus the frequency of x-rays is different as well. There are guidelines published by the ADA that aid a dentist in prescribing the number, type and frequency of dental x-rays.
Note: Patients who have tooth decay, periodontal disease, tooth mobility, pain in one or more teeth or possible impacted teeth need more frequent radiographic examinations than patients without such problems. Remember: For a pediatric patient who is caries free (and asy-mptomatic). the first bite-wing radiographs should not be taken until the spaces between the posterior teeth have closed. Note: Occult diseases (/br example, small carious lesions, .!-sts qnd tumors) are those presenting no clinical signs or symptoms, Because occult disease in the perioral tissues is so rare (except Jbr caries), a radiographic examination of the jaws should not be undertaken solely to look for it in an individual with teeth when there are no clinical signs
or symptoms. However, every x-ray taken should be evaluated for these lesions. Remember: Caries is an exception to the above rule because ofits much higher prevalence as comnared to occult cvsts or tumors.
The hamulus lalso known as the hamular proc'ess.) is a srnall hook-like projection olbone
extending from the medial pterygoid plate ofthe sphenoid bone. The hamulus is located posterior to the maxillary tuberosity region.
On the radiograph its image is seen in proximity to the posterior surface ofthe tuberosity ofthe maxilla. It varies greatly in length, width and shape from patient to patient. It usually exhibits a bulbous point, but sometimes the point is tapered.
The maxillary tuberosity appears as a radiopaque bulge distal to the third molar region
Reprinred from Haring, Joen Iannucciand LauraJansen: DentalRadrography:Prin' ciples and Techniques: Ttird Edilion. o 2000. *ith pemission from Ekevir
RADIOLOGY
NormalAnat
The image ofthe coronoid process of the mandible often appears in periapicrl x-rrys o{:
. The incisor region ofthe mandible

. The molar region of the mandible
. The incisor region ofthe maxilla . The molar region of the maxilla
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NormalAnat
Identify eech structure that the arrows 1-8 point to in the anterior region ofthe maxilla.
''Cornesy Dr Sluan C. $'l'ne, UCLA SchooloiDenrisfy.'

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As the mouth is opened, the process moves forward, and therefore it comes into r iew
most often when the mouth is opened to its fullest extent at the time the exposure is made. It is evidenced by a tapered or triangular radiopacity, which may be seen below, or in some instances, superirrposed on the molar teeth and maxilla.
The coronoid process appears as a triangular-shaped radiopacit_v.

Ifrenretdtio ior
Repnnred liom H.nDg. Joen Iannuccilnd L.ura Jansen Lind: Rldiograph'c tlle Dent.l l lr-gienr \r. 10 199.1- sitir permissioi frcn El!e!rer
l.
The opaqu lin
-+
Lateral wall ofnasopalatine canal (inci.sive canal)
2. The opaque line
-)
Anterior wall of maxillary sinus
3. 'Ihe radiolucent structure

4. The opaque
5. The opaque
-)
Nasopalatine lossa
line
-) -)
Floor ofnasal fossa
structur
-+
Soft tissue tip ofnose
6. The opaque
7. The opaque
line
Lamrna dura
line -+ Border ofrnaxillary sinus line -+ Periodontal ligament

space
8. The radiolucent
NormalAnat
Identify each structure that the rrrows l-7 point to in th anterior region ofthe
''Counesy Dr. Stuan C. Whi1e. UCLA School of Denrisrry
"
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Identify each structure that the .rrows l-5 point to in the mandibular molar region.
"Coudesy Dr. Stuan C. wlrire, UCLA School of Denrirry. ' 13 CoDright C 20ll-2011- Dertal Decks
1.
The opaque structur
Anterior nasal spine
2. The opaque
line
-t +
Lateral wall ofnasopalatine canal
3. The radiolucent 4. The opaque
lin -+ Intermaxillary suture

Floor ofnasal fossa
llne
5. The radlolucent structure 6. The rediopaque
Incisive/l.,lasopalatine foramen
tissue tip ofnose
line -+ Soft
7. The oprque structure
-t
Alveolar crest
1.
The radiopaque linss
Nutrient canal
2. The opaque
line line
-t +
Bony trabecular plate
3. Th oprque
Inferior border ofrnandibular canal
d. The radiolucent space

5. The radlopaque
Submandibular gland fossa
structure
Inferior border ofmandible
NormalAnat
Identify each structure that the arrows 1-8 point to in the maxillary molar region.
"Counesy Dr Stuart C. Whire. UCLA School ofDenrisrrv '
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RADIOLOGY
Identify each structure that the arrows I -7 poina to in the mandibular incisor region.
"Counesy Dr Sruan C. Whne. UCI-A School ofDcntistry. '

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1. The opaque
line
+ + + + + + +
Anterior wall ofmaxillary sinus Inferior concha

Floor ofnasal fossa
2. The opaque mass 3. The opaque 4. The opaque 5. The opaque 6. The opaque 7. The opaque
8. The opaque
lin
line line
line line
Inferior border ofzygomatic process ofmaxilla

Posterior wall ofzygomatic process ofmaxilla
Inferior border of zygoma (zygomatic arch)

Floor ofmaxillary sinus
structure
Mucosa over maxillary alveolar ridge
1. The opaque
structure
Lingual cusp of lst premolar
2. The radiolucent
line -+ Periodontal ligament space
3. The opaque mass 4. The opaque mass 5. The radlolucent 6. The opaqneline
+
-+
Film holder
Genial tubercles
circle
+ -t
Lingual foramen
-)
Bony trabecular plate
7. The radlolucent sprce
Marrow space
Identify each structure that the arrows 1--4 point to in the mandibular premolar region.
"Courtesy
Dr
Snran C. wltite. UCLA School of Denlistry" 16
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Identify each structure that the rrrows 1-3 point to in the msndibular premolar rsgion.
''Counesy
Dr
Stuan C. Write, UCLA School of Dentisrry
"
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l. The radiolucent line -+

2. The radiolucent space
Periodontal lisament Mental foramen
sDace
-)
3. Large radiolucent space 4. Dark
-+
dot -+ Film clin mark
1. The opaque
line
-)
Cemento-enameljunction
-+
Mental foramen
3. Large radiolucent space
->
Identify each structure that th arrows 1-7 point to in the maxillary premolar region,
''Coudesy Dr Stuan C. \lhne, UCI-A School of Denrisln."

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}IOLOGY
Identify each structure that the arrows 1-6 point to in the maxillary canine region.
''Counesy
Dr
Stuart C. White, UCLA School of Denrisrry. 19

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1. The opaque
mrss -+ Inferior concha
2. The opaque
line
3.The opaqueline
-) +
Anterior wall ofmaxillary sinus

Floor ofnasal fossa
4. The radlolucent space 5, The opaque
+ +
Maxillary sinus
line -+ Floor ofmaxillary sinus

Inferior border ofzygomatic process ofthe maxilla
6. The opaque structure 7. The opaque
llne
Lingual cusp offirst premolar
1. The opaque
line -+ Floor ofnasal fossa

line line line
2. The opaque 3. The opaque 4, The oprque
-) + -) +
Lateral wall in nasopalatine canal
Ala ofnose Anterior wall ofmaxillary sinus
-t
Maxillary sinus
6, The oprque
line
Lingual cusp of lst premolar
RADIOLOGY
NormalAnat
Identify each structure that the arrows 1-6 point to in the maxillary molar region.
''Counesl Dr Stuan C. Whire, UCLA SchoolofDenrsln.
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RADIOLOGY
NormalAnat
Identify each structure that the arrows 1-3 point to in the mandibular incisor region.
''Coudes) Dr Sruan C. w]rne, UCLA S.hool of Dentinry Copyrighr rr
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1. The opaque
line -+
DEJ
2. The lucent
line -+ Periodontal ligament space

line -+ Lamina dura
3. The opaque 4, The lucent
line -> Periodontal ligament space ofpalatal root
5. The opaque spot
-+
Film holder
Mucosa over maxillary ridge
6. The opaque region
-+
l. The radiopaque
2. The radiolucent
masses --> Mandibular tori
circl -+ Lingual foramen
3. The radiopaque mass
-+
Genial tubercles
RADIOLOGY
NormalAnat
Identify each structure that the arrows 1-4 point to in the mandibular incisor/canine region.
''Councsy Dr Sruart C. Wh're. UCI-A SchooIoIDcntistry.'

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RADIOLOGY
NormalAnat
Identify each structure that the arrows 1-8 point to in the maxillary incisor region.
*Counesy
Dr. Stuart
C whrte. UCLA
23
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l. The radiopaque structure

2. The radiopaque 3. The radlolucent 4. The radiopaque
Alveolar crst
line line line
+ + +
Lamina dura Periodontal ligament space Bony trabecular plate
l. The radlolucent
2. The radiolucent
spsce
-t
Marrow space
line
+ + -l
Periodontal ligament space Bony t'abecular plate Lamina dura
3. The radiopaque 4. The rrdiopoque 5. The lucent
llne line
line -+ Pulp canal
6. The opaque structure 7. The opaque structure 8. The opaque structure
-+
Alveolar crest Dentin (root)

Enamel ofsrown
-) +
RADIOLOGY
NormalAnat
ldentify each structure that the arrows l-9 point to in the maxillary incisor region,
"Counesy
D'
Sruan C. Whire. UCI-A School of Dcnrisrry
24
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RADIOLOGY
NormalAnat
Identify each structure that the arrows 1-12 point to in the maxillary canine region,
''Counesy
Dr
Stuan C. Whre. UCLA School ofDentistry.-
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1.
The opaque materiol
+ + + -t
Dentin
Bony tabecular plate Bony marrow spac
2. The rsdiolucent
line
3. The radlolucent space

4. The lucent 5. The lucent
structure
Pulp canal
space
line -+ Periodontal ligament
6. The opeque
line
Lamina dum
7. The oplque structure 8. The oprque structure 9. The lucent structure
-+
Alveolar crest
-) Enanel + Pulp chamber
+ Trabecular plate 2. The lucent sprce -t Marrow space

l.
The opaque
line
3. Tooth numbr? 4. The opaque line

5. The opaque
+ +
l0
Larnina duxa
materhl -+ Dentin
llne
6. The radiolucent
+ Periodontal ligament space 7. The opaque structure + Alveolar crest

8. The radiolucent 9. The radiolucent 10. The opaque
11.
structure structure
+ +
Pulp canal Pulp chamber
mtterid
Enamel
The oprque clrcle
Premolar buccal cusp over raised film dot
12. The opaque line
-+ DEI
NormalAnat
Identify each structure that the arrows 1-8 point to in th maxillary premolar region.
''Courtesv
Dr
Stuan C. Whire. UCLA School
Dent istry."
CoDrighr
al:0ll
?012
Denral Decks
NormalAnat
Identify each structur that the arrows 1-15 point to in the partial panorex.
C. While, UCLA
CopyriShr i.]
20ll
2012
'
Denral Decks
.1, Tooth number?
-+
2.lYhat material is this? -+ Silver amalgam

3.
Whrt
ls thls
oprcity?
Plastic bite block
4. The black
5. The black
dot
Film dot
marks line
PLS for Kodak Ektaspeed plus film Lamina dura
6. The opaque 7. The lucent
+ +
line
Periodontal ligament space Lamina dura
8. The opaque llne
-) Air in nasal fossa 2. The opaque line + Nasal septum 3. The opaque line + Lateral wall ofnasal foss4 medial wall ofmaxillary sinus 4. The opaque line + Infrao6ital rim 5. The opaque line + Border ofinfraorbital canal 6. The radiolucent space + Pterygomaxillary fissure 7. The opaque line + Pterygoid spine ofsphenoid bone 8. The opaque mass + Zygomatic arch 9. The oprque line + Posterior wall of maxllla (maxillary sinus) 10. The oprque line + Posterior wall of zygomatic process of maxilla 11. The opaque mass + Ear lobe 12. The oprque llne + Inferior border ofmandibular canal 13. The opaque rnsss + Anterior nasal spine 14. The opaque line + lnferior border ofmandible
1.
The lucent sprce
15. The oprquc msss
-)
Hyoid bone
RADIOLOGY
NormalAnat
Identify each structure that th arrows 1-13 point to in the partial panorex.
C.
while. UCLA
C.t\ric
rr
' -'nll l0 I
Dcnr,l DeLrr
RADIOLOGY
The pattern of stored energy on an exposed film is trmed tbe latent image; this image remains invisible until it undergoes processing A chemical solution known as the developer is used in the development process to chemically reduce ths exposed, energized silver halide crvstats to trlack metallic silver.
. The first statement is true; the second statement is false
is false; the second statement is true
. Both statements are true
. Both
statements are thlse
29 Copyrighr C
20tl,t0l:
Dcnrit Dccks
1.
The opacity -> Tipof
nose
2. The opaque
line -+ Hard palate/floor ofnasal fossa
3. The lucent area 4. The opaque line 5. The opaque line

6. The opaque
-+
Orbit
Hard palate/floor ofnasal fossa
Floor of n.raxillary sinus
structure
-+
Soft palate
-+ Air between the soft palate and the dorsum
of tongue
8. The opaque
line -+ Dorsum oftongue
9. The opaque line (dots) 10. The lucent

11.
-+
Shadow of opposite mandible (re.ferred to as ghost image)
oval -+ Mental foramen
The diffuse opacity
-+ -+
Shadow ofcervical spine Submandibular gland fossa
12. The broad lucency 13. The
opacity -+ Articular tubercle
The purpose
oflilm processing is trlofoldi . To conven thc latent (invisible) imagc on the film into a visible imagc proccss -der'eloping . To presene the visiblc image so that it is pemanent and docs not disappear tiom the dental x-ray
fi\ing
process
\\-hen a bcam ofphotons exposes an x-ray film, it chemically changes thc photosensitivc siher halide crystals in the film emulsion lldtent image). Important: Exposed arcas will becomc radiolucent, s hereas nonexposed areas will become radiopaque.
\-rat.' developing solution contains the following:
.,\
developing agent, such as hydroquinone, which is a chemical compound that is capablc ofchanging the exposed silvcr halide crystals to black mctallic silvcr. At the same time, it produces no appreciablc cffcct on thc unexposed silver halidc crystals in the emulsion. Gives detail to the x-ray image. Note: Elon, also kno\r'n as metal, acts quickly to produce a visible radiographic inage. It scncraics the many shadcs of gray. . An lntioxidant preserrativ, for example. sodium sulfite, prevents the developer solution from ox-
idizing in the presencc ofair.

. An
accelerator
an alkalt (sodium
carbonate)
activates thc dcveloping agents and maintains the
alkalinity ofthe developer at the correct value. It softens geiatin ofcmulsion. . A restrainer, such as potassium bromide, is added to dcvclopcrs to conffol the action ofthe developing agent so that it does not develop the uncxposcd silvcr halide crystals to prodrtce fog. Noter Thc optimal iemperature for thc dcvcloper solution is 68oF.
Importanti The function ofdeveloping solution is to remove the ha)idc portion ofthc enposed, energized silver halide crystals to black rnctallic silver, this is refened to as reduction. The developer solution softcns the film emulsion during this proccss. The function offixing solution is lo stop developmcnt and remove remaining unenergized, unexposed silvcr halide crystals ftom the film emulsion. The fixer hardens thc film emulsion during thc proccss.
Film processing involves the following 5 steps:( I ) immerse film in developer (2) rinse film in water bath (rinsing dilutes lhe de*loper slott,ing the development process br removing lhe alkali accelerllor, Prevnting neutralizution ofthe acidfxer) (3) immerse film in fixcr (4) q'ash film in watcr bath and (5) dry
the
film.
''.'
L-'
Which ingredient of lixer solution fuDctions to remove ill unerposed and underdweloped silver halide crystals from the trlm emulsion?
. Fixing agent
. Acidifier
. Hardening agent . Preservative
30 Coplright O
20ll-2012
Dental Deck5
. .
Decrease the temperature Increase the temperature
ofthe developing solution ofthe developing solution
. Replenish the developing solution
. Increase the mA setting .

Increase the
kvp setting
31
Coplrighr O 20ll-2012 - Denral Dects
X-.ay fixing solrtion conlains thc following: . Thc fixing agent f. /e.7rirg ager, is madc upofsodium thiosulfate orammonium thiosulfate and is commonly called hwo. The purposc ofthc fixing agcnt is to remove or clear all unerposed and underdveloped silver halide crystrls liom thc film emulsion. Thc chcmical "clcars" thc film so that thc black silver rmagc produccd by the dcvclopcr bccomcs distinctly pcrccptiblc. whcn the film is impropcrly cicarcd, the rcmaining unexposed silvcr halide crystals darkcn upon exposure to light and obscure ahe imagc. . An antioxidant preservative, thc samc prcservativc uscd in thc dcvclopcr solution. sodium sulfite, is also uscd in the fixer solution. lt prevcnts thc chcmical dctcrioration ofthc fixing aSent. An acidifier such as acetic acid or sulfuric acid is uscd to ncufalizc thc alkaline dcvclopcr Any unncutralizcd alkali may cause the uncxposcd crltals to continue to dcvclop in thc fixcr It also produccs thc neccssary acidic cnvironmcnt required by lhc fixing agcnt. . Thc hardener agcnt used is potassium alum, lt shrinks and hardcns thc gclatin in lhc film cmulsio affcr it has been softcned by the accclcmtor in thc developing lolution. It shoflcns drying timc and protccts the cmulsion fionr
l'ollowing lixation, a walcr bath is used to wash the tilm.This stcp is ncccssary to thoroughly rcmovc all cxccss chcmicAls (i.e., thnsufaE ions atd sil\,er thiosurli?re.rnpldir, from thc cmulsio . Thc final step in rhc film proccssing is the drying ofthc films. Iiilms nay be air-dricd at room Ienpcraturc in a dus!
lrec area or placcd in a hcated drying cabinct.
Ntanual processing is a simplc mcthod uscd to dcvclop, rinsc, fix, and wash dcntal x_ray films lhc csscntial piecc ofcquipmcnt rcquircd for manual proccssing is a proccssing lank, which is containcr dividcd into compartmcnts for thc dcvclopcr solution, walcr bath. and fixcr solution. Notel Thc optimum tcmpcraturc lbr ihc devclopc. is bct$ccn 68'F and ?0'F, tnical timc in developer is 5 minutcs. nnsc lor 30 seconds, placc in fixcr solution for l0 minutcs and
wash for at lcast l0 minulcs and
dry
Automatic processing is anothcr simplc way
to proccss dental x-ray fillll. Thc essential piccc ofcquipmcnt required for automatic processing is thc automatic processor, which automalcs all film proccssing steps
.- . 1. Fixing timc is always at lcast twice as long as thc dcvcloping limc. j\ote* 2. wirh both automalic and manual processing,8 oz. offrcsh dcvclopcr and fixcr should bc added per gallon of solution per dr]. ''&r! L tf u ariea radiograph werc proccsscd a sccond rime, thcrc would bc no cbangc in contmst or dcnsity.
Safelighting providcs illumination in thc darkroom lo carry out proccssing activities safely without cxposing or damaging the film. Thc GBX-2 safelight filter by Kodak with a l5-watl bulb at lcast 4 fcct from thc workinq surfacc is rccommendcd.
,1.
As thc dcvcloping solution gts weaker, the films will get lighter. Both the devcloping and fixing solutions should be replenished on a daily basis Remember: with both automatic and manual processing 8 oz' of fresh dcvclopcr and fixcr should be tdded per gallon of solution per da].These solutions also need to be changed on a regular basis, and the tanks need to be scrubbcd and cleancd as well. The following factors affcct the life ofa developing solutionl the clcanliness ofthe tanks, the sizc ofthe films processed, the number of films processcd, and the tempcrarure ofthe solution
l. Yellowish-brown film will result from insufficient tlxing or rinsing

2. Fogged
(See
Jigute #l).
film storage or outdated films. 3. Low solutio levels will appear as: developcr cut-off fJll?lg, I vhile boftler SeeJigure #?or {ixer cut-offfs/rdight hlack border, Seetigure #3). 4. Light spots on film may result from contact with thc fixer beforc processing (Seefgrre film may
also result from improper
#1).
5. Developer spots appear dark or black (See
Jigure #5).
Fig
#!
AI
prctures .eprinFd from Hanng. Joen Iannucci and Laura Jdsen Lrnd: Rad iogrnphic Inrerprerltion for lhe
Dotal Hygienisl. O
1993.
$itb pemission iom Elsevier
Aftr processing a film, you notice that is rppears too dark What is the most likely caused of this problem?
. Inadequate development time
. Developer solution too cool . Depleted developer solution . Excessive developing time
Copright O 201l-2012 DenlalDecks
A straight white border appears on the x-ray film. What is the most likely cause of this?
. Fixer cut-off . Developer cut-off . Overlapped films
. Static electricity
Coprigh
O 201 I -20 12
'
Dental Decks
- Inadequate delelopmmt time - Developer solution too cool - lnaccurate trmer or thermometer - Depleted developer solution
- Check development nme - Check developcr tcmperxrure
- Replace
t_aul9"
- Replenish developcr
timcr or lhermometer vith fiesh
- Excessive developing time Chcck dcvclopment tjme - Check developer temperaturc - Developer solution too hot - lnaccurate timr or lhermometer - Replace faulty timcr or thcnnometer - concenEated developer solution ' Replcnish dcveloper with fresh
Sudden tmperature change Check tempcrature of processing between developer and water bath solutions and *dter brthi a!'oid
- Exrmine film p.rckets for defects - Never unwrap films in the trcsence lvhite lighr Gray: lack ofdetail - Improper safe lighting
of
'Light
leaks in dark'room
- outdated - Improper
fitms film storage
" Contaminated solutions
- Check the filter and bulb wattage of th safe light - Check rhc darkroorn fbr light leaks - Check rhe erpiration date offilln packages ' Srorc films in a cod. dry. proiected arc! - Aroid contaminated solurions by cover-
- Developer solulion too hot
ing tanks alier each usc - Check temperature ofdeveloper
Lxample
Developer
Appearance Stmight u'hite border
Problems
Underdeveloped portion film due to low level of
Solutions
of
cut-off
Fixet Straighi black border
Check developer levcl bcforc processing: add solulion if

needed
developer Unfixed portion
offilm
due to
cu!-off
Overlapped
low level offixer
Chcck fixer Ievel befbrc processingl add solution ifneeded

Separate films so thal no contact
whitc or dark
areas
films
appear on film where overlapped
Two films contacing each other during processing
iakes placc during processing
Airbubbles whitc spots
Air trapped on ihe film

surface after being placed in the processing solutions
cenlly agitale film racks aftcr

placing in processrng solutions
Fingemail
Black crescent
shaped lnarks
al.ifact
Fingerprint artifact
Static
Film emulsion damaged by cenlly handle films by the edScs the opemtoa's fingemail during onlY rough handling Fi:m louched by ingers that are contaminated with fluoride or developer
- occurs when film packet is opened quickly - Occurs when film pack is opened before the radiographer touches a conduciive object Wash and dry hands thoroughly before processing - Open film packel slowiy - Touch a conductive object before unwrapping films Use care when handling films and film racks
Black fingcr?rint
Thin. black, branching
electricjty
Scratchcd
film
RqJr.rerl
Soft emulsion removed from the film by a shalp objecr
li.r
Hrnng..loen tannu.ci and Lluri Jahen: Denlal RadDgrlphy: Pnnciples and Te.hnlques Thrd Ediri.n
!'
1000.
*nh
I)enni$ron from !l\e\rer
. REM
.RAD
. Roentgen
.Qy
34
Coplrighe20ll-2012
- Dentd Dect3
. Mature bone cells . Muscle cells . Nerve cells
. Epithelial cells
Coplright C 2011-2012 - Denral Decfts
The rad (radiotion absorbed dose) is a unit used to measure a quantity called absorbed dose. This relates to the amount ofenergy actually absorbed in some material, and is used
for any type ofradiation and any material. One rad is defined as the absorption of 100 ergs per gram of material. The unit rad can be used for any type of radiation, but it does not describe the biological effects ofthe different radiations.
The rem (roentgen equivalent man) is a unit used to derive a quantity called equivalent dose. This relates the absorbed dose in human tissue to the effective biological damage ofthe radiation. Not all radiation has the same biological effect, even for the same amount ofabsorbed dose. Equivalent dose is often expressed in terms ofthousandths ofa rem, or mrem. To detenrine equivalent dose (rent),yon multiply absorbed dose (rad) by a quality factor (QF) that is unique to the type ofincident radiation. The QF is a t'actor used lor radiation protection purposes that accounts for the exposure effects of different types of radiation. For x-rays QF : 1.
The roentgen is a unit used to measure a quantity called exposure. This can only be used to describe an amount of gamma and x-rays, and only in air
Exposure is a measure ofradiation quantity, the capacity ofthe radiation to ionize air.
Equivalent dose is used to compare the biologic efl'ects ofdifferent types ofradiation to
a tissue or organ.
Effectiye dose is used to estimate the risk in humans.
Gra\ /Gr,
100 rad.
js a unit lor measuring absorbed dose; the Sl unit equivalent to the rad:
I gray
All ioniting radiation is h:rrmful
T\o
and produccs chemical changes th.rt rcsults in biologic damsge in liviDg tissuc. spccific mcchanisms olradiation injury are possiblc: ionization and frec radical formation /1, is is l|rc pritnd^'
hcorics ofradialim injury:
. Thc direct theort: suggcsts lhal ccll damagc rcsuhs whcn ionizirg radialion directll hits crilical arcas. or tar!.rs. q Jlhin $c ccll. Dircct altcration ofbiologic molccrlcs (i.c., (u bohrlrat$, 14il!, prct?int, DN 1/ occuts. Ap pro\rrnalcl) one-third ofdrc biologic cffccls ofx-ray cxposurc rcsult from dircct cllccts. . Th. indircct theort suggcsts that x-ray photons arc absorbed wilhin thc ccll and causc lhc lbnnation oi loxins. \ hich in tum d.rnagc rhc ccll For cxamplc. \'hcn x-ray pholons arc absorbcd by watcr within a ccll. free radicalforDaiion rcsul1s. Thc iicc radicals combinc to form loxins /s.g, l/r(r. which causc ccllular dysfunction and
rro'lrg1. danl3sc. Aboul two{hirds of radiation-induced biological damagc rcsults fiom indircct ctlccls.
lmponant: I)amag. lo thc DNA molecul is lhc primafv ncchanism fbr radiation induccd
cel1 dcirth.
nutation, and
dos response curve is uscd to dcmonslratc thc rcsponsc i/drndgel of(issucs to thc dosc arr?ornr.) ofradiation rc-
Biological cfTects ofradiation can bc classificd as: . Stochastic cftcctsi occur as a direct function of dosri lhc probabilirr" ofoccurrcncc incrcascs \\'iih incrcasing ibnrrbcd dose: howeve., lhc sclcrity ofcliccls does not dcpcnd on thc magnitudc ofthc ahsorbcd dose. Examrlc\ ofsrochastic cficcls includc cancer r... trrro,-./ induction and genetic m|Itations (i.?., DNA tld"ng.') . \ on sroc h a stic cffects /.le ter ti i\ ti( L'[e. ts)t arc somatic cficcts tha! havc a th reshold and i n creasc in scvcrily $ith increasing absorbcd dosc.Eranrplcs of nonslochaslic eilccts includc erylhcma. oral changes. loss of hair,
cararact ibnnation, and dccrcascd fcriility. Importanl When comparcd fi-cts require Iarger radiaiion doscs to seriously impair hcalth.
silh slochastic eflects. nonstochastic cl-
\ot
.rll cclls rcspond 1r) r:rdidlion in thc samc manncr In general, thc gre.tcr thc rate or potential for mitosis and thr morc immsture rhc cclls and tissues are, thc greatcr the sensitiritl or susccplibility to radiation. Cclls that arc radiosensitire includc blood cclls. immaturc rcproductivc cclls, epithelial cclls, and iroung bonc cclls. Thc ccll that rs most scositive to radiation is ths small lymphocyrc. Radioresistant cclls includc cclls ofbonc. musclc and ncrvc.
Rsdiosensitive organs composcd ofradioscnsitive cells includc lymphoid tissucs. bone marro$,, tcstcs. and inlcstincs. Examplcs of rad iorcsista n t tissues includc thc salivary glands. kidncy and liver
. Latent period . Period ofcell injury . Recovery period
. Cumulative effects
36 Cop)ri8hr O
201
1,2012 - Dental Decks
. Osteoradionecrosis
. Bisphosphinate related Osteonecrosis ofthe jaw
. Rampant periodontal
. None ofthe above
disease
37 Coplriglrt i 201l-2012, Denial Decks
Chemical reactions /e.g., ioni:dtkr1. .lree rudi(al fornalion) lhal lollo."\, the absorption of radiation occur rapidly at thc molecular level. I lonever. varying amounts of time are required fbr these changcs to alter cells and cellular functions. As a result, the obsenable effects ofradiation are not visible immediately aftq cxposurc. Instead, following exposurc, a latnt period occurs. The latent period is the pcriod of time between radiation exposure and the onst ofsymptoms. It may be short or lonc, depending on the tohl dose olradiation received and the amount of time it look to receive the dosc. Thc period ofcell injury fbllo$ s the latent period. Cellular injury may result in cell death. changes in ccll tunction or abnormal mitosis ofcellsThe rcovery priod is the last event in the sequcnce ofradialion injury Some cells rccover fioni the radiation ir1jury, especially ifthe radiation is "low level." Note: The eflects ofradiation exposure are additive and rhc damagc that rcmains unrepaired accumulatcs in the tissues. The cumulative effects ofrepealed radialion exposure can lead to various serious health problems le.g., carcinogenesis, r|hi.h leuds to r\trious caxilonar, genetit nutatiotis whi.h cdure hirth defets. diflerent kinds of lculienia and utdrads).
Radiation effects can be classified

amounts ofradialion absorbed
as
cithcr:
. Shorl-term effects: ellecls ofradiation

ir1 a
that appear within minutcs. days, or \r'eeksl associated with largc short period oltime. These effects are not applicable !o dentistry. . Long-1rm effects: effects of radiation that appear aftcr years, decades, or generations; associated with small amounts ofradiation absorbed repeatedly over a long period oftimc- Repeated low levcls ofradiarion erposure are linked to thc induction ofcancer, birth abnormalities, and genctic defects.
Radiation elTects on rells:

. The cell nucleus is morc sensitive to radiation than the cytoplasm. Damage !o the nucleus allccts thc chro' mosomes con{aining D\A and resuhs in disnlplion ofcell division, \l'hich in tum may lead !o disruprion ot cell lirnction or cell death. . lllitotic delay occurs afier irrldiation ofa population ofdividing cells. . Radialion causcs cell death by damaging chromosomcs! preventing successful mitosis and also by apposit.s /proNromnted cell de.tth). . Cell recovery involvljs enzymatic repair of sirgle-strardcd brcaks of DNA.
Thc clinical complications that occur in bone following inadiation relate to lhe marked reduction in vascularity and the consequcnt d.crcased capacity oflhc bonc to resist infection. Therc is a strong possibilily that inf'eclion and nccrosis ofbone will resuh in a nonhealing \lound if the orrl mucous rtembrancs aQlredd] tomprotniscd b) r|rddidli.r,l breaks do\,'n. This may occur spontaneously or fbllowing a loolh extraclion or denture sore and is kno\\ n as osteorrdionecrosis, Osteoradionecrosis is morc common in the mandible than in thc maxilla. becausc oflhe richer vascular supplv to the nra\illa and lhc fact that lhe nandible is morc frequently inadialcd. Thc mosl conlmon faclors precipitating osleoradionecrosis arc pre- and pos!ilradialion extractions lnd periodonta] disease. Note: Damage to lhe blood lessels /d-f.)ppor_erl /o nen,es, ius(le, eL., predisposes a patient 1o thc developmen! of osteoradionecrosis Histopathologically, ihe I Hs ofORN arc hypocellu)ar bone. hypovascular tis\ue, and h),poxic tissue and bone
To prerent osleoradionccrosis: extract all hopelcss tceth three weeks prior to bcadineck radiation trcattncnl, If cxrracting afler radiolherupy, lhc use ofsystemic antibiolics is recommended. Sonc sludies suggesl hypeftaric oxygcn rrealmcnls bcfore and afler lrcaimcnt to reduce the risk ofosleoradionecrosis flrr:r r soncrhd (ontn'
Eflccls ofl'hole t ody irradiation: . When the whole body is exposed to low or moderate doses of radialion. thcre are ch.rracleristic changes kolled the aute rddiation slndtomc) th develop, which are quitc different irom thal secn when a relatively small volume oftissue is exposed. . Embryos and fetuses are considerably more radiosensitive than adults bccause mosl embryonic cclls are relatively undifferenliatcd and rapidly mitotic. Prenatal irradiation may lead to dcadr or lo spccific devclop menlal abnonnalilies depcnding on the stage of developmcnl at the tine of irradialion. \otc: No effccts on
en'lbryos or fetuses have been shown from low doses used in denlal rldiography.
Late somatic effects:

. Somatic eflects are those seen in the irradiated individual. The most important are radialion-induccd cancers. . Carcinogenesis: - Radiation-induccd cancers are not distinguishable from cancers produccd by odrer causcs. - Thc incidence ofleLlkcrnia bther thdn CLL) rises following cxposure ofthe bonc marrow lo radialion - Radiation induced solid canccrs, including in lhe thyroid. brain, and salivary glands. generally appeer 10 or more yean aftcr exposure and elevdled risk remai.s for lifetime. - Pcnons younger than 20 ycars ofage are more al risk for solid tumors and leukcmias than adults
. The first statement is true; the second statement is false
. The first statement is false; the

second statement is true
. Both statements are false
38
Coplrighi o 201l'2012 Dental Decks
. kvp
.mA
. Tirne (sec)
.
All of the above
39 Coplrighr O 20ll-2012 - Dental trcks
The oral cavity is irradiated during the course oftreating radioscnsilivc oral malignant tumors. usually squamous cell carcinoma. Radiation therapy for malignant lesions in the oral cavity is usually indicated when the lesion is radiosensitiv, Ndvanced, or deeply invasiv and cannot be approached surgically. Fractionation ofthe totalx-ray dose into multiple smalldoses provides greater tumor destruction than would be possible with a largc single dosc. Fractionation also allows incrased cellular rpair of Dolmal tissues, \\+ich are believed ro havc an iiheritantly grcatcr capacity for recovry than tumor cells. Another vahrc offractionation is that i1 increases the mean orygen tension in an inadiated rumor, rendering the turnor cells morc radiosensitive.
Radiation effect on oral tissus: . Oral mucous membranes: by the end of the sccond weck ofthempy the mucous mcmbrancs bcgin to show areas ofrcdness and inflammation (zac.rrr'ti9. As therapy continues. lhe mucous membmne begins to break down, u,ith the fomation ofa white to yellow pseudomembralne ldesquamated epithelial larcr). At the cnd oftherapy the mucositis is usually most severe, secondary infection by Candida albicans is a common complication. After inadiation the mucosa bcgins to heal rapidli, and is usually complete by about 2 months. . Taste buds: arc sensitive to radiation. Therapeutic doses cause extensive degeneration ofnormal histologic architccture oftaste buds. Patients often notice a loss oftastc acuity during the second o. third week ofradiotherapy. . Salivary glands: during the first lew weeks ofthenpy thcre is usually marked and progtessive loss ofsali\'ary secretion. fi extent ofreduced flow is dose-dependent. The mouth becomes dry freloslomldl and tender, and swallo$'ing is difliculr and painful. xcrostomia that has persisted belond a year is lcss Iikely to show significant retum of function. Importrnt: Salivary changcs hav a profound influence on thc oral microflora and secondarily on the dentition, often leading to radiation caries. . Teeth: inadiation ofteeth with therapeutic doses during their development severely tetards their growth. \ote: Aduh reeih are vcry resistant to the direct effects ofradiation exposure. . Radiation cariesi is a rampant lonn ofdentaldecay that may occur in patients who have received a course
ofradiotherapy. The carious lesions result lronl changes in the salivary glands and saliva, including reduced tlo(. decreased pH. reduced buffering capacity, and increased viscosiLv. . Bone: lhc primary damagc to maturc bone rcsults from radiation-induced damagc to lhe fine vasculature, \\ hrch is normally already sparse in a dense bone such as the mandible. Subsequent to irmdialion lhere may be a replacement ofnormal marrow with f'atty narrow offibrous connective tissue. ln addition, the endosreum become atrophic, sho*,ing a lack ofosteoblastic and osteoclastic acti\.ity, an indication ofncrosis.
The speed with which electrons travel from the filament ofthe cathode to the target ofthe
anode depends upon the potential difference between the two electrodes (kilovoltage). This, in turn, has a very important effect on the x-rays produced at the focal spot. The kilovoltage has nothing to do with the number of electrons that compose the stream flowing from cathode to anode. The numbr of electrons (vhich determines the quantity o-fx-rals producedl is controlled by the temperature of the tungsten filament (milliumperage setting). The hotter the filament, the more electrodes are enitted and available to form the electron stream (the x-ra1,tube cut-rent).Inthe x-ray tube the number ofelectrons flowing per second is measured in milliamperes. The intensity of x-rays produced at a particular kilovoltage depends on that number. Note: Setting the x-ray machine for a specific milliamperage actually means adjusting the filament temperature to yield the current flow indicated. The milliamperage range for dental radiography is 7-15 mA.
Note*,'
l. In dental radiography, the quality ofthe x-ray beam is controlled by kVp. 2. The kilovoltage range for most dental x-ray rnachines is 65-100 kV. 3. Digital units use a range from 8-40 kvp.
4. A higher kilovoltage produces x-rays with greater energy Ievels, shorter wavelengths and more penetrating ability. 5.To increase film density, you should increase mA, kVp and time. Also, you should decrease the source-object distance.
. One-fourth
as intense as intense as intense as intense
. One-eighth
. Four times . Eight times
40
Coplright O 201l-2012 - Dental Dects
Decreased density
. More latitude
. A shorter scale of contrast
. A longer scale ofcontrast
41
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2012, Denial Decks
The Inverse Square Law is stated as follows: The intensity ofan x-ray beam at a given point is inversely proportional to the square ofthe distance from the source ofradiation. Important: Changing the distance between the x-ray tube and the patient thus has a marked effect on beam intensity.
The intensity of an x-ray beam at a given point is dependent on the distance ofthe measuring device from the focal spot. The reason for this decrease in intensity frtr,l, il rs ,nversely proportional) is that the x-ray beam spreads out as it moves from the source. The "spread out"
beam is less intense.
For example, when the PID length is changed from 8 to l6 inches, the sourcelo-film distance is doubled. According to the Inve6e Square Law, the resultant beam is one-fourth as intense. When the PID length is changed from l6 to 8 inches, the source-to-film distance is reduced by one-half. According to the Inverse Square Law, the resultant beam is four times as
intense.
The following mathematical formula is used to calculate the Inverse Square Law:
original intensity
new
tance.
= new distance2 intensity original distance':
Remember: The intensity ofthe radiation is inversely proportional to the square ofthe disthe path ofthe x-ray the intensity by one-halfis termed the half-value layer. For example, if an beam that reduces x-ral beam is said to have a half-value of4 mm, a thickness of4 mm of aluminum would be necessary to decrease its intensity by one-half. Measuring the half-value layer determines the penetrating quality of the beam. The higher the half-value layel the more penetrating the beam.
Important: The thickness of alumrrr,tm (approxinateb'2 mm) placed n
ofa change in kilovoltage is a changc in the penetrating power ofthe x-rays. Incrcasing kilovoltage reduces subject cont ast (and the longer lhe scdle ofcontt?saJ; decreasing kilovoltagc incrcascs subject contrast fard rhe shorter lhe scale of conlrasl. A second effect ofan increase in kilovoltage is that not only are neu', morc pcnctrating x-rays produced, but morc ofthe less pcnctrating rays which were also produced at the lower kilovoltage are omitted. Remember: Kilovoltagc controls the speed ofelecOne effect
trons. Conclusion: kilovoltage influences the x-ray be.m and radiograph by: . Altering contrast quality ([or patienls v,ilh thick jaws, iro"ase I ilovoltage) . Detcrmining the quality ofthe x-rays produced . Detcnninillg the velocity ofthe electrons to the anodc
Sharpness refers to thc capability ofthe x-ray film to reproduce the distinct outlines ofan objcct, or, in othcr s ords. to how well the smallcst dctails ofan object are reproduced on a dental x-ray. A ccrtain lack oi imagc sharpness is prescnt in every dental x-ray. The fuzzy. unclcar area that sunounds a radiographic image is termcd the penumbra. Thc sha.pness ofa film is influenced by three factors: . Focal spot siz: the tungsten target ofthc anode senes as a focal spot; this small area convcrts bombarding electrons into x-ray photons. The focal spot concentrates the electrons and crcatcs an cnor_ mous amount ofheat. The size ofthe focal spot ranges from 0.6 mm: to 1.0 mm:and is determined bt rhe manufacturer ofthe equipment. lmporlant: The smaller the focal spot area, the sharper the inlage appears: the larger the focal spot arca, the greater the loss of imagc sharpness . Fitm composition: sharpness is relative to the size ofthe crystals found in the emulsion. The emulsion offastcr film contains larger crystals that produce less image sharpness, whcreas slowcr film contains smaller crystals that produce more image sharpness. . \Iovement: a loss of image sharpness occurs ifeither the film or the paticnt moves during x-ray cxposute.
Note: Image sharpness can also be improved by increasing the distance between the focal spot and thc
object by using a long, open-cndcd cylinder and also by decreasing thc distance betwceil the object and the film.
'kVp
.mA
. Exposure time . Whether the film is
a one-film packet or a
two-film packel
t2
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@
2011,2012, Denial Decks
. Positive anode
. Negative anode
. Positive cathode
. Negative cathode
43
Coplriglt O20ll-2012
- Dental Decks
Density rcfcrs lo thc ovcralldarkncss r/b/d(izer, ofa radiograph: . Dcnsit_v will increase as mA. kvp, or cxposurc limc is incressed . Dcnsity will decrease as mA, kVp. or cxposurc timc is decreased . Reducing lhc distancc bctwccn thc focal spot and thc film also increases thc dcnsit)
Note: Thc thicker thc objcct or thc grcatcr its dcnsity, thc morc thc x-ra] bcam is attcnuatcd and lhc lighter thc rcsultant image will bc. Thc blackening oflhe fi1rn Nflcr x-ray cxposurc is cxprcsscd in tcnns ofits optical densit!: D = log l0 (lo.l1)
whcrc
l0 is thc rnlcnsity
ofincidcnt light /e,.a.,/.),r a vi4 rar./ and Ir is thc intcnsity of
thc lighl transmittcd through thc lilm.
In roulinc radiogr.phy thc uscful rangc ollilnr dcnsilics is approximatcly 0,j ften light) to 2 l|e^ dort.t. Bcyond thcsc cxtrcmcs thc imagc is usually too light or 1oo dark to bc diagnoslically uscful. Not: ln a \\,cll-cxposcd and proccsscd radiograph. thc opticaldcnsit_v ofcnamcl is about 0.,1, dcntin is about L0, and soli lissuc 1s about 2.0.
Rcmcmber: Thc operator ofan x-my unil is in conirol ofthrcc factors:
L Kilo\oltage: thc quality or penetrating power ofthc x-ray bcam 2.}{illiamperrge: the quantity or numbcr of x-rays produccd
in thc numbcrofx-rays produced and an increase in lhc tcmocralurc of thc filamcnt. 3. Exposure time: thc lcngth of time x-rays are produccd and patient is cxposcd to lbcm. ljxposurc tnnc is mcasurcd in impulses bccausc x-rays arc crcalcd in a scrics ofbursts or pulscs rathcr than a continuous skcam. Onc inrpul\c occurs clcry 1160 ofa second; thcretbrc, 60 impulscs occur in I second.
*** lncrcasing nrillianrpcragc rcsults in an increase
L Radiographic
Notc.
dcnsir,v. Thc fastcst dcntal
speed is thc amounl ofradialion rcquircd 1o prodlcc a radiographic film cuncntly availablc is F-spccd.
tilm ofslandard
2.Thc film characlcristic thal js ihc rcvcrsc ofcontrast is film latitude. Thc highcr thc contrast. thc smallcr thc laiitudc and the lowcr thc contrast, thc grcalcr Ihc latiludc. La{itudc is. thercforc, thc rangc ofradlation intensitics that a film is capablc ofrccording. l. Radiographic not(le /o/-nrrre) is thc appcarancc ofuncvcn dcns;ty ofan cxposcd radiographic film. .l Rrdiographic artifact$ arc dcfccts causcd by cnors in film handling or crrors in film proccssing. or marks or scratchcs fiom rough handling. 5. Sharpness is thc ability ofan x-ray lo dcfinc an cdgc prcciscly. 6. Rcsolulion. or rcsolving powcr, is thc ability ofan x-ray to rccord scparalc structurcs that a.c closc logcthcr.
Thc r-ral tubehead is a tighlly scalcd. hcavy mctal housing that conlains thc x-ray tubc thal produccs dcnlal x-ray!. Thc componen! pans ofthc tubchcad includc the following:
. Ntetal housing: is thc mctal body oflhc tubchcad lhat sunounds ihc x'ray tubc and transfonncrs and is iillcd \lith oil: it prolccts thc x ray tube and grounds thc hiSh-voltagc componcnts .Insulating oil: ;s thc oil tha! srmounds thc x-ray tubc and transformcrs insidc thc lubchcadi it prcvents ovcrhcating by absorbing thc heat crcalcd by thc produclion ofx-rays
'Tubeherd seal: or thc aluminum or lcadcd glass covcring thc tubchcad that pcrmits lhc cxil ofx-rays lionl thc tubchcadt it scals lhc oil rn lhc tubchcad and acts as a flltcr to Ihc x'ray bcam . X-ray tube: is thc hcart ofthc x-ray gcncrating systcm . Transformer: is thc dclicc that altcrs thc voltagc ofincoming clcctricilv . Aluminum di$ksl shccts of0.5-mn thick alurninum placcd in thc path ofthc x-ray bcaml they filtcr out non' pcnctrating, longcr wavclcngth x-mys . Lead collimator: is a lcad platc wilb a central holc that fits dirccily ovcr thc opcning ofdrc mcial housing whcrc thc x-rays cxit; ii rcstricts lhc sizc ofthe x-ray beam . Position-indic:rting device (PID)r is an opcn'cndcd. lcad-lincd cylindcr that cxtends from thc opcning ofthc mctal housing ofthc tubchcad; it aims and shapcs thc x-ray beam
Thc x-rar" tube is thc hcarl ofthc x-ray gcncrating systcm. It consists ofa lead-glass housing, a negative cathode, and a positive rnode. Electrons arc produccd in thc cathode and acceleratcd toward thc anodc; thc anode con\cr(s lhc electrons into x-ravs.
. l,eaded-glass housing: is a leaded-glass vacumm tubc that prevents x-rays liom cscaping in all dircclions. Onc ccnlral arca ofthe ieadcd-glass tubc has a "window" that pcrmils lhc x-ray bcam lo cxit the lubc aDd directs lhe x-ray bcan toward thc aluminum disks, collimator and PID. . Cathodc /r/ rgdrtrt, r1e. rftr.L,/: consists ofa tungsten wire lilament in a cup-shapcd holdct nradc of molybdenum. The purposc oflhc calhodc is to supply the electrons nccsssary to gcncralc x-rays. Thc clcclrons pro duced in rhc nega(i!e cathodc arc accclcratcd loward thc posjlivc anodc. Thc cathode includcs thc ibllorling: . Tungsten filament: is a coilcd wirc madc oftungstcn. which produccs clcctrons \vhcn heatcd .llollbdenum cup: tbcuscs thc clcctrons into a narro$,bcam and dirccts thc bcam across thc tube lo*,ard drc tungstcn targcl ofthe anode . (ot poriti\,t ?l?(rod4r consisls ofa waftr-thin tungstcn platc cmbcddc'd in a solid coppcr cord. Thc pw' ^node pose oithe anode is to convert elcct.ons into x-ray photons. The anodc inludcs thc following
. Tungsten target: scrvs as a focal spol and convcrts bombarding clectrons into x-ray photons . Copper stem: funclions to dissipatc thc hcat away from thc tungstcn largct
. Copper stem . Filament . Vacuum
. Molybdenum cup
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-2012 - Dntal Drcks
. A neutral atom without
nucleus
. An atom with equal numbers ofprotons and electrons

. A neutral atom that loses an electron and becomes a positive ion
. None ofthe above
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Coplrighr
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-2012 - Dntal Dcks
ReFinrcd ti.m Haring. Joen Ia.nuc.i and l-lura Ja.rn: Dental RxdioErdy Princlties rnd Tec|'
.\ue\: lhinl Ldilron O
1000.
$nh t.nnss.n ftonr Flsc\icr
Refrinted no'n Haring..roen lrn

nuccr trnd Laura J.nsen Denhl Rt
drgrdphl: tnncrples ard Techniqoes: Ihid ldiron '! 1000.

wirh pennr$io. from FheYler.
X'.a\s arc gencratcd whcn a srrcam ot clcctrons (\'hkh are prod ed hr rre /i/drrertl tra\cls from thc calhodc to lhc anodc ond is suddcnlr- stoppcd by its impact on thc tungslcn larscl. Thc filancnt locrlcd in rhe carhodc is nradc is lhc source of \oilungrrcn Nirc Thc smallarca on thc targcl that thc clcclrons strikc is callcd drc focal spot
-il
\oles
L Thc sizc of thc fbcal spol directly influences thc x-nty dcfinition: thc larger the focal spot. thc greair rhe loss nfdcfin:(ion and r\c greater lhe lo\r oI rhc .hartnc.. ol lhc imalc
Copper rs uscd Io hous!' thc anodc bccausc it is a good thcrmal conduclor. dissipating hcat tiom thc tungstcn krgct and rcducing thc risk ofrnclring lhc largct-
Matter is anything lhat occupics spacc and has mass; rlhcn mattcr is altcrcd, energy rcsulls. Thc indamcntal unil ofmaller is thc atom. Thc atom consists oal\vo parls: . A ccntral nuclus: is composcd of protons and neutrons. Protons carry positiv clcctnc!l chargcs, !{hcrcas ncutrons cary no clcctrical chargc and arc slightly hcavicr than lhc proton . Orbitin8 electrons: arc t;ny negatively chargcd particlcs ihal havc vcry little mass; rn clcctron wcrghs approxas
imatcly 1/1800 as much orbits or shells
as a prolon
orncutron. Elcctrons rravcl around thc nuclcus in $cl1-dcllncd paths known
An atom contaiis a maximum ofsevcn shclls, cach localcd at a spccific distanc lion1lhc nuclcus and rcprescrtrng diflcrcnt cncrgy lcvcls. Thc shclls arc dcsignatcd wift lhe lclters K, L. N{, N, O, P and Q; thc K shell is locatcd clos' est ro rhe nucleus and has $c highestenergy level. Elccrrons arc maintaincd in thcir orbits by thc electrostalic forceJ orallraction. bclwccn thc posilivc nuclcus and thc ncgativc clcctrons. This is known as ihc binding energy ofan clcctron. Atoms arc capablc ofconibining wilh cach olhcr 1o lbrm molcculcs. A neutrrf atom conlains an cqual numbcr of protons (posi!i,e Lharyes) ]nd electrons /neg.?/a'. .rr4i.'.!/. An atorn with an incomplclcly Ullcd outcr shcll is clcctrically unbalanccd and aiicmpls 1o capturc an clcclton from an adjaccni atom. An aton that gains or loscs an clcclron and bccomes electrically unbalarccd is known as an ion. Ionization js thc producrion ofions. or thc proccss ofconvcning an elom inlo ions. Ionizalion dcals \\'ith electrons only and rcquircs sufticicnt encrgy ro ovcrcomc thc electrostatic lbrcc that binds thc clcctron to the nuclcus. Ionizing rad;ation is capable ofproducing ions and can bc classificd inlo two groups: . Particulate radiationr arc iiny particlcs ofmattcr that posscss mdss and lra!cl in straight lincs and al high spccds. Thcrc arc lbur typcs: . llfectrons: can bc class classificd as beta particle. lldst nnring ?l.cttotlj eniuetl lon the tt (k'tts ol rddioactir. otonts) ot c thode rays (strcams ol hi!:h-spe.l ek'( trcDs thut origindte in an .\ tut nh.) . Alpha particles: arc cniltcd from thc nuclci ofheavy mctals and cxisl as t\\'o protons and nculrcns. $ithout clcclrons
. Protonsi arc accclcrated paniclcs. spccifically hydrogcn nuclci, with a nlass of I and . Neutrons: are accclcratcd pariiclcs with a mass of I and no clectrical chargc
a chargc
of+l
. Electromagnetic radiation: can bc dcfined as lhc propagation ofwarc-likc cncrg)" /r'rrorlr l,alltr./ through spacc or mattct Illcctromagnctic radiations arc manmade, or occur nah.rrally;cxamflcs includc coirnic rr] \ camma ruyJ, x-r!!-s, UV rays. visiblc light. infrarcd light, radar $avcs, nicro$avcs, and radio wavcs. Thc particle concept (Q d,1tun l2orr) .haructcrizcs clcctromagnctic mdiations as discrctc bundics ofcncrg-v called photons or quanta, Thc wave concept characterizes cleckomagnctic radialion as lvavcs and focuses on thc propenies ofvelocit]'. $avclcnglh. and frcqucncy.
. The first statement is falsej the second statement is true
. Both
statements are true
a6
Coptright
,O 20 I 1,20 | ?
, Denial Decks
Which of the following occurs only at 70kVp or higher and accounts for a very small part ofthe x-rays produced in the dental x-rry machin?
. Compton scatter
. Coherent scatter . General (Bremsstahlung) radiation
. Characteristic radiation
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Dental Decks
llcctricity is thc encrgy that is uscd (o make x-rays. Electrical encrgv consists ofa flow ofclcctrons through a conductor; this flo$'is known as thc clcctric currcn(. The clcctric currcnr is tcnned direct currcnt frcl whcn thc clcctrons flo$,in one direction through lbc co duclor Thc lcnn alternating current /-,14) dcscnbes a currcnt ;n which thc elcctrons flow in tl4o opposite dircctions. Rectitication is thc convcrsion otaltcmatiig currcnt lo dircct currenti thc dcntal x-ray tubc acts as r self-rectificr ir that it changcs AC irto DC \r'hilc producing x'rays. This cnsrLrcs that lhc current is alwa]s flor}ing in thc samc dircclion, morc spccilically, liom cathode to anode.
Amperagc is thc rncasurcncDl ofthc number ofelectrons nroving through a conductor Current is measu.cd in amperes or milliamperes /rr,.1/. l'oltage is the meas rcment ofelectrical force thal causcs clcctrors lo movc fron a ncgativc pole to a posili\'e oDc. Voltagc is measured in volts or kilovolts /krr. Note: ID thc produclion ofx-rays. bofi thc lmpcrage and volfagc can bc adjuslcd on thc contfil pancl (mA aditstDrctt dnd kI? adiusttrcrt s\\itthes).
A circuit is a palh of clcctrica I currcnt. Two electrical circuits arc uscd in lhc production ofx-rays:a lolrrvoltage or filamcnt circuil and a high-voltage circuit. Thc Iilament circuit uscs J to 5 volts. regulatcs thc llo\\, ofclcckical currcnt to thc filament ofthc x-ray tubc, and is controllcd by thc milliampere settings. Thc high-r'oltage circuit uscs 65.000-100.000 ! olts. providcs thc high voltagc rcquircd lo accclcratc clcctrons and to gencratc x-rays in thc xray tubc, and is conlrollcd by thc lilovoltage settings.
A transformer is a dcvjcc that is uscd to cithcr incrcasc or dccrcasc lhc vollagc in an clcctrical circuil. Transfbrncrs altcr thc \oltagc ofthc incoming eleckical currcnt and then routc lhc cleckical cncfgy to thc x-ray tubc. In lhc production ofdcntal x-ra)'s, thrce transfbrmers arc used to adjusl lhc clcctrical circuils: . Step-down transformcr: is uscd to dccrcasc thc vollagc fiom thc inconring I l0 or 220 line voltage to the 3 to 5 \ ohs rcauircd . Step-up transformer: is used to inc.casc the voltag from the I l0 or 220 linc roltagc lo thc 65,000 to 100.000 \0lts rcquired . Auto-transformer: scn,cs as a voltagc compcnsator that corrccis for miror flu!tuations in the currcnl I Thc milliamperage f/r,.|.) or tube current swltch on thc control panel regulates thc tempcr.tura of \ot{* th filament and thus thc number ofelectrons emitted, 2.Tube current or mA controls thc numbcr ofphotons gclcratcd //,rlersitt ol the bru , but rot thc beam cncrgy. Thc quantity of radiation produccd by an x ray tubc is dircctly proponional 1o lhc tubc currcnt /rr.,1/ cxposurc timc. L Thc livp control sclccts voltage from diftcrenl levels on thc autotransformcr and applies it across Ihc primary winding ofthc slcp-up transtbrmcr ,+. In dcntal x rays, the qualit) ofthe r-ray beam is controllcd by kvp. 5. Thc cflcct ofchanging timc is sinply 1l) control thc "quanlily" ofthe ex?osutc (the nunbcr ol phoIotts sencratel).
Not all x-ra)s produccd in thc x-ray lubc arc thc same; x-rays rlilltr in energy and wavclength Th cnergy and lvrvclcnglh ofx-ravs varies bascd on how the clcctrons intcract wilh thc tu'rgstcn atonrs in lhe anodc. Thc kinctic cn crgy of rhc clcctrcns is converted to x-ray pholons via onc oft$o mcchanisns: . Gene.^l (Rrcnsstrfihnrg or braking radiation: a fomi ofradialion lhat occurs lrhcn speeding clcctrons are slosed bccausc ofihcir intcraclions with thc nuclei oftarget alofis. Thc tcmr braking radiation, rcLrs to thc sudden stoppnrg or slowing ofhigh-speed eleclrons hitling the tarSet in thc anodc. Most x-rays arc produccd in lhis
lpprorimately 707o ofthc x-ray cncrgy produced at thc anodc can be classificd as gcncral radiation . Charactcristic radiationr is produccd wien a high-spccd clcctron dislodgcs an inncr shell elcctron liom thc tungslcn alonl and causcs ionization ofthat atom. This tlpc ofradiation accounts for a vert-' small part oi x rays produced in thc dcntal x-ray nrachinc and occurs only at 70 kvp and abovc bccausc thc binding cncrgy oflhc K
nlanner; shcll .lcctron is approxirnatcly 70
kcv
anode and cxjls thc lubc
Priman radiation refcrs to lhc pcnctrating x-ray bcam that is produccd at lhe llrrgcl oflhc hJld Tlij \,rr] beam is olicn rcfcrrcd to as thc primary bcam or useful beam.
Secondarr r!diation reicrs to x-radialion that
f Jn.rratrng lhan
is crc.rtcd whcn thc primary bcam inlcracls u'ith mattcr li tl tal rd' ,li ].t,rp/l.krutoitklud(skesolitissu(softheheud,thehotrcsolth"skull,adtheteeth).NoteiSccondaryisless
primary radialion.
Coherent scaner is onc ofrhc intcracrions ofx-radialion rvith mattcr in which thc path ofan x-ray pholon is altcrcd b\ cr $ ith ou t a c h,lngc in cncrly. Cohcrcnt scattcr accounts for 8 o/" of t hc inicractions of mattcr with thc dcnia I
'ran
ComDton scatter
is onc
ofthe intcractions olx-radiation with matter in which thc x-ray photon is dcllcctcd from its
parh and loses cnergy. (lomplom scaitcr accounts ibr 6270
ofihc scaitcr that occurs in diagnostic radiography
Photoelectric absorption is onc ofthe intcractions ofx-radjation \\'ith mattcr, 3n x-ray photon intcracb with an or' brtrl .1cctron, and all of the cnerg! of the photon is absorbed by thc displaccd clcclron in thc form of kinctic en-
crg] Thrs
accounts for 307o
oflhc inlcractions ofmattelwith lhc dcntal x-ray bcam.
Dclennining the qurntily ofrudiation exposufc or dosc is tcrmcd "dosimetr)." . Erposure: is a measurc ofradiation quantily, the capacily of thc radiation to ionizc uir Thc roentgcn /Rl is thc tradilional unil ofradiation exposurc mcasurcd in arr
o f enerey impartcd by any typc of ionizing radiatbn 1o a nass of any typc of (Gy). thc tradilional unit is lhe /ad . Effective dosc: is uscd to cstimalc lhc risk in humars. Thc unil ofcfteclive dose is thc Str'r'l?,'/ (Sv) . Radioactiritr: is thc decav ratc ofradioactivc matcriai. The unit is thc 8c(quercl(Bq)
. A bsorbed dose: is a m casurc
matl
tcr Thc SI unit is thc
gr"d-r,
All ofthe following rre components of inherent liltration EXCEPT one. Which one is the EXCEPIIOM
. oit . Unleaded .A
glass window
leaded cone
. Tubehead seal
48
Copyright O
201
l-20 | 2 - Dental Decks
Rad Protection
Man has always been exposed to natural radiation arising from the earth as well as from outside the arth. The radiation we recive from outer space is called terrestrial radiation or terrestrial rays.
We afso receive exposure from man-made (artificial) radiation, such as x-rays, radiation used to diagnose diseases and for cancer therapy.
is true; the second statement is lalse
49
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Denral Decks
There are two types of filtration used in the dental x-ray tubehead:
. Inherent filtration:
aluminum.
takes place when the primary beam passes through the glass
window of the x-ray tube, the insulating oil, and the tubehead seal. The inherent filtration of the dental x-ray machine is equivalent to approximately 0.5 to 1.0 tnm of
. Added filtration: refers to the placement of aluminum disks in the path ofthe x-ray beam between the collimator and the tubehead seal in the dental x-ray machine. The purpose of the aluminum disks is to filter out the longer wavelength, low-energy xrays from the x-ray beam. The low-energy, longer wavelength x-rays are harmful to the patient and are not useful in diagnostic radiography.
filtration ofthe x-ray beam before it reaches the patient consists of the inherent filtration plus the added filtration. Important: Govemment regulations require total filtration to be equal to the equivalent of 1.5 mm of aluminum for up to 70 kVp and 2.5 mm of aluminum for higher voltages.
The total
x-rays (those produced ut lower kilovollages) are easily atrsorbed. .:.r-olcq',' '.:.ta,;tt... 2. Shorter wavelength x-rays (those produced at higher kilovoltages) penetrate objects more rcadlly (the!-Jbt"m the image on theJilm). 3. Filtration of the x-ray beam results in a higher energy and a more penetrating useful beam. Filtration reduces patient dose, decreases contrast and incrass the density of film. Remember: The x-ray beam is composed ofrays ofdifferent wavelengths and penetrating po*er (the tern used Jbr this is polychromatic) because the potential across the tube
changes constantly as the voltage varies.
, . .. l. Longer wavefength
***
The radiation wc rcceive liom outer space is called cosmic radiation or cosmic rays.
Sources of radiation exposure:
. Naturaf r:rdiation /rackgrourul rarliation)t
is by f'ar the largest contributor (8J%) to the radiafion exposufe ofpeople living in thc U.S. today. Background radiation, resulting fiom extemal and intemal sources, vrelds an a\erage annual E ofabout 3 msv.
Erternal: exposure in this category is due to cosmic and terrestrial (/iom lie rolll rtdiation or that originaling in thc cnvironment. These sources contribute about l670 ofthe radiation exposure lo lhe population. - Internal: sources ofintemal radiation include inhaled mdon fi6z,, and ingested radionuclides 111%/.
. ArtificiAl radiation lnan-made radiation)i Ihese may be categorized into tbree major groups -medical diagnosis and treatmcnr (11%, of rJhich dental x-ray examinations are rcspottsible for only 2,5% ofthk alerage ual t-ru! diagnosrt etporrle/, consumer and industnal products and sources d9'o/, and nuclear medicine f4?ir. Artificial radiation yields an average annual E ofaboul0.60 mSv or l77o ofthe annual radiation exposure !o the U.S. population.
Radiation protection standards dictate the maximum dose ofradiation that an individual can receive. Thc maximum permissibl dose /MPD./ is defined by the N^tional Council on Radiation Protection and Measurements fNCRP) as the maximum dose equivalent that a body is pelmifted to receive in a specific period oftime. The MPD is the dose ofradiation that the body can endure with little or no injury Important: The yearly MPD for a non-occupationally exposcd person is 0.1 rem/year (.0001 Sv/year). The yearly MPD for occupationally cxposcd pcrsons, or persons who work with radiation, is 5.0 rem/year (0.05 Sv,/year). The IUPD for an occupationallv e!posed pregnant woman is the same as that for a nonoccupationally exposed pcrson, or 0.1 rem/year (.0001 Svlyear). Exposure and dose in radiography: The goal ofradiatiorl protectjon procedures is to minimize the exposure of ofllce perconnel and patients during the radiographic examination. The philosophy ofradiation protection currently used in practice today is based on the principles
ofALAR{
(As Low As Reasonabb' Ac hierah
le ).
Note: The primary risk from dental radiogEphy is radiation-induced cancer. Although the risk involved with dental radiography is extremely small in comparison with other risks such as smoking or consumption of fatty foods, no brsis exists to assume that it is zero.
. The first statement . The first statement
is true; the second statement is false is false; the second statement is true
. Both statements are true . Both statements are false
50
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. Discrimination . Collimation . Filtration
. Barrier placement
5t
CoplriSht O 201l-2012 ' Dmtal Decls
.\ll ofthe lbllowing reduce the amount ofradiation to thc patient: . Lead aprons and collars. Lcaded thyroid collars are recommendcd in individuals undcr
30 years ofage. lvlany statcs mandate lhe use ofa lead apron on all patients. . Increased flhmtion using an aluminum disk . Use E-speed film. F-spced fitm or digiral imaging for pcriapical and bite$ing radiographs . Lead diaphragms placcd within the cone ofan x-ray tubehcad . Collimating an x-ray beam: using a rctangular collimator siSnificandy reduces patlenl exposure . Using a long 116 ircl, PID is prclcrrcd because it produces less divcrgence oflhe x-ray beam. By doing Ihis )ou are increasing the source-film distance and rcducing patient exposurc as \r'cll as inlproving imagc
. The use of rrre earth intensifying screens for all panoramic and cephrlomctric radiography
. Frlrn-holding
devices are also eflective in reducing a patient's exposufe to x-radistion
. E\posure iactor seleciion also limits the amount ofx-radiation cxposure reccivcd by thc patient The deniilassisrant can control thc cxposure factorsby adjusdng thc kilovoltage peak, milliamperage. and dre time ic:tings on thc control panel ofthc dcnlal x-ray machine. Note: On some machines the kvp peak and orA :eirings are presct by the manufacturff and cannot be adjusted.
- \ .cI'irg
of ?0 lo c0 k\ p lecn. nalicnls cxf'osure ro 3 mitrimum - Scr m'\ value to highst possible value ifvariablc. Iligher mn sefiings produce a beam \\ ith morc crlergt and increasc the intensity ofthe x-ray beam. - \diust exposure time to achieve optimum density Important: nrA and exposure time are inversely relatcd. \lllen altering mA, the exposure time nust bc adiusred to maintain diagnoslic density ofa film. Operator protectioni Radiation exposure to the opcralor can be reduced by standing at least six feet a\\'ay, _::.r:c a l.ed shield, or bolh when exposiDg diographs. The operator should never remain in lhe room hold_: :-:: \-.3\ packcl irl place tbr the palicnt. If a film must be held in place by someonc else (/br d clliki). :::ac :h.' f,rr.nI and havc him or her hold rhe film. AII dental personnel should lvcar film badgcs thal moniior :\.r.,r:. lloiages. \otei The opemtor must avoid the primary x-ray beam by positioning lhemselves at a 90 ro l-15 degree angle ro ihe beam.
taking and processing of dentr I radiographs, al$ays remcmber!o maintain propr infection controf /appl.l tniverssl prccauliohs) at all tims!:!
\ote: R:sarding the
In the x-ray tubehead a collimator (leatl plate \4ith a hole in the middlel is uscd to restrict the size and shape ofthe x-ray bea . A collimator may have either a round or rectangular opcniDE.
. A rectangular collimator resfficts the size ofthe x-ray beam to an area slightly iarger than a sizc 2 InrrdL,ral film anJ \rgnificantll rcduccs paticnl c\lo\urc . A circular collimator produces a cone-shaped beam that is ?.75 inchcs /7 czrl in diameler, considerabJy Iargcr than a size 2 intraoral film. Important: wtcn using a circular collimator. fcdcral regulations require that thc x-ray beam be collimated to a diameter of no more than 2.75 inches 17 cD, as it exits from the PID and rcaches thc skin ofthe patient.
The positioning-indicating device /P1Dl, or cone. is uscd to dircct thc x-ray beam. Therc are three basic types ofPlDs:
. Conical: appears as a closed. pointed plastic cone. Wlen x-rays exit from the pointed cone, they penetmte the plastic and produce scatler radiation. To climinatc cone-produced scattct radiation. the conrcal PID r\ no longer used in dcnliqlrv. . Open ended and lead-lined rectangular or round PIDs: arc uscd that do not producc scatter tadiation. Both rectangular and round PIDS are commonly available in n\,o lcngths:
. Short /8-i,r.r, . Long (16-inch) *** Thc long PID is preferred because less divergence of the x-ray bcam occlrrs. Of the three
r-vpes
of PlDs. the rectangular type is most effective in rcducing patient exposurc.
These devices do not reduce thc amount of radiation rcceivcd by thc exposed tissucs. but reduce thc radiation to surrounding tissues duc to x-ray bcam divcrgcncc.
Remember: The x-ray beam consists ofmany different $'avelengths. The short w.velength (high ener'gl, rays have great penetrating powcr; long wavelength flox,erergl, rays have low pcnctrating po\r'er and do not rench ihe fiJm in reasonable quantitics since thcy are atlenuated by the soft tissues. Low encrgy rays add only to thc total amount ofradiation the patient receives. Aluminum discs are used to filter out the useless long wave rays. increasing the overall quality ofthe beam.
. The film is bent . The film is placed backwards in the mouth

. An improper vertical angulation is used
. An improper horizontal angulation is used
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. Source-film
distance
. Film-object distance . Focal spot size

. Central ray direction . Film parallelism
Copright O 201l-2012 - Dnbl Deck
Figure #1. A rcversed film appcars light lvith a hcrringbonc cfiect.
Figure #3. Thc bcnt tilm appcars distorted.
t_igure #2. The film dcmonstrates a doublc cxposure.
Figure #4. Movcmcnt rcsulls in
a blurred image.
\ . .rlr thol(ri refnnred fionr HlrlngIIf .ennjrion liom Elsevier
Joc.lannuccr and Laura J.nsen: DerialRadiography: Iri.ciples.nd Te.hniques:Ihrd F.dilion O :000.
Five rules for accurate image formation when taking x-rays:
l. Use the smallest focal spot that
is practical.
Note: The size ofthe focal spot influences radiographic definition or sharpness. They
are inversely proportional. The operator cannot control the size
ofthe focal spot.
2. Use the longest source-film distance that is practical in the panicular situation.
i.
Place the
film as close as possible to the structure being radiographed.
J. Direct the central ray at as close to a right angle to the film as anatomical structures
ll ill allorv.
5. As far as is practical. keep the
film parallel to the structure being radiographed.
RADIOLOGY
Tech
A periapical of the left maxillary canine shows an elongated tooth which does not capture the apex of the canine. \yhile taking the periapical of the left maxillary canine, the operator had an:
. lncorrect horizontal angulation . Incorrect vertical angulation

. Either ofthe above
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RADIOLOGY
Tech
The two radiographs below were taken with the buccal object rule in mind, In film #2, the x-ray tube was directed from a mesial angulation. What is the spacial position of the circular object in these radiographs?
. The object lies lingual to the first molar . The object lies buccal to the first molar . The object lies between the second premolar and the first molar . The object lies directly apical to the first molar
Film
#l
55
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Film #2
Vertical angulation is directing x-rays so that they pass vertically through the part being examined. This is accomplishcd by positioning thc tubchcad and direction ofthc ccntral ray in an up-anddown (vertical) planc. lmportant: Foreshortening (See fgurc #1) rcfcrs to a shortcncd imagc and elongation /Seefgzrc #2) refers to an elongated image. Both are produced by an incorrect vertical angulation. Excessive vertical angulation causes foreshortened images, while insullicient vcrtical angulation causcs clongatcd images.
If the vertical angulation is too stccp. thc images a.c foreshoracned.

Figure #1.
Figure #2. Ifthe venical angulation is too flat. thc imagcs arc elongatcd.
Borh phoros rerrinred from
Hlnng, Joen Iannucci and Laun J$sn: DenraL Radioelaphy: Principles and Tcchniquesl
ftnd
Ednion.
1000, rvilh
I)emission frcm
Eh.vi.r
Horizontal angulation is maintaining the central ray at 0 degrees as the tube is n]oved around the head. This is accomplished by positioning the tubehead and direction ofthe central ray in a sideto-side (horizotlt.il) plane. r-ote: The general rule for horizontal angulation is that the central ray should be perpendicular to the mean antcropostcrior plane ofthe teeth being x-rayed. Important: lncorect horizontal tube angulation causes overlapping (teeth images are superimpo,;ed on eaclt otlrcr).
Tle central ray
is said to be at 0 degrees when the x-ray tube is adjusted so that the central ray is parallel to the floor Ifthe tubehead is directed at the floor, it is called positive angulation; ifit is dirccted toward the cciling. it is called negative angulation.
The buccaf objct rule falso called the tube shili technique) is used to determine an object's spatial position within the jaws. This technique utilizes two radiographs of an ob-
ject exposed with slightly different tube angulations. It then compares the object's position on the radiograph with respect to a rferenc point (e.g., /re root of a tooth,/.
lf
the tube is shifted and directed from a more mesial direction, and the object in
question appears to have moved mesially with respect to the reference point, then the object Iies lingual to that reference point. Conversely, ifthe tube is shifted mesially and the object in question moves distally, it lies on the buccal aspect ofthe reference object. Remember the acronym SLIQB
-+ $ame-!ingual,
Qpposite-guccal.
object in question appears to move in the same direction as the x-ray tube, it is on the lingual aspect. lfit appears to move in the opposite direction as the x-ray tube, it is on the buccal aspect.
*** Ilthe
Tech
After developing her bitewings, a dntist realizes that she has too much overlap t etween the contacts of adjacent teeth. This is an error caused by:
. Too much vertical angulation

. Too little vertical angulation
. lncorrect horizontal angulation

. Beam not aimed at center of fihrl
55 CoDtighr
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RADIOLOGY
Tech
cause
Which of the following positioning errors is the most likely ofthe reverse occlusal plane curve on the panorex below?
. Chin tilted too far upward . Chin tilted too far downward . Head tumed slightly
coplri8ht
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Some errors often made when taking dental radiographs: . Elongation (most common error): teeth appear too long be caused by too lit-may tle vertical angulation, the film not parallel to tbe long axis ofthe teeth or the occlusal plane not being parallel to the floor. . Foreshortening: teeth appear too short may be caused by too much vertical angulation or poor chair position. . Cone cutting: portion of film will appear clear with a curved line the beam was
not aimed at the center ofthe film. See figure #l . Herringbone effect: zigzagged pattern appears on the film the film was placed backwards in the mouth. . Poor film placement: the film was not placed lhr enough back or not forward enough in the mouth. See figure #2 . Overlapping: interproximal areas are overlapped, reduces diagnostic quality of film to incorrect horizontal angulation (the central x-ray was not directed perp-due penditular to the curvature of the qrch and through the conldclt. See
cLr\.d une\posed ldear)
ligur #1.,\ cone'cur appears as. Figur #2. Improper filln placearca on } mcnt: no apices appear on ihis film
(t
Figure #3.lncorecr horizontalangulation results in orerlapped conlactareas
:on. \rh |lemr$ion
r.e phoNi repnnled fron Hrrin-q, Jocn lannucci and Laura Janscn: Dcntal Rrdrograthy: Principles and Techniqu.s: Third Edrtion fro'n Else\ier
aa
***
Mandibular structures look narrower and maxillary structures look wider (looks Iike
o "frotn").
Chin tilted too far downward:
L Occlusal plane shows an excessive upward curve (look like a "big smile").
See figure trelow 2. Severe interproximal overlapping, anterior teeth appear very distofied.
Tech
The periapical x-ray below appears distorted, What is the most likely cause of this?
. Overbent film
. Patient had glasses on
. Exposure to secondary radiation . Cone cutting

. X-ray arm drifted
Tlnd Edition O
?000.
Copyflghr C 201I,2012 - Dental Decks
IOLOGY
Tech
Which ofthe following is a major disadvantage of the paralleling technique?
. The image formed on the film will not have dimensional accuracy
. Due to the amount ofdistortion, periodontal bone height cannot be accurately diagnosed
. An increase in exposure time is necessary
due to the use of a long cone
. An increase in exposure time is necessary due to the use
ofa short cone
59
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Some other common errors made when taking dental
. Light films
(undarexposetl /intage NOT dense
radiographs cause: e ough)'. ircorTect milliamperage floo
/onf or exposure (too short)a incorrect focal film distance; cone too far from patient's f'ace, film pJaced backu,ards. See figure #1 . Dark fifms (overexposed / image too dense) , incorrect rnilliamperage (too h igh), expos\ve /too long), incorrect kVp (too higlt). See figure #2 . Double exposure: hlm rvas used twice . Fogged {ilms: exposed to radiation other than primary beam. See figure #3
. Artifacts:patient didn't remove eyeglasses, earrings, or rernovable prosthetic appliances. . Poor contrast: incorect kVp (too high) . Blurred image: patient movement or drifting ofx-ray arm . Clear films: were not exDosed to rudiation
Figure #1. \n undcrcxposcd
l-igure #2, An ovcrcxposcd
rilln anp.ars hght.
filn
appean dark.
l'igure #3, A fbggcd film appcars gray and lacks dctail and contrast
Techn'que!: Thi.d Edrlron. C
: ,' *
\'rlr.erhfr.rrepnnredlonHdnng.JoerlanrucciandLauraJans.n DentalRadrogi.phl: rniciplcs a.d

rh rennl\sl.n
fon llscvier
The paralleling technique is based on the concept ofparalielism. Other names for this technique include XCP (extension tone paralleling te.hnique), rtght-aflgle technique, and longcone technique. Note: This is the preftred technique for making intraorcl x-rays.
Basic Principles:
. Film is placed parallel to the long axis ofthe tooth being x-rayed . Central x-ray is directed perpendicular to both the tilm and thc long axis ofthe tooth . A film holder lXCPl must be used to keep the film parallel to the Jong axis ofthe to()th . The object-film distance must be increased b keep the film parallel. This results in
irnage magnification and loss ofdefinition
. The source-film distance must also be increased to compensate for the image magnification and to make sure that oniy the most parallel rays uill be aimed at thetooth and the filn. Using a long cone (16 inclt tatEet-liln distonce) results in greater deflnition and less
imase masnification.
ReFnred tilJn lllrine. Joe. lannucci .nd Lnura Jrn5c.: I)cnlal ltrdiogr! tht Pnncrpler and lechnquer: Thtrd Fdnlon t 1000. \irh l]crni$ro.
Positions of thc lilm, tccth, and scntral ray of thc x-ray bcam in thc paralleling tcchnique. Thc film arrd long axis oflhc tooth arc |arallel. Tbc ccntral ray is pcrpcndicular 1() thc loorh and fi1nl. An incrcascd
targetfilm distance //6
ir.l.t
is .equired.
. Image
on x-ray
film may be dimensionally distorted (amount may vary)
. lncreased exposure time
. Due to the
use
ofa short cone (which results in divetgent rays), the image
is not a true
reproduction of the object
. May not be able
to judge the correct alveolar bone height
60 Coplrighr O20ll-2012 - Dental Decks
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***
The exposure time is actually decreased.
The bisecting technique (also knov'n as the short-cone technique) rs based on the geometric principal known as the rule of isometry. The rule states that two triangles are equal ifthey have two equal angles and share a common side. The following best describes the bisecting tchnique: . The dental x-ray film is placed along the lingual surface ofthe tooth . At the point where the film contacts the tooth, an angle is formed by the plane ofthe film and the long axis ofthe tooth . The person taking the x-ray needs to visualize a plane that biscts this angle. This plane creates two equal angles and provides a common is called the imaginary bisector -this side for the two imaginary equal tdangles. . The central ray is positioned perpendicular to the imaginary bisector
LOng axrs ot looth lmaganary
Cenkal
ray
bisector
Length of imag
Reprinrd frotn H.ri.g. Joen Iannucci and Laura Janscn: Dental RadiogrAphy: Princilles and Techniques:Third Edition. O 2000. srlh pennnnon lrom
Central ray of the X{ay beam aimed tfirough the toolh apax tong axis of the tooth Bisecting line
Figure #1. The theoreticalbasis ofthe bisected angle technique. The angle between the long axes ofthe tooth and film is biscctcd and x-ray beam aimed at right angles to this linc, through the apcx of the tooth. With this geometrical Long axis of ihe film amangement, the length of thc tooth in the mouth is equalto the length ofthc image ofthe tooth on thc film, but as shown, thc pcriodontal bone levels will not bc represented accurately.
Both lrhoros rprinred fton Haring, Joen llnnucci and Laun Jansen: Dental R.diography: Pflncitles and Techniquesr Thnd Ediiion.O 2000. wilh p.mssion fron Elsevier.
Vertical angulation
Figure #2. Diagrams showing the magnification ofthe image that results from using (A) a shon cone
and a diverging x-ray beam and (B) a long cone and a near-parallel x-ray bcam.
RADIOLOGY
X-rays
Posterior bitewing radiographs are the most useful x-ray projection for detecting caries in the distal third of a canine and the interproximal and occlusal surfaces of premolars and molars, Periapical radiographs are used primarily for detecting changes in the periapical and interradicular bone.
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RADIOLOGY
X-rays
The occlusal film is the film ofchoice for the evaluation ofperiodontal disease.
The bisecting techniqu is th preferred periapical exposure method for the demonstrrtion ofthe anatomic features of priodontal disease.
. The llrst statement
. The first statement is false; the second statement is true . Both statements are true . Both statements are lalse
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Radiography is uscful for the detcction ofdcntal carics because the carious proccss causcs tooth deminralization. The carious lesion (the demircrali:ed ared ofthe tooth that alloN.t greater passage ol is darker than the unaliected portion (more radiolucen, and may be detected on radiographs. Note: The most useful adult bitcwing cxamination consists offour no. 2 size films for separate prcmolar and molar projections.
Fqt
A number ofcolor changes may be seen *,ith dental caries. Occlusd surfaces may show dark stairling in rhe fissures, pits. aud grooves, or may show ar obvious cavitation. Because ofthe superirnposition ofthe dense buccal and lingual enamel cusps, early occlusal caries is diflicult to sec on a dental x-rayi consequentl)! occlusal caries is not seen on an x-ray until there is involvement of the DEJ. Important: The classic radiogmphic appearance ofocclusal caries extending into dentin is a bmad-based, radiolucent zone, often beneath a fissure, with little or no apparcnt changcs in thc cnamcl.
Caries that appear interproximally may be diflicult or impossible to detecr clinically.On a dental x-ray. interproximal caries is typically seen at or just below the contact point. As caries progresses inward through rhe enamel oflhe looth. it assumes a tri{ngular configuration; the ap)r ot' the lriangle is seen al the DEJ. As caries rcaches thc DEl, it spreads laterally and continues into dentin. Another triangular configuradon is scen in denlin; this timc lhe base ofthe dangle is along the DEJ and thc apex is pointd loward the pulp
chamber.
Because ofthe superimposition ofthe dersities ofnonnal tooth structure, buccal and lingual caries are difficult to detect on a dental x-ray and ar best detected clinicall),. \\hen vie',\'ed on a dental x-ray, caries that involves the buccal or lingxal surface appears as a small, circular radiolucent ara with sharp, well-dfined borders. As ihese lesions progress, they become elliptic or semilunar.
Clinicall,v. root surface caris is easily detected on exposed root surfaccs. The most common locations include rhe e\posed roots ofthe mandibular premolar and molar areas. On a dental x-my, mot surl_ace caries appears as r cupped-out or crater-shaped radiolucncy j ust below the CEJ. Early lesions may be difficull to detect on the dental x-ray.
orher radiosraphic appearances ofdental caries include: recunent caries, rvhich appears as a radiolucenc! adjacent to an existing restoration, and rampant caries, which affects numerous teeth.
Dcntal radiogmphs play an intcgral rolc in thc asscssmcnl ofpc.iodontal discasc. Dcntal radiographs must bc used in conjunction $,ith a clinical cxaminadon. Thc periapical radiograph is lhc film of choice for thc cvaluation of pcriodontal discasc. Thc paralleling technique is lbc prcfcrrcd pcriapical xposure method for thc dcmonstralion ofthc anatomic fcaturcs ofDcnodontal discasc. Thc radiographic appcarance ofhealthy alveolrr bone can be dcscribcd as tbllo$si . l,amin! dura: in hcalth. dle lamina dura around thc roots oflhe (ccth appcars as a dense radiopaquc linc. 'Alveolar crest: the normal alvcolar crcst is located approximatcly 1.5 to 2.0 mm rpical to the Cf,J ofadjacent teeth. Thc sbrpe and dcnsily varies between thc antcrior and poslcrior rcgions ollhc mouth. In the snterior rcgions, thc alvcolar crcst appears pointcd snd sharp and is normall) \'ery radiopNque' In the postcrior rcgions, the alvcolar crest appears tlat, smooth, and parallel to a line betwcen adjacent CEJ's. Thc alvcolar crcst in thc postcrior regions appcars slightly less rrdiopaquc than that in lhc anterior rcgions. ' Pcriodontal ligament space: rhc normal pcriodontal ligamcnl spacc appcars as a thin radiolucenl line bct\l ccn thc root ofthc tooth and the lamina dum. In hcallh. it is continuous around thc root structurc and is 01 unifbrm thick-
lflportant: With pcriodontal discasc, the alvcolar crest is no longer locatcd L5 to 2.0 mm apical to thc CEJ and no longer appcars radiopaquc. Instead, thc alvcolar crcsl appears indistinct, and bonc loss is sccrPatlern ofbone lossi . Horizontal bone loss: thc bonc loss occurs in a plane parallel to the CEJs ofadjaccnt tccth.Note: ln horizontal bonc loss rhc crcst ofthc buccal and lingual cortical plates and the intervcning intcrdenlal bonc havc bccn rc. vertical (angular) ttone lo.si thc bonc loss dos not occur in a planc parallcl to thc Cts's ofadjaccnt tcclh. Note: wilh thcsc dcfccts thc crcst ofthc rcmaining bonc typically displays an oblique angulation to the Iinc
thc ChJs in the arca ofthc involvcd tccth.
of
Classification of periodontal dise.se: . ADA Case Type I (gr'rgivr?r9r No bony changc sccn . ADA Case Type If fedrb' peiodontitis)i Mildbonc loss /./'.rld/ .rdrg?.tl is sccn . ADA Case Type II I f,, oderute periodontitis)t Modcratc bonc loss f/, ro JJ% /rrt is sccn. Thc patlcm ofbonc loss may bc horizontal or vcnical and thc distnbution may bc localized or gcncralizcd. Furcation involvcmcnt
may also oc sccn. . ADA case Type lV /ssverc peiodontitis). S.\erc bonc loss f-r3% or rrol", is sccn. Bonc loss is so cxlcnsivc that thc rcmaining tccth show cxcessivc mobilily and dritling. Extcnsive horizontal and vcrtjcal dcfccts may bc prcs-
X-rays
A small town dentist gets a phone call late on Saturday night from a patient of record. Th patient has been in a bar fight where he was punched just below the right eye. The dentist suspects a zygomatic complex fracture. Which ofthe following projections is best for this examination?
. Waters projection
. Submentovertex projection
. Reverse Towne projection . Lateral cephalometdc projection
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RADIOLOGY
X-rays
At the dental clinic, an emergency patient arrives complaining of swelling associated with a carious upper left molar. The patient complains of "stuffiness'and feels more so when she bends ovr to pick up stuff. The dental clinic is equipped with conventional radiography. Which of the following projections is best for the examination ofthe rnaxillary sinus?
. Lateral jarv projection .

Reverse Toivne projection
. Waters projection
Submentovertex projection
For this projection the neck is maximally extended and the film cassette touches the top ofthe head. The x-ray beam enters the head under the chin (near the mental tubercle of the mandible) and, exits at the vertex. This view is used in conjunction with other projections, and allows direct visualization ofthe base ofthe skull. The zygomatic arches stand out like rhe handles ofa jug on this view.
; !
Floor
Film
casse[e
Re[inred lion Haring. Joen lannucciand Laun.]anrcnr Denlal R.diogrdph]: Pnnciples and Techiiques: Tlird Ed,r,on q 2000.r'ith l]emisstun liom El
This is a posterior-anterior projection with the patient's face lying against the film and the x-ray source behind the patent's head. Waters' projection is the most useful conventional radiographic technique to image the maxillary sinuses. In this projection, the radiographic densities ofnormal maxillary sinuses are the same on both sides and equal to those ofthe orbits. Ifone ofthe sinuses is diseased, Waters projection will exhibit either a radiopaque tllildl level, a sinus opacification, mucosal hyperplasia, a radiopaque growth or a loss of conical borders of sinus. Other useful projections include periapical, panoramic, occlusal, lateral head. and Caldwell. It is also one of the best films for radiographic diagnosis of
mid-facial fractures.
Tip ol nose
l'trom
film
tl
X-ray unrt
Film
casselle
Reprinled from Haling.J@n lannucci and LauraJansenrD.ntal Radiognphyr Pn.ciples and Techniqu.s: Thnd Ednion. O 2000. $ith
pemision fron Ehelier
On the way out ofyour dental chair, the patient gets up too fast, feels dizy, and falls chin lirst onto your tiled operatory floor. Suspecting bilrteral subcondylar fractures, which of the following proiections would best allow for this examination?
. Waters projection . Transcranial projection . Townes projection
. Submentovertex projection
CoplriShr O 201l,?012 , Dental Decks
Uses of the
prnorrmic radiograph include Nll of the following EXCEPT oae.Which one is the TXCEPTIOIW
. Evaluation of impacted teeth
. Evaluation oferuption
pattems and growth and development
. Diagnosis ofearly carious lesions . Detection ofdiseases, lesions, and conditions ofthe jaws
. Examination ofthe extent of large lesions . Evaluation of trauma
Coplriglu C
201
67 l-2012 - Dental Dcks
The patient lies on his back with the film under his head. The x-ray source is from the front, but rotated 30 degrees from the Frankfort plane and is directed right at the condyles. The Townes projection is often ofvalue in assessing the status ofthe condyles, condylar neck and rami because superimposition ofthe mastoid and zygoma over the condylar neck region in the straight postero-anterior projection often makes interpretation difficult. The Townes projection eliminates this superimposition, thus giving good visualiza-
tion of lhe condvlar area and rami. Note: The "reverse Towne projection" is used to identify fractures of the condylar neck and ramus area.
The following can be demonstrated on conventional
TMJ
radiographs:
. Position ofthe condyles in the glenoid fossa . The range of antero-posterior movement ofthe
condyles
. Areas ofbone destruction on condylar heads

Repriiled fiom Harng. Joen lannuccr and I -anra Jrnsen, De.t.l RadiosEphy: Prnripks r.d Techniques: Ihird iid'r,on. O 1000. wrth
l]emission
lion lllsc\ie.
*** The main drawback ofa panoramic radiograph is that thcre is a loss ofimage detail /il earl! carious lesions). Bite-wing x-rays are requircd for the diagnosis ofcarious lesions
r't
,ard to didgno.te
In prnoramic radiography, both ihe film and x-ray tubehad are conneoed and rotale sim haneously around the patient during exposure. The movcmcnt ofthc film and the tubehead produces an image through the process kno$'n as tomography. Rotational centers allow the image layer to confomr to the elliptical shape of the dental arches. The numbcr and location of the rotational centers influence the size and shape of thc focal
trough. The focrl trough is a three-dimensional curved zone in nhich structures are clearly demonstrated on a panoranric radiograph: the structures located within thc focal trough appear reasonably well delined,whcreas
structures outside
ofthc focal trough appear blurred.
The paticn! must b positioned according to the manuf'acturer's rccommendalions for the positioning ofthe spine @erjictlr straighr.teeth (anterior teeth positioned in theloul trough indicated l)) the groove in the bite b/o.i), midsagittaf plane (petpendidtlar to the lloor). FrankJort pl^ne lpurdllelto the Jloor),lips (.[ased on bite blo(k)and. aon+re lpositioned on the nol oflhe noulh). \oter Ale^d apron must be placed on the patient and all radiodense objects must be rmovd from the head and neck region.
Other indications fot a panoramic radiogr:rph: . Treatment planning /e spec ia lb' ort hodontic cases) . E\ aluation ofanomalies ' Edenrulous patients /ptior to construding.lull aentrres) . Patients thal are unable to !olerate inlm-oral x-rays
is tl.pically used to supplement bite-wing and periapical films and is not for infraoml films. The panoramic radiograph should not be used !o evaluatc caries, periodontal disease. and periapical lesions. Note: Apanoramic radiograph gives less detail and definition than periapical radiographs due io intensifying screens, movement ofthe x-ray nlbe and film and increased object-film distance.
Important:The panoramic radiograph

a substiturc
Oiherdisadvantages of a panoramic radiograph: . Image quality: not as sharp due to intensilying screens . Distonion ofimage due to increased objecl-film distancc . Focal trough limitations:objects ofinterest lhat are located outside the focal trough are not seen
. Eouiomcnt
cost
RADIOLOGY
X-rays
Identify each structure numbered in the partial panoramic radiograph below?
''Counes) Dr Sruan C. $}ne. UCLA School of Denlislry 68 Cop\righi
"
(l
20l l-201 1 - Denral Dects
RADIOLOGY
X-rays
A phenomenon caused by a relatively lower x-ray absorption on the mesial or distal aspect ofteeth, between the edge of the enamel and the adjacent crest of the alveolar ridge is called:
. Apical burnout
. Cen ical bumout . Coronal burnout

. Root bumout
69
Cotlrighr ill201l-10l2 - Denral Decks
l. Th opaque mass
2. The opaqu
J J
Inferior concha
sinus
3.Theopaqueline ) Posterior wall of zygomatic process ofmaxilla 4. The opaqu line -+ Posterior wall ofmaxillary sinus
Zygomatic arch 5, The opeque mass 6. The opaque line -+ Hard palatc/floor of nasal fossa 7. The opaque line Floorof ms,(illarysinus Dorsum oftongue 8, The line ofcontrast Inferior border of pterygoid plares 9. Th opaque line of contrasl 10. The verticNl lin ofcontrast -+ Posterior wall ofnasopharynx Soft palate The opaque mass
line -+ Medial wall ofmaxillary
-r
ll.
12. The line ofcontrast --) Dorsum oftongue 13. The opaqu msss -+ Calcified stylo-hyoid ligament 14, The opaque mass --) Ear lobe
-)
Inferior border ofopposite mandible /dkd ghost image ofcontralaleral nalrdible) 15. The fine of contrast The panoramic radiograph is excellent for third molar pathology as well as to observe the TMJ, rhe sinuses, and siafogaphy irftic, is a lechnique used in ra.liology in h,hich a salivaD'gla d is.lilned a,l'ter an opaque st$stance is injected into lrs 1/l/.r. A sialolith which is located in Wharton's duct, however, can best be viewed by using
a
cross-sectional occlusal x-ray.
partfulde
obj ects (e.g-, ef'eglasses, edrings, necklaces, hairpins, removable tures, complete dentures, orthodonti. retainers, hearing aids, antl napkin chains) are not removed before the exposure ofa panoramic film, a ghost image results lhat obscures diagnostic information. A ghost imege is a radiopaque artifact seen on a panoramic film that is produced when a mdiodense object is penetratd twice by the x-ray beam. A ghost image rescmbles its real counterpart and is found on the oppo_ site side ofthe film; it appears indistinct, lrrger, and higher than its actual counterpan.
lmporlant:lfall metallic or radiodense
the panoramic x-ray as ifyou were looking at the patient, with structures on the patient's right side positioned on your left. In this way, the image is presented to you in the sam orientation as ihat ofthe perirprcal and bite-wing x-rays, making ioterpretation more comfortable. Remember: Intensiling screens are routinely used in panoramic radiography because they significantly reduce thc amount ofradiation rcquired for properly exposing o radiograph. Also, several manufacturers have developed direct digital acquisition panoramic machines. Tle receptor on such a machine is either an array of charged-coupled devices /CCD, ora film-sized photostimulable storage phosphor plate (PSPJ ratberlhan
\ote:vie\\
film.
Because of the relative diminished x-ray absorption, these arcas appcar relatively radiolucnt with ill-defined margins.
It is causcd by the normal configuration of the affected teeth decreased x-ray absomtion in those areas.
not be mistaken for a
(lre
c?r,le ntoefiamel
junction). which results in
Importanl: These radiolucencies should be anticipated \r'hen viewing x-rays ofalmost any tooth and should
ca
ous lesion.
Borh phoios reprinted from uaring. Joen lannucci lnd Laur. Jans.ni Denral RrdioSr.phy: Pnnciples and Techniques: Third Ednion. O 20{0, *ith penntrs,on fron El*!M
Limitations of radiogruphs:
. Radiographs provide a two-dimensional view ofa three-dimnsional situstion . Radiographs will lend to show less severe bone deshuction than is actually present . Radiographs do not demonstrate the soft tissue to hard tissue relationships and therefore provide no information about the depth ofperiodontal pockets
. The earliest finc?ien, mild destructive lesions in bone do not caus sumcient alterations in density to
be detectable
RADIOLOGY
X-rays
dentify this
view?
What are its
indications?
How is the patient positioned?
70
Cop]_rigbr
a:01l -l0ll
- Dental Decls
RADIOLOGY
X-rays
A patint is coming into your office for the first time. You can see obvious carious lesions on the facial surfaces of multiple teeth when she talks. Due to her high caries activity, you take a full mouth series. Of these radiographs, which are the most useful in detecting interproximal caries?
. Periapical radiographs
. Bitewing radiographs . Occlusal radiographs
71 Cop),riglrt
(l 20ll
l0ll
Derr.l Decks
The lateral cephalometric x-ray must be compared with "normal" lateral radiographs from an accepted norm. Linear and angular measurements are obtained utilizing known anatomical landmarks in the lateral head radiography ofthe patient. These measurements are then compared with those considered within normal limits and in that way enable the orthodontist to assess aberrations in the dentition and iaw structures which result in malocclusion.
Analysis ofcephalometric radiographs is not limited to the hard structures such as bone and teeth, but also includes measurements ofsoit tissue structures such as the nose, lips, and solt tissue chin. Superimposition in longitudinal cephalometric studies is generally on a reference plane and a registration point. This will best demonstrate the growth of structures farthest from the plane and the point. The most stable area from which to evaluate craniofacial srowth is the anterior cranial base because of its early cessation of growth.
Cephalometrics are useful in assessing tooth-to-tooth, bone-to-bone, and tooth-to-bone relationships. Serial cephalometric films can show the amount and direction of growth. \ote: The lateral cephalometric is commonly used by orthodontists in evaluation of gro$ th and development.
***
Thc
Thcsc x-rays show thc crowns ofboth N{ax. and Mand- tecth; not root apiccs.
primart rerson for taking bitcwing radiographs is to dctcct interproximal caris. Thcy arc also uscful in mon iloring thc progression ofperiodontal disease. Thcsc films sho\,crcslal bonc lcvcls as rvcil as intcrproximal arcas oi both archcs. 1n ordcr for thc fi lm 1o bc of diagnoslic usc. lhe qual ity of thc fo llo\r'ing must bc cxccl Icnl: dimcnsional accurac\', opcn contacts. and oplimum contrast and clarity olthc imagc.
\\ hcn taking bitewing radiographs, the film must bc placcd in cithcr! horizontal or vertical position and thc ccnIral ra\ should bc direclcd slightly do*,nward through the contacts and includc thc crowns ofthe maxillary and nandibuhr lcelh and thc ah,colarcrcsts. ltrtical bitewirgs providc morc pcriodontal infonnation, such as bory dc 1-rcrs 3nd furcalion involvcmcnt. A izzy or indistinct imagc ofcrcstal bone is oftcn associatcd wjth carly pcriodonInrs. T\ o bitcwrngs arc usually taken on a child, one on cach sidc. lfthc child has primary dcntition only, numbcr"0" ilm1iu5cd Ifrhc child has mixcd dcnlition. numbcr"l film is utilizcd. Oncc thc individualhas sccond molars. two
lo i'our numbcr fillnsarcconvcntionallyutilizcd.Ifusingfourfilms,onclllmimagcsthcprcmolararca.rvhilcthc orhL'. ima,:cs thc molar arca. Somctimcs nvo. long. numbcr "3 ' lilms are Dtilizcd (o,rc lbr ekh si./c/ instead oftwo nunrL,cr iilms on cach sidc. This practicc is nol rccommcnded duc to thc curvaturc ofrhc arch making it difiicult ro opcn allcontactson onc film.
"l
^:
\ots!. r',..-:
Thc vcrtical angulation for bitcwing radiograpbs should b bchvccn +8 and +10 dcgrces. 2. Adjust horizontal angulation to dircct thc ccntral ray loward thc ccnlcr oflhc film. 3. Alvolar bone resorption is best demonstratcd on bitoving x,rays. ,l \trtical bitewing x-rals will show morc dveolar bone than traditional horizonlal bitewings. 5. The largst intraoral film size is # "4". 6. Thc strndard fllm sizc is # "2". 7. Occlusal rldiographs display a relatively large scgment ofthc dcntal arch. May includc thc palatc or floor oflhe mouth and a rcasonablc cxlcnl ofcontiguous lateral strxctures. lJ. Conccm about radialion protcction is most imponant for children bccausc oftheir greater sensitivity to irradiation. Thc bcst way to rcducc unncccssary cxposure is lbr thc dentist to lakc thc minimal number offilms rcquired lbr each patient and to usc thyroid shields, 9. No incidcnccs havc bcen reportd ofdamagc to a fbtus from dcntal x rays. Howcvcr, radiographic cxamjnation tbr tbc prcEnant paticnt should bc consistcnt with the patienas necds. I0. widcning oi lhc pcriodontal ligamcnt space at (he apex ofthc intcrradicular bony cresl oflhc furc, a(ion is strong evidence that thc pcriodonral diseasc proccss involvcs thc firrcarion.
I 1. The most common route
for furcation involvcment of thc maxillarv oermancnt first molar is
fiom thc mesial sidc.
. The image produced
is less distorted
. The processing solutions are absorbed more easily
. The film
has less sensitivity to radiation
. The film requires less radiation exposure to make an image
72 Coplriglt O
201 I -20 l2 - Denral Decks
The use oflntensifying screens nequlres more rrdiation to expos a screen lilm and results in more radiation exposure for the patient
. The flrst statement is true; the second statement is false
. The first statement is false; the second statement

is true
73
Cop)'right O 20ll-2012 - Dental Decks
The x-ray film used in dentistry has four basic components:
L Film base: is a flexible piece ofpolyestcr plastic that rneasurcs 0.2 mm thick and is constructed to withstand hcat, moisnrre, and chenrical exposure. Thc primary purposc ofthe film base is to provide a stable support for the delicate emulsion; it also provides strength. 2. Adhesive layer: is a thin layer ofadhesive material that covers both sides ofthc film base. It scncs to attach the emulsion to thc basc. 3. Film emulsion: is a coatirg aftached to both sides ofthe fllm base by rhc adhesive layer to Sive the film greater sensitivity to x-radiation. It is a homogeneous mixfurc ofgelatin and silver halide
crystals.
is Llsed to suspcnd and cvcnly dispcrsc millions ofmicroscopic silver halide cwstals over the film base. During film proccssing. thc gclatin serves to absorb thc processing solutions and allows the chcmicals to react with the silver halide crystals. . Halide crystals: is a chemical component rhat is sensitive to radiation arld light. Silver bromide and silver iodide are two rypes of silver halide crystals fbund in film cmulsion; the typical emulsion is 80 to 9970 silver bromide and I to loyo silver iodide. 4. Protective layeri is a thin, transparent coating plaoed over the emulsion. It sencs to protect thc cmulsion surface from manipulation as wellas mcchanicaland processing damagc. Den!al x-ray film packets have four basic components:
. Gelatin:
l. Intraoral x-ray film: is a double-emulsion typc of film; doublc-cmulsion film is used instead of single-emulsion lilm bccausc it requires less mdiation exposure to prodlice an imagc. Tlc film packct may conlain one film or two films. In one comer ofthe intraoral film, a small raiscd bump kno&n as the identification dot is found. The raised bun]p is used to detormine film orientation. L Paper film rvrapperi within the film packet is a black paper protectivc shcet that covers the film and shiclds thc film from light. ,l. Lead foil sheet: is a single piece oflead foil that is found within the film packct. It is positioncd bchind the l'ilm to shield the film from back-scattered /.recor./dr-1, radiation that rcsults in film fog. ,+. outer package $ rapping: is a soft virlyl or papet wrapper that hermctically seals the film packet. prorcctr\e black paper. and lcad foil shcct.
***
The use ol'inlensilying scrccns requires less radiation to expose a scrcen
filn
and rcsults in less
radiation exposure fbr the patient. An intensifying screen is a dcvicc that transfers x-ray energy into visible lighti the visible light. in tum. cxposcs thc screen lilm. Tlrcsc scrcens intensify the cflcct ofx-rays on thc liln With the usc of intcnsilying screens, less radiation is required to cxposc a screen film, and the paticnt is exposed to less radiation. Note: A screen film is an cxtraoral Iiln that requircs the use ofa scrccn lbr exposure.
a screen film is sandwiched bctwccn two intensifying screens and secured in a cassette. An intensifying screen is a smooth plastic shcct coated with rninutc fl'torcsccnt crystals knou,n as phosphors. Wben exposed to x-rays. the phosphors lluoresce and emit visible light in thc blue or green spcctrum; the emitted light thcn exposes the fiLn. Conventional calcium tungstate screens have phosphors that cmit bjue light. Thc newer rare earth screens have phosphors /r.rrall.t, rare-eafih elenents lanthatum a Ll gu./o/iiittrt.) that emit grccn light
ln ertraoral radiography,
Important: Thc rarc earth screens arc more ellicient and requirc lcss x-ray exposurc and are considcrcd l'astcr.
\ot
L Duplicating film is a special typc of photographic film used to makc an idcnlical copy ol'an intraoral or extraoral radiograph. lt is used in a darkroom and is not exposed to x-radiation. 2. Film is advcrsely affected by hcat, humidily, and radiation and nrust bc storcd away l'rom sources of radiation in tcmperatures of 50 to 70"F and with a rclative humidity
lcvel of30 to 509/o. 3. Dental film should always be used bcforc thc expiration datc on the label. 4. A grid is composcd of a scries of thin lead strips embcddcd in a matcrial 1e g , p/as ti4 that pcrmils the passage ofthc x-ray beam. It l'unctions to prevent scatter radiation from rcaching the film during exposurc. This decreases film fbg and increases the contrast of the radiographic image.

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RADIOLOGY

Which tlTe of digital image receptor is most common at tlris time?

. CID (Charge Injection

. CMOS/APS (Complementarv Metal Oxide Seniconductor/Atiive Pixel Sensor)

Copyright t) 20ll-2011 - Denhl Decks

Superior gray-scale resolution

. Reduced patient exposure to x-radiation . Increased speed of image viewing

. Effective patient education tool . Enhancement ofdiagnostic image

. Indirect digital imaging

Storage phosphor imaging

Cop)right O 201 I -20

Digital or electronic imaging

E-speed films F-speed films

. Panoramic instead ofa full mouth series

2011,2011 - Dental Decks

. The first statement

is true; the second statement is false

exposure for the patient.

and rhc x-ray

_;tt bc on the film.

:.::r:c:esulti ln an increas in imagc magnification.

dirrortion ofa radiographic image is influenced by:

'object-film alignment:10 minimize dimensionaldistortion

and should be parallel to the long

scales ofcontrast: is rhe range ot'usefur densitics secn on ofan x-ray:

radiograph.Tu,o rcrms arc usd ro dcscribe

' short-scal contrast:

rrast results from the usc

ofa higher kilovotage

. The patient . The dentist . The state . None ofthe above

Less radiation penetrates the structure and reaches the film

**+ Dental radiographs should be kept indefinitel"v.

. Agree with the patient

. Tell the patient that bite-wing x-rays should be taken once

. None ofthe above

. The incisor region ofthe mandible

Coplaight ie 20ll-201: - DeDtal Decks

''Cornesy Dr Sluan C. $'l'ne, UCLA SchooloiDenrisfy.'

The coronoid process appears as a triangular-shaped radiopacit_v.

The opaqu lin

Lateral wall ofnasopalatine canal (inci.sive canal)

2. The opaque line

Anterior wall of maxillary sinus

3. 'Ihe radiolucent structure

Floor ofnasal fossa

Soft tissue tip ofnose

line -+ Border ofrnaxillary sinus line -+ Periodontal ligament

''Counesy Dr. Stuan C. Whi1e. UCLA School of Denrisrry

lil20ll'?01: ' DenEl

The opaque structur

Anterior nasal spine

Lateral wall ofnasopalatine canal

3. The radiolucent 4. The opaque

lin -+ Intermaxillary suture

5. The radlolucent structure 6. The rediopaque

7. The oprque structure

The radiopaque linss

Bony trabecular plate

Inferior border ofrnandibular canal

d. The radiolucent space

Submandibular gland fossa

Inferior border ofmandible

"Counesy Dr Stuart C. Whire. UCLA School ofDenrisrrv '