Post on 06-May-2015
description
Advanced diagnostic aids in
periodontology Radiographs & imaging
Introduction A better understanding of the periodontal disease process challenged usefulness of traditional clinical and radiographic methods for diagnosis and prompted revision of outdated diagnostic aids.
DIAGNOSIS
The act or process of identifying or determining the nature and cause of a disease or an injury
Evaluation of patient history
Physical examination
Laboratory investigations
PRINCIPLES OF DIAGNOSIS
Diagnostic test are assessed in terms of their sensitivity and specificity
Specificity – is the ability of test to clearly differentiate one disease from other
True negative
Percentage of subjects with truly absent disease who have a negative test
SENSITIVITY - the ability of a test to detect the disease whenever it is present
Percentage of subjects with truly present disease who have positive test
PREDICTIVE VALUE –Probablity that the test result agress with disease status
Positive predictive value-Probablity of disease in a subject with positive test results
Negative predictive valueProbabllity of health in presence of negative test results
RADIOGRAPHS
It is the traditional method to asses the destruction of alveolar bone associated with periodontitis.
CONVENTIONAL RADIOGRAPH CAN BE USED TO EVALUATE
Bone levels Bone loss – even or angular patterns Intra(infra) – bony defects Root morphologies ⁄ topographies Furcation radiolucencies Endodontic lesions Endodontic mishaps Developmental anomalies Root length and shape(s) remaining in bone
RADIOGRAPHS
INTRA ORAL
IOPA,BITEWINGS
&OCCLUSAL
EXTRA ORAL
OPGS
CONVENTIONAL AND DIGITAL
CONVENTIONAL RADIOGRAPHS
INTRA ORAL RADIOGRAPHS
Intra oral periapical radiographsParalleling technique
Also called as “right angle” or “long cone technique”. X-ray film is placed parallel to long axis of tooth and central ray of x-ray beam is directed at right angle to teeth & film.Preferable technique for periodontal use.
Central ray is directed at right angles to a plane bisecting the angle between long axis of teeth & film.
Bisecting angle technique
Projection Maxilla MandibleIncisors +40 degrees -15 degreesCanine +45 degrees -20 degreesPremolar +30 degrees -10 degreesMolar +20 degrees 2-5 degrees
Extraoral Periapical Radiograph
(Newman And Friedman 2003)
Limitations with intraoral periapical radiographic imaging: Advancing age Anatomical difficulties like large tongue, shallow palate, restricted mouth opening, Neurological difficulties, and size of radiographic sensor
Chen et al in 2007 developed a sensor beam alignment aiming device for performing radiographs using this technique
aiming device with placement of the sensor
BITEWING RADIOGRAPHS
Records the coronal part of upper & lower dentition along with periodontium.
USES 1)To study height & contour of interdental alveolar bone. (2)To detect interproximal calculus. (3)To detect periodontal changes Horizontal bitewing radiographs useful for proximal caries
detection limited use in periodontal
treatment and treatment planning if bone loss is advanced
Vertical bitewing radiographs film is placed with its long axis at 90º to the placement for horizontal bitewing radiography, can be helpful in evaluating periodontium
POSITIONING DEVICES FOR BITEWING
Hawe Paro-Bite Centering Device
a positioning aid is advised to reduce the need for repeat radiographs and hence the unnecessary x-ray exposure is reduced
Occlusal Radiographs – Intraoral occlusal radiographs enable viewing of a relatively large segment of dental arch.
They are useful in patients who are unable to open mouth wide enough for periapical radiographs
LIMITATIONS OF RADIOGRAPHS
Conventional radiographs are specific but lack sensitivity
More than 30% of bone mass at alveolar crest must be lost to be recognized on radiographs
Radiographs provide a 2-dimensional view of a 3-dimensional situation,
provides only information about inter proximal bone level.
Radiographs do not demonstrate soft tissue - to - hard tissue relationship hence no information about depth of soft tissue pocket
STANDARDIZATION OF RADIOGRAPHS
• Constant film position – film holders, stents
• Constant tube geometry - Positioning devices , Cephalostat
• Using paralleling techniques • Using vertical bitewings • Using superimposed mm grid
Extraoral radiographsExtraoral radiographs are taken when large areas of the skull or jaw must be
examined or when patients are unable to open their mouths
for film placement. Useful for evaluating large areas of the skull and jaws but are not adequate for detection of subtle changes such as the early stages of dental caries or periodontal disease.
Conventional panoramic
imaging/Pantamography
LIMITATIONS OF OPG
Image distortion Lingual structures would be projected higher than
buccal surfaces Use of screen film combination results in less details
than intral oral images Production of ghost images
It can be used as a alternative for intra oral full mouth series when combined with bite wing radiographs
Tugnait et al. 2000,2005 The periodontal structures of interest noted on
periapical radiographs are also noted on panoramic radiographs.
The radiographic features of interest on a panoramic radiograph supplemented when necessary by a small number of intra-oral views, is sufficient for the management of periodontal diseases.
Pepallasi EA et al 2000 Panoramic radiographs may not reveal alveolar bony defects as accurately as periapical radiographs.
But question is whether there is any additional therapeutic yeild from greater accuracy from IOPAs
Vazquez et al 2007
Determined the efficacy of panoramic radiographs in the preoperative planning of posterior mandibular implants
mental nerve parasthesia following implant placement in 1527 patients with 2584 implants with only OPGs as preoperative imaging technique
No permanent sensory disturbances of the inferior alveolar nerve
Only 2 cases 0.08 %reported paresthesia
Panoramic examination safe preoperative evaluation tool
Digital radiography Digital radiography is a superior alternative for film based imaging
Digital in digital radiography means numeric format of image content as well as its discreteness
Images are numeric and discrete in two ways – • Spatial distribution of picture elements (pixels) and
• In terms of different shades of gray of each of pixels• Collections of individual pixels organized in a matrix of rows and columns
Digital image
DIGITAL RADIOGRAPHY
Direct Method
Uses a Charge Couple Device (CCD) or CMOS sensor linked with fiberoptic or other wires to computer system
CCD receptor is placed intraorally as traditional films , images appear on a computer screen which can be printed or stored
Indirect Method
This method uses a phosphor luminescence plate, which is a flexible film like sensor placed intraorally & exposed to conventional x-ray tube.
A laser scanner reads the exposed plates & reveals digital image data.
Direct Digital ImagingComponents• X-ray source• an electronic sensor, • A digital interface card, • a computer with an analog
to- digital converter (ADC), • a screen monitor, software,
and a printer.
Direct digital sensors- charge-coupled device (CCD) or complementary metal oxide semiconductor active pixel sensor (CMOS-APS).
array of X-ray or light sensitive pixels on a pure silicon chip.
Indirect imagingPhotostimulable phosphor radiographicsystems
PSP is scanned with a helium-neon laserbeam. The emitted light is captured and intensifi edby a photomultiplier tube and then converted intodigital data.
ADVANTAGES image can be instantly viewed by patient &
dentist. Reduction in radiation received by patient by as
much 50% to 80%
Images can be altered to achieve task specific image characteristics for eg. density & contrast can be lowered for evaluation of marginal bone and increased for evaluation of implant components.
enables the dental team to conduct remote consultations.
Computerized images can be stored, manipulated & corrected for under & overexposure
DISADVANTAGES
Familarity with digital nature of images and understanding of principles of image manipulation is required
Lack of infection control.
Patient discomfort during placement.
As image can be easily manipulated, it can be misused in legal proceedings
Grossly overexposed or underexposed images cannot be corrected
Radiovisiography (RVG)
Duret F et al (1988)
Based on use of CCD
Radio – X-ray generator connected to sensorVisio – storage of incoming signals during exposure and convertion to gray levelsGraphy – digital mass storage unit – connected to various video printout devices
latest version
Trophy has released a wireless version of their RVG intraoral sensor named the RVG 6500.
Mechanism of image displayRadiographic digital
detector
Conventional radiographic source
used to expose sensor
Detector converts X-rays to visible image
Image display on monitor
Mouyen F et al (1989): The RVG system when compared with conventional uses considerably reduced levels of radiation to produce an image immediately after exposure..
Adosh L in 1997 in a comparative study for marginal bone between RVG and after surgical exploration presented that Majority showed difference of less than 0.5 mm between two techniques
The radiographic measurements overestimated interproximal bone loss as compared to the intrasurgical measurements:
A.R. Talaiepour et al in 2005 evaluated the accuracy of RadioVisioGraphy
(RVG) in the linear measurement of interproximal bone loss in intrabony defects.
Comparison between RVG measures and intrasurgical estimates were performed in 56 teeth with intrabony defects
Diagnostic efficacy of digital imaging
with regard to periodontal lesions
Nair et al. 2000 investigated the accuracy of alveolar crestal bone detection utilizing Ektaspeed Plus film, Sidexis direct digital images, and brightness-enhanced digital images. No significant differences were found
Wallace et al 2004 Demonstrated that E film displayed the highest sensitivity and specificity followed by PSP and CCD images when observers were able to adjust digital image contrast and brightness enhancements.
Specialized techniques
Introduction of digital radiography applications with meaningful in dentistry diagnostic utility
Early detection
Quantitative assessment
3 D imaging
Digital subtraction radiography
Zeidses des Plantes (1935) : 1st demonstrated use of subtraction imaging Depends up on conversion of serial
radiographs into digital images.
The serially obtained digital images are superimposed & image intensities of corresponding pixels are subtracted
If change has occurred
The brighter area represents gain
Darker area represents loss
.
This technique facilitates both qualitative & quantitative visualization of even minor density changes in bone by removing the unchanged anatomic structures from image
Base line after one year bone gain
Ortmann (1994)- 5% of bone loss can be detected. Diagnostic subtraction radiography (DSR) can be used for enhanced detection of crestal or periapical bone density changes and to evaluate caries progression
STANDARDIZATION
Baseline projection geometry and image density should be reproduced
bite blocks must be made and attached to the film holders and the film holder must be reproducibly aligned to the x-ray beam collimating device
Several image processing techniques are also developed to reduce the error in DSR
Semiautomated registration Byrd V et al 1998
Automated registration algoritham .Ettinger et al
samarabandhu et al 1994
Computer corrected of distorted projections webber1984
Overall contrast is improved Trabecular marrow spaces are visualizedEnhancement of low and high density images
no objective descriptionHigh standardization of x raysNo reduction in exposure
ADVANTAGES DISADVANTAGES
COMPUTER ASISTED DENSITROMETRIC
IMAGE ANALYSIS SYSTEM
Introduced by Urs Brägger et al 1988
A video camera mesaures the light transmitted through the a radiograph
Signal are converted to grey scale images
Camera is interfaced with computer and image processor for storage and mathematic manipulation of image
Offers an objective method for studying alveolar bone changes quantitatively
High degree of sensitivity ,accuracy and reproducablity
Urs Brägger et al in 1988
CADIA was more sensitive than subtraction radiography
CADIA was capable of assessing differences in remodeling activity over 4–6 weeks after periodontal surgery
Objective method to quantify alveolar bone density
Deas et al 1991
on monitoring the relationship of CALs and CADIA, found that prevelance of progressive lesions as detected by radiograph is higher than previous accepted data
CADIA is still used in research purposes for detecting quantitatively the alveolar bone density
Computer-Based Thermal Imaging
Compare the rewarming rates of normal and inflamed human gingiva
gingival temperature measurement Valuable objective method for the diagnosis of periodontal diseases
Infra-red thermography provides a non-invasive method
Probeye Thermal Imaging Systems
The camera's lOx lens provides a spatial resolution of 0.1 mm at a distance of approximately 15 cm from the gingiva.
composed of indium antimonide which detects wave lengths from 2000 nm to 5600 nm
Technique is no more in use
Extra oral digital imaging
Conventional tomography Designed to image a slice or plane of tissue
Accomplished by blurring the images lying outside the plane of interest
It consists of an x ray tube and radiographic film rigidly connected which moves about a fixed axis and fulcrum
As exposure begins tube and film move in opposite direction simultaneously .
Objects located with in the fulcrum remain in fixed positions and are viewed clearly
Used less frequently with the introduction of:
MRI , CT and Cone beam imaging
OPG is a variant of conventional Tomography
Computed tomography Godfrey Hounsfield and Allan MacLeod Cormack (1979) shared Nobel prize
Consists of a x ray tube emitting finely collimated x ray beam directed through the patient to a series of scintillating detectors or ionizing chambers
Detectors form a continuous ring and x-ray tube moves in a circle with in the ring
Patients lie stationary and x ray tube rotates one turn .Then the table will move 1 to 5 mm to next scan
HELICAL CT
Introduced in 1989
The gantry containing x ray tube and detectors continuously revolve around the patient ,where as patients table advances through the gantry.
Result is acquisition of a continuous helix of data.
DETECTORS
Gas filled ion chambers xenonSolid state detectors cadmium tungstate
CT Image construction
Computer algorithms use photon counts to construct digital CS images
Images are displayed in individual blocks -----VOXELS
Each square of the image is matrix----PIXELS
Each pixel is assigned a CT number representing tissue density
CT number HOUNSFIELD units
Range -1000 to 1000
ADVANTAGES
Eliminates superimposition of images of structures outside area of interest
High contrast resolution – differences between tissues that differ in density < 1% - can be distinguished
Images can be viewed in axial coronal and sagittal planes
Naito T et al. 1998, Pistorius A et al. 2001.Used Computed tomography (CT) in studies in relation to periodontal defects.
CT does not offer any favourable cost benefit, dose exposure or therapeutic yield advantage in periodontal practice and is unlikely to find a routine
CONE BEAM COMPUTED TOMOGRPHY Developed in 1982 for angiography
Utilizes cone shaped source of ionizing radiation & 2D area detector fixed on a rotating gantry .
Multiple sequential images are produced in one scan
• Rotates 360° around the head
• Scan time typically < 1 minute
• Image acquisition involves a Rotational scan of a x ray source and reciprocating area detector moving synchronously around patients head
• Many exposures are made at fixed intervals to form basic images.
• Software programs are used to reconstruct 3D images
Image reconstruction
INTERFACE CONE-BEAM CT MANAGEMENT SOFTWARE
INDICATIONSEvaluation of the jaw bonesImplant placement and evaluation evaluation TMJ Bony & Soft tissue lesionsPeriodontal assessmentEndodontic assessmentAlveolar ridge resorption Orthodontic evaluationAirway assessmentNeed for 3D reconstructions
panoramic cbct
superimposition
CT V/S CBCT
Conventional CT scanners make use of a fan-beam and Provides a set of consecutive slices of image
Conventional CT makes use of a lie-down machine with a large gantry.
Greater contrast resolution &
More discrimination between different tissue types (i.e. bone, teeth, and soft tissue
Utilize a cone beam, which radiates from the x-ray source in a cone shape, encompassing a large volume with a single rotation.
a sitting-up machine of smaller dimensions
Commonly used for hard tissue Ease of operation Dedicated to dental Both jaws can be imaged at the
same time Lower radiation burden
Artifacts arising from metal restorations are more severe using conventional CT.
artifacts that arise from metallic restorations are less severe with the i-CAT
Kelly A. Misch et al . 2006 Compared radiographs with CBCTResults: Three-dimensional capability of CBCT offers a significant advantage in linear measurements for periodontal defect All defects can be detected and quantified.
Mol A and Balasundaram 2008 Evaluated The NewTom 9000 CBCT scanner Results: Better diagnostic and quantitative information on periodontal bone levels in three dimensions than conventional radiography can be obtained
B. BEZAK et al 2010 Assessed reliability and accuracy of Cone Beam Computed Tomography (CBCT) against CAL .CBCT measurement protocol is reliable. Accuracy of CBCT measurements correlates with CAL gold standard measurements.
Brently A. et al 2009
Compared the measurements from digital IR and CBVT images to direct surgical measurements for the evaluation of regenerative treatment outcomes.
Compared to direct surgical measurements,CBVT significantly more precise and accurate than IRs.
CBVT may obviate surgical reentry as a techniquefor assessing regenerative therapy outcomesWalter C et al..2011-
Suggests that cone-beam CT may provide detailed information about furcation involvements in patients with chronic periodontitis and so may influence treatment planning decisions
MICRO CT
The term micro the pixel sizes of the cross-sections are in the micrometer range
.
Microtomography KNOW AS Industrial CT Scanninguses X-rays to create cross-sections of a 3D-object
Used in animal studies analysis of bone biopsies without destruction of samples
Denta scan
DentaScan is a unique computer software program
provides computed tomographic (CT) imaging of the mandible and maxilla in three planes of reference: axial, panoramic, and oblique sagittal
.
Uses
♣ visualization of internal bone morphology in three dimensions ; precise treatment planning
♣In cross sectional view, observation regarding bone quality, density can be made
♣ pre-operative planning of endosseous dental implants and subperiosteal implants
♣to visualize the bony structures pre-operatively
Dentascan CT provides information of the internal structures that cannot even be gained by direct intra-operative visualization
the precise location of the mandibular canal
the location of the floor of the maxillary sinuses
Dr Urvashi shah, Dr Subraya bhat
Utilization of denta-scan for treatment planing in patients with infra-bony defects
Infra-bony defects better visualized by denta-scan compared to intra-oral radiographs
Computer program for assessing oral implant site
Uses raw data from CT along with advanced computer graphics
Advantages: • assessment of bone
volume, bone height &quality
• proper length of implant can be selected
• Clear visualization of inferior alveolar canal
SIMPLANT
Digital tomosynthesis (DTS) Digital tomosynthesis (DTS) is a limited-angle tomographic
technique
only small rotation angles (a few tens of degrees) with a small number of discrete exposures are used.
provides some of the tomographic benefits of computed tomography (CT)
at reduced dose and cost
K Ogawa et al 2010
Developed a new dental panoramic radiographic system
based on a tomosynthesis method
This system allowed the extraction of an optimum-quality panoramic image regardless of irregularities in patient position
the authors could freely reconstruct a fine image of arbitrary planes
C Beda in 2010 proposed the Use of both DTS and CBCT reconstruction methods as an integrated solution for providing tomographic data in dental application
OPTICAL COHERENCE TOMOGRAPHY Optical coherence tomography (OCT) is an
optical signal acquisition and processing method
an interferometric technique, employing near-infrared light. Layperson's explanation
“a technique for obtaining sub-surface images of translucent or opaque materials at a resolution equivalent to a low-power microscope.”
OCT is well-suited for periodontal diagnosis
pocket morphology, and attachment level are digitally recorded
quantitative information of thickness and character of the gingiva, root surface irregularities, and the distribution of subgingival calculus
Otis L.L et. al. 2004
demonstrate the capacity of OCT to determine gingival thickness and the shape and contour of the alveolar crest.
Xiang et al. (2009)OCT imaging can offer three-dimensional imaging of periodontal soft tissues and bone at a very high resolution . Identify active periodontitis before significant alveolar bone loss occurs.
Reliable method for determining attachment level
TACT-tuned aperture CT Based on the principles of
tomosynthesis
Low cost,low dose ,3D Imaging stystem
Series of radiographs taken from different angles
Soft ware (work bench) stacks the basic images and reconstruct in to multi planar images
Caries detection Vertical root fracture Helps to detect osseous defects around implants Detection and localization of osseous changes in
crestal bone
Onanong Chai-U-Dom in 2002
Compared the potentials of conventional and TACT DSR detecting simulated bone-gain in periodontal defects, in vitro
TACT-DSR provide greater sensitivity and technique flexibility in detecting periodontal bone-gain than standard DSR.
Nair M K et al in 2002
Compared the diagnostic efficacy of tuned-aperture computed tomography (TACT) and conventional two-dimensional direct digital radiography (DDR) in an in vitro environment for detecting bone loss in mid-buccal and lingual crests.
TACT-IR performed significantly better than DDR
SMALL VOLUME CT Form of CBCT
utilizes small field high resolution detector to generate high resolution 3D volume
Generally comparable to size of intraoral radiographs
van Daatselaar 2003 based on comparison made between a full CT geometry and a local CT geometry.
“local CT of dental structures appears to be a promising diagnostic instrument.”
MRI Magnetic resonance imaging
does not involve the use of ionizing radiation
it involves the behaviour of protons in a magnetic field.
Hydrogen protons are used to create the MR image.
The image itself is another example of a
tomograph orsectional image that at first glance resembles a CT
Used for imaging intracranial and soft tissue lesions,
The patient is placed within a very strong magnetic field (usually between 0.5–1.5 Tesla)
patient’s hydrogen protons, behaves like magnets to produce the net magnetization vector (NMV ) which aligns itself readily with the longaxis of the magnetic field
Radiowaves are pulsed into the patient by the
body coil transmitter at 90° to the magnetic field
Hydrogen atoms to resonate(store energy )
When radio frequency is turned off ,the stored energy is released from body and detected as a signal in a coil in scanner
Reconstruction of image
USES IN HEAD AND NECK REGION
Assessment of intracranial lesions involving particularly the posterior cranial fossa, the pituitary and the spinal cord.
Investigation of the salivary glands
Tumour staging
Investigation of the TMJ to show both the bony and soft tissue components
Implant assessment
Schara et al 2009 In an invitro study evaluated the used the use of MRI to characterize inflammation and healing process in periodontal tissues
It was concluded that MRI can characterize the type and healing process of inflammation
BONE SCANNING or RADIONUCLIDE
IMAGING
IN contrast to X-ray, CT, MRI which require structural or anatomic changes to be recorded,this technique assesses biochemical alteration in body
It Is a nuclear scanning test that identifies new areas of bone growth or breakdown.
It can be done to evaluate damage to the alveolar bones,and monitor conditions that can affect theperiodontium (including infection and trauma)
radioactive tracer eg. 99m technetium pertechnetate substance is injected into a vein in the arm.
Areas that absorb little or no amount of tracer appear as dark or "cold" spots, which may indicate a lack of blood supply to the bone (bone infarction) or the presence of certain types of cancer
Areas of rapid bone growth or repair absorb increased amounts of the tracer and show up as bright or "hot" spots in the pictures. Hot spots may indicate the presence of a tumor, a fracture, or an infection.
Other radioactive isotopes used are – iodine(131 I), gallium(67 Ga) & selenium(74Se)
γ scintillation camera is used to capture photons and then convereted to light and to voltage signal
Signal is constructed to planar image that shows radionuclide in the image
Advanced nuclear imaging
• Single photon emission computed tomography
• Positron emission tomography
Positive bone scans are detected in beagle dogs with advanced experimental periodontitis kaplan 1975 ,Jeffcoat et al 1985
Jeffcoat et al1985 –There exist a significant association with high intake of 99mTC and bone loss in moderate to severe periodontitis
Sensitivity of 83 % and specificty of 84 %
Reddy et al 1991 scintillation camera images following radiopharmaceutical administration is accurate in detecting bone loss
IMPLANT IMAGING
In 2000, the American Academy of Oral and Maxillofacial Radiology (AAOMR) recommended “some form of cross-sectionalimaging be used for implant cases “
conventional cross-sectional tomography be the method
2012
PRINCIPLES OF IMAGING FOR
DENTAL-IMPLANT ASSESSMENT
Images should have appropriate diagnostic quality and not contain artifacts that compromise anatomic-structure assessments
Images should extend beyond the immediate area of interest to include areas that could be affected by implant placementsPractitioners should have appropriate training in operating radiographicequipment and competence in interpreting images from the modality used
Initial examination
•PANORAMIC RADIOGRAPHY SHOULD BE USED AS AN IMAGING MODALITY
RECOMMENDATION 1
•USE IOPAs TO SUPPLEMENT PANORAMIC RADIOGRAPHY
RECOMMENATION 2
•DO NOT USE CROSS SECTIONAL IMAGING AS AN INITIAL DIAGNOSTIC AID
RECOMMENDATION 3
Preoperative site specific imaging
•establish characteristics of residual alveolar bone
•determining orientation of RAR
•identifying local conditions restricting implant placement
• match imaging findings to the prosthetic plan
RECOMENTATION 4cross sectional imaging of any potential implant site
RECOMENTATION 5CBCT considerd as the imaging modality of choice for imaging implant sites
RECOMMENDATION 6CBCT should be considered if need for augmentaion or other site development procedure is present
Postoperative imaging
In the absence of clinical signs use IOPAS or
OPGs
Patient has mobility or
altered sensation use cross sectional
imaging /CBCT
Implant retrieval
CBCT
DICOM StandardThe Digital Imaging and
Communications in Medicine
facilitate communications between imaging devices and systems.
By dictating specific data and interface requirements, DICOM ensure that devices--particularly devices made by different suppliers--can communicate with one another.
:
Transmission and persistence of
complete objectsEg images,docs
Query and retrieval of
objects
Printing images on
film
Work flow managemen
t
Quality and consistency of
image apperance
DICOM address five primary areas of functionality:
RADIOGRAPHS IN PERIODONTAL
DISEASE DIAGNOSIS &
MANAGEMENT
Features of periodontal diagnostic interest are
apparent on radiographs
Relationship exists b/w clinical attachment and
radiographic bone height
Radiographs can be used in all stages of
periodontal care
Tugnait et al 2000
Considered a provoking review
EF CORBET, DKL HO, SML LAI 2009
Radiographs only inform with respect to diagnosis for a small proportion of periodontal conditions
Radiographs play a pivotal role is in treatment planing
Imaging approaches, such as cone-beam computed (digital volume) tomography,show some usefulness
Will probably remain a research tool without much clinical application
Full-mouthsurveys of paralleling periapical radiographs have been considered to be a ‘‘gold standard’’ for periodontal diagnosis and treatment planning or
a panoramic radiograph supplemented by selected intra-oral radiographs , numbered less than four per patient reach the ‘‘gold standard’
EXPOSURE FROM X RAYS
IOPA F speed ,rectangular collimator- 0.001mSV
IOPA E speed round collimator --.004mSV
Full mouth .080mSV
Panoramic .009 mSv
Cone Beam .068 mSv
Hospital CT 0.6 mSv
Radiography must not be a substitute for clinical investigation
X-rays as a component of periodic examinations cannot be condoned.
Radiographic examination in clinical periodontology is only justified if changes in treatment plans from those treatment plans developed on the basis of clinical examination supplemented by any already available radiographs are anticipated
TO CONCLUDE…….
Advanced imaging systems like CTs,CBCTs,have enabled better visualization of periodontal structures and pathologies in3D thus helping in better diagnosis and treatment planning
The cost factor and other technical difficulties have limited their cliniclal utility but their utility as a research tool is unquestionable
FURTHER IMPROVEMENT S ARE WARRANTED IN FIELD OF DIGITAL IMAGING And in near future these imaging techniques will become routine diagnostic tools
THANK YOU