MEDICAL IMAGING METHODS

IN STOMATOLOGY

MEDICAL IMAGING METHODS IN STOMATOLOGY

Radiological methods:
Intraoral radiography
Extraoral radiography
Special methods:
With contrast media (artrography, sialography)
Panoramic Radiography
CT

Ultrasonography
MRI

Intraoral Dental Radiographs

Periapical projection shows all of a tooth,
including the surrounding bone, for optimum
depiction of apical or periapical lesions.
Bitewing (coronal, interproximal) projection
shows only the crowns of teeth and the adjacent
alveolar crests, this is particularly indicated for
interproximal caries detection.
Occlusal projection shows an area of teeth
and bone larger than periapical radiograph, for
depicting the jaws in the third dimension.

Intraoral Dental Radiographs

The lowest level of distortion and the highest level of
image clarity will always be found in the region of the
central ray projection.
The clinical indication actually sets the priority for
selection of the individual types of intraoral radiographs,
and the radiographic quality of other structures is of
secondary importance.
The image receptor (film) should be as perpendicular as
possible to the central ray and as parallel as possible to
the tooth long axis in order to guarantee optimum
radiographic interpretability.

Intraoral Dental Radiographs

Periapical projection
Projection techniques
Paralleling technique (right-angle or long-cone
technique)
Bisecting-angle technique

Intraoral Dental Radiographs

Periapical projection

Paralleling technique

The x-ray film is supported parallel to the long axis of the teeth
The central ray of the x-ray beam is directed at right angles to the
teeth and film.
This orientation of the film, teeth, and central ray minimizes
geometric distortion. To reduce geometric distortion further, the x-ray
source should be located relatively distant from the teeth.

Intraoral Dental Radiographs

Periapical projection

Paralleling technique
Film-holding instruments

Intraoral Dental Radiographs

Periapical projection

Paralleling technique
Film-holding instruments

Intraoral Dental Radiographs

Periapical projection

Bisecting-angle technique

Cieszynski's rule of isometry (geometric theorem): two triangles are

equal when they share one complete side and have two equal
angles.
Position the film as close as possible to the lingual surface of the
teeth, resting in the palate or in the floor of the mouth.

Intraoral Dental Radiographs

Periapical projection

Bisecting-angle technique

The plane of the film and the long axis of the teeth form an angle
with its apex at the point where the film is in contact with the teeth.
Construct an imaginary line that bisects this angle and direct the
central ray of the beam at right angles to this bisector.
This forms two triangles with two equal angles and a common side
(the imaginary bisector).

Intraoral Dental Radiographs

Periapical projection

Bisecting-angle technique

Consequently, when these conditions are satisfied, the images cast

on the film theoretically are the same length as the projected object.
To reproduce the length of each root of a multirooted tooth
accurately, the central beam must be angled differently for each
root. Another limitation of this technique is that the alveolar ridge
often projects more coronally than its true position.

Intraoral Dental Radiographs

Periapical projection

Bisecting-angle technique
Angulation of the tube head.

when the occlusal plane is oriented parallel with the floor.

NOTE: With a positive (+) angulation the aiming tube is pointed
downward, and with a negative (-) angulation it is pointed upward.

Angulation of the tube head

Angulation of the tube head

Intraoral Dental Radiographs

Bitewing projection

Projection technique
Place the film between the tongue and the teeth, far enough
from the lingual surface of the teeth to prevent interference by
the palate on closing and parallel to the long axes of the teeth.
Project the central ray to the center of the film.

Intraoral Dental Radiographs

Occlusal projection
Projection technique for maxilla
The patients head is straight up and the central ray enters
perpendicularly through the region of the maxillary first molars.

Intraoral Dental Radiographs

Occlusal projection
Projection technique
The patients head is tipped far backward and the central ray is
targeted perpendicularly through the region of the mandibular
molars onto the film.

Mounted full-mouth set of radiographs consisting of 17 periapical views

and four bitewing views.

Extraoral radiography

Posteroanterior Skull Projection

Lateral Skull Projection
Axial Skull Projection
Mandibular Radiograph

Posteroanterior Skull Projection

Is used for documentation of skull and facial skeletal asymmetries.

Lateral Skull Projection

Is used for documentation of skull and facial skeletal asymmetries.

Axial Skull Projection

As an initial radiograph to check the condylar axes, or as a supplement to a
panoramic radiograph for localization of extremely laterally impacted
maxillary third molars.

Mandibular Radiograph
For the clear depiction of the angle of the mandible, the ramus, and the
mandibular canal.

Panoramic radiography
(orthopantography (OPG) or panoramic tomography)
The X-ray tube (right) and the film holder (left) move in
the clockwise direction around the skull.

Panoramic radiography

Makes it possible to depict in a single image a complete

representation of the jaws, teeth, temporomandibular joints (TMJ),
and the alveolar recess of the maxillary sinuses.
Gives dentists the opportunity to record and analyze all components
of the masticatory system and their interrelationships.

Sialography

Involves the injection of a small amount of a water-soluble contrast

medium into the salivary ducts of a single gland, followed by routine
X-ray projections.
Indications: since the advent of contrast CT, sialography and
ultrasonography are rarely indicated in the investigation of the
patient who has parotid disease. Sialography is helpful in suspected
cases of ductal stricture, calculi or sialectasia.

Computed Tomography

Reproduces only those anatomic and pathologic details that lie within
the selected slice.
Offers the possibility of multi-planar reconstructions of the region.

MRI

The method of choice for determining the position of the articular disk
and for examination of the intra-articular soft tissue structures

Ultrasonography

For the examination of joints, articular disk, the intra-articular soft

tissue and salivary glands.

Radiographic Anatomy

1 Orbit
2 Cervical vertebrate, with tooth axis
3 Basal compact bone of the opposing jaw
4 Nasal septum
5 Inferior nasal concha
6 Maxillary sinus (borders)
7 Anterior nasal spine
8 Horizontal osseous palatal lamina
9 Laterobasal border of the nasal cavity
10 Palatal velum
11 Pterygopalatal fossa
12 Body of the zygomatic bone, with innominate
line
13 Zygomatic arch

14 Basal compact bone

15 Mylohyoid line
16 Mandibular canal
17 Mental foramen
18 Digastric fovea or mental fovea, depending upon
the positioning of the mandibular anterior segment
in the plane of focus
19 External ear, with auditory opening
20 Mandibular articular process (condyle)
21 Muscular process of the mandible
22 Styloid osseous temporalis process
23 Hyoid bone
24 Base of the tongue

Radiographic Anatomy

1 Enamel cap enhanced by the tangential effect

2 Cervical region between the enamel cap and the
alveolar crest; burn-out effects
3 Periodontal ligament space and lamina dura
4 Root canal
5 Vestibular crest of the alveolar bone
6 Palatal crest of the alveolar bone
7 Soft tissues of the nose
8 Entrance into the nose
9 Median suture, incisive foramen, nasopalatal
(incisive) canal

10 Foramen of the nasal nasopalatal canal

11 Piriform aperture
12 Laterobasal border of the nasal cavity
13 Palatal root, tooth 14
14 Palatal cusp, tooth 14
15 Vestibular cusp, tooth 14
16 Anterior lobe of the maxillary sinus
17 Maxillary nasal crest with anterior nasal spine
18 Laterobasal border of the maxillary sinus
19 Floor of the maxillary sinus
20 Three-rooted tooth 24

Radiographic Anatomy

1 Enamel cap enhanced by the tangential effect

2 Cervical region between the enamel cap and the
alveolar crest; burn-out effects
3 Periodontal ligament space and lamina dura
4 Root canal
5 Vestibular crest of the alveolar bone
6 Palatal crest of the alveolar bone
7 Soft tissues of the nose
8 Entrance into the nose
9 Median suture, incisive foramen, nasopalatal
(incisive) canal

10 Foramen of the nasal nasopalatal canal

11 Piriform aperture
12 Laterobasal border of the nasal cavity
13 Palatal root, tooth 14
14 Palatal cusp, tooth 14
15 Vestibular cusp, tooth 14
16 Anterior lobe of the maxillary sinus
17 Maxillary nasal crest with anterior nasal spine
18 Laterobasal border of the maxillary sinus
19 Floor of the maxillary sinus
20 Three-rooted tooth 24

Radiographic Anatomy

1 Enamel cap enhanced by the tangential effect

2 Cervical region between the enamel cap and the
alveolar crest; burn-out effects
3 Periodontal ligament space and lamina dura
4 Root canal
5 Vestibular crest of the alveolar bone
6 Palatal crest of the alveolar bone
7 Soft tissues of the nose
8 Entrance into the nose
9 Median suture, incisive foramen, nasopalatal
(incisive) canal

10 Foramen of the nasal nasopalatal canal

11 Piriform aperture
12 Laterobasal border of the nasal cavity
13 Palatal root, tooth 14
14 Palatal cusp, tooth 14
15 Vestibular cusp, tooth 14
16 Anterior lobe of the maxillary sinus
17 Maxillary nasal crest with anterior nasal spine
18 Laterobasal border of the maxillary sinus
19 Floor of the maxillary sinus
20 Three-rooted tooth 24

Radiographic Anatomy

1 Laterobasal boundary of the nasal cavity

2 Floor of the nasal sinus
3 Laterobasal border of the maxillary sinus
4 Floor of the maxillary sinus
5 Intrasinus septum
6 Anterior lobe of the maxillary sinus
7 Alveolar lobe of the maxillary sinus
8 Zygomatic lobe of the maxillary sinus
9 Zygomatic process of the maxilla
10 Body of the zygomatic bone
11 Zygomatic arch
12 Alveolar ridge

13 Lateral lamina of the pterygoid process

14 Hamulus of the medial lamina of the pterygoid
process
15 Pyramidal process of the palatal bone
16 Maxillary tuberosity
17 Zygomaticomaxillary suture
18 Coronoid (muscular) process of the mandibular
ramus
19 Root tips of the maxillary first premolars. The
longer root is the palatal root
20 Burn-out effect
21 Secondary caries

Radiographic Anatomy

1 Laterobasal boundary of the nasal cavity

2 Floor of the nasal sinus
3 Laterobasal border of the maxillary sinus
4 Floor of the maxillary sinus
5 Intrasinus septum
6 Anterior lobe of the maxillary sinus
7 Alveolar lobe of the maxillary sinus
8 Zygomatic lobe of the maxillary sinus
9 Zygomatic process of the maxilla
10 Body of the zygomatic bone
11 Zygomatic arch
12 Alveolar ridge

13 Lateral lamina of the pterygoid process

14 Hamulus of the medial lamina of the pterygoid
process
15 Pyramidal process of the palatal bone
16 Maxillary tuberosity
17 Zygomaticomaxillary suture
18 Coronoid (muscular) process of the mandibular
ramus
19 Root tips of the maxillary first premolars. The
longer root is the palatal root
20 Burn-out effect
21 Secondary caries

Radiographic Anatomy

1 Laterobasal boundary of the nasal cavity

2 Floor of the nasal sinus
3 Laterobasal border of the maxillary sinus
4 Floor of the maxillary sinus
5 Intrasinus septum
6 Anterior lobe of the maxillary sinus
7 Alveolar lobe of the maxillary sinus
8 Zygomatic lobe of the maxillary sinus
9 Zygomatic process of the maxilla
10 Body of the zygomatic bone
11 Zygomatic arch
12 Alveolar ridge

13 Lateral lamina of the pterygoid process

14 Hamulus of the medial lamina of the pterygoid
process
15 Pyramidal process of the palatal bone
16 Maxillary tuberosity
17 Zygomaticomaxillary suture
18 Coronoid (muscular) process of the mandibular
ramus
19 Root tips of the maxillary first premolars. The
longer root is the palatal root
20 Burn-out effect
21 Secondary caries

Radiographic Anatomy

1 Vestibular interdental bony septum tip

2 Lingual bony interseptal tip
3 Mental spine
4 Vertically coursing vascular canal
5 Vascular canal in cross-section
6 Mental fovea
7 Burn-out effect
8 Radiopacity due to the chin prominence
9 Basal compact bone of the mandible
10 Periodontal ligament space irregularities due to
variations in the cross-sectional profile
(depressions)

11 Trabecular bone of the alveolus in the

depression of the root cross-section
12 Slender root tip massively superimposed by
trabecular bone
13 Alveolar crest
14 Root fragment
15 Mandibular canal
16 Mental foramen
17 Incomplete root canal filling with chronic apical
periodontitis

Radiographic Anatomy

1 Vestibular interdental bony septum tip

2 Lingual bony interseptal tip
3 Mental spine
4 Vertically coursing vascular canal
5 Vascular canal in cross-section
6 Mental fovea
7 Burn-out effect
8 Radiopacity due to the chin prominence
9 Basal compact bone of the mandible
10 Periodontal ligament space irregularities due to
variations in the cross-sectional profile
(depressions)

11 Trabecular bone of the alveolus in the

depression of the root cross-section
12 Slender root tip massively superimposed by
trabecular bone
13 Alveolar crest
14 Root fragment
15 Mandibular canal
16 Mental foramen
17 Incomplete root canal filling with chronic apical
periodontitis

Radiographic Anatomy

1 Vestibular interdental bony septum tip

2 Lingual bony interseptal tip
3 Mental spine
4 Vertically coursing vascular canal
5 Vascular canal in cross-section
6 Mental fovea
7 Burn-out effect
8 Radiopacity due to the chin prominence
9 Basal compact bone of the mandible
10 Periodontal ligament space irregularities due to
variations in the cross-sectional profile
(depressions)

11 Trabecular bone of the alveolus in the

depression of the root cross-section
12 Slender root tip massively superimposed by
trabecular bone
13 Alveolar crest
14 Root fragment
15 Mandibular canal
16 Mental foramen
17 Incomplete root canal filling with chronic apical
periodontitis

Radiographic Anatomy

1 Typical trabecular structure in the alveolar

process of the mandible
2 Radiolucency (subtraction effect) caused by the
submandibular fovea
3 Typical trabecular structure of the body of the
mandible
4 Mental foramen
5 Taurodont
6 Mandibular canal

7 Internal oblique line (continuation of the temporal

crest of the right mandible)
8 External oblique line (anterior margin of the right
mandible)
9 Mylohyoid line
10 Retromolar triangle, with medial and lateral crura
11 Island of bone marrow following tooth extraction
12 Basal compact bone of the mandible
13 Interdental calculus

Radiographic Anatomy

1 Typical trabecular structure in the alveolar

process of the mandible
2 Radiolucency (subtraction effect) caused by the
submandibular fovea
3 Typical trabecular structure of the body of the
mandible
4 Mental foramen
5 Taurodont
6 Mandibular canal

7 Internal oblique line (continuation of the temporal

crest of the right mandible)
8 External oblique line (anterior margin of the right
mandible)
9 Mylohyoid line
10 Retromolar triangle, with medial and lateral crura
11 Island of bone marrow following tooth extraction
12 Basal compact bone of the mandible
13 Interdental calculus

Radiographic Anatomy

1 Typical trabecular structure in the alveolar

process of the mandible
2 Radiolucency (subtraction effect) caused by the
submandibular fovea
3 Typical trabecular structure of the body of the
mandible
4 Mental foramen
5 Taurodont
6 Mandibular canal

7 Internal oblique line (continuation of the temporal

crest of the right mandible)
8 External oblique line (anterior margin of the right
mandible)
9 Mylohyoid line
10 Retromolar triangle, with medial and lateral crura
11 Island of bone marrow following tooth extraction
12 Basal compact bone of the mandible
13 Interdental calculus