Welcome !

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Dental anatomy and Imaging

With Eriks

Oct 2012

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Dental Anatomy

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General naming of teeth:Tip: Views always look into the patients mouth (not your own).

Maxillar (Upper)

Mandibular(Lower)

Dental Anatomy

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“Directions”:

Dental Anatomy

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Tooth numbering: Always look into the patients mouth (not your own).

ADA System:

International System:

Kids (1st set of teeth) have there own “numbering” with letters !

Dental Anatomy

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Intraoral imaging:

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Periapical image:

Bitewing:(interproximal)

Health of teeth, roots, bone.

Interproximal decay (caries)

Intraoral imaging:

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Occlusal image:

exploring calcifications of the sublingual salivary glands.

Magnification

Equal image enlargement

Caused by long object-sensor distance and short source-object distance

Minimized by controlling distance factors & focal spot

Intraoral imaging technique:

Shape Distortion

Variation of the true shape of the object

Vertical distortion results in elongation foreshortening or

Horizontal distortion results in image widening and overlapping

Intraoral imaging technique:

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Intraoral imaging technique:

Assembled Instruments

1. Anterior PA viewsright and leftmaxillary and mandibular

2. Bitewing viewsright and left

3. Posterior PA viewsright and leftmaxillary and mandibular

Paralleling Periapical Technique

Applies most rules of accurate image formation

Most accurate periapical technique

Preferred technique for periapical imaging

Bitewing Technique Applies principles of paralleling technique to imaging the teeth crowns

Used to record interproximals

Most accurate view of the crowns and bony margins

Intraoral imaging technique:

+20º

0º

Vertical Angulation (with tabs)

When the film is positioned in the mouth, the upper portion of the film is angled approximately +20° as it contacts the palate. In the mandible, the film is upright (0° angle). The average between these two angles is +10°. This +10° is the vertical angulation selected when using bitewing tabs.

Bisecting Angle Periapical Technique

Applies one of the rules for accurate image formation

Angle is formed by sensor and object

Produces images with shape distortion and magnification

Intraoral imaging technique:

Intraoral imaging technique: FMX (Full Mouth X-Ray) obsolete!

FMX

Not to be confused with (although you might need dental a FMX after this):

Foreshortening

Short image from too much vertical angulation

Correction - place receptor parallel to tooth long axes and reduce the vertical angle

Placement Errors

Elongation

Long image from not enough vertical angulation

Correction - place receptor parallel to tooth long axes and increase the vertical angle

Placement Errors

Horizontal Overlap

Teeth widening and overlapped contacts from diagonal entry of the x-ray beam

To correct, place receptor parallel to horizontal plane, direct beam through

proximal contacts

Placement Errors

Cone Cut

Zone of non-exposure from not centering x-ray beam over receptor

To correct, direct central ray through entry point and to the center of the receptor

Placement Errors

Receptor not placed in proper position to cover desired structures

Use receptor placement guidelines

Placement Errors

Positioning Error

Exposure Error

System will correct for most over or underexposures

Overexposure – exposure factors set too high

Underexposure – exposure factors set too low

Dental Anatomy

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Digital Pan Landmarks & Positioning Errors

Hyoid bone

Outline of Ear Eye Socket

Sinus

Calcification of carotid

Necklace shadowEagles

TMJSpine

Nasal fossa/Airways

Sinus

Mandibular canal

Mandib

ular

canal

Mental foramen

Septum

Patient demonstrates too much smile – chin is positioned too far down26

P1…Panoramic P1C…25% Magnification & Special Needs

P1A…Artifact Reduced

P12…Anterior Views

S1…Sinus Frontal

TM1…Lateral TMJOpen / Closed

MS1…Slices(molar region)

BW1…Bitewing View BW2

ORTHOPHOS XG 3D Ready 2D PROGRAMS

T h e D e n t a l C o m p a n y

Right - Left

Upper - Lower

P2 =Dentition – P2A Artifact Reduced – P2C Constant Magnification also for Compromised PatientsP10…Pediatric

Upper

Lower

6 TMJ views offered4 Sinus views

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ORTHOPHOS XG 3D Ready 2D PROGRAMS

T h e D e n t a l C o m p a n y

Easy Patient Positioning(select appropriate bite piece, contact segment, or chin rest)

General Information –Cover all patient contact surfaces with hygienic covers Patient must remove: Glasses All jewelry above the neck, to include earrings, necklaces, metal hair pins All removable appliances in the mouth that are removable

Easy Pad Assists with Correct SelectionsTap on P1, P1A, P1CTo access sub programsTap to Scroll through programs ( ) (+) touch pad

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ORTHOPHOS XG 3D Ready 2D PROGRAMS

T h e D e n t a l C o m p a n y

Review:Workstation• Select patient from Worklist or Register patient in

SIDEXIS• Select PAN GREEN flashing light indicates

Ready Digital Pan• On LCD Screen Select Program – Patient Type, Etc. • Position Patient (if using lead apron solid is to back) Use light to make certain Mid and Frankfurt correct• Remind Patient to swallow, place and keep tongue at

Roof of mount, and keep lips closed during digital Image taking. Remote Exposure Station – Confirm Selections• Press and hold to initiate exposure 14 sec. until you hear (3) beep-beep-beep sound the procedure is complete and unit is at restDigital Pan LCD Display• Shows snapshot of image - tap screen to

remove image

• Send image to PACS

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Support : 1 800 659 5977 opt. 2, opt. 2

Patient Positioning DevicesOne Piece Yellow Bite Block and Contact Segment – For Panoramic Images

Bite Block Contact Segment

Patients with anterior front teethanterior teeth in groove

Patients with missing anterior teeth Position under nose with cotton roll or 4x4 for space relationship

Chin Rest – for patients with stability issuesPatients with anterior front teeth Patients with missing front teeth

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Support : 1 800 659 5977 opt. 2, opt. 2

Patient Positioning Devices -ContinuedMore Positioning Guides: Universal Positioners

Used with/for: Use Recommendations

AutoFunction

Reorder Foam Inserts Cat. #

Auto Position Function

61 41 449 -100 pcs. EA

For patients with and withoutAnterior teeth. Assists operator with proper Occlusal and Frankfurt Positioning. Eliminates chin cut off.

All Purpose -Sliding Bite Piece Positioner-Optional

Sliding Positioner Cat. #

Universal for Pan, TSA, etc. // Optional – may be purchased as accessory.

61 41 431 EA.

For patients with and withoutAnterior teeth. One positioning piece for all Panoramic Programs

==

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Support : 1 800 659 5977 opt. 2, opt. 2

Patient Positioning Devices -ContinuedMore Positioning Guides: Sinus Views

Used with/for: Use Recommendations

Short Blue PositioningContact Segment & BiteBlockPatient isPositioned Lower to permit SINUS Areain FOV (field of view)

Check Programs on LCDEasy Pad for correct positioning piece

Programs: S1 & S3

Programs: S2 & S4

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Support : 1 800 659 5977 opt. 2, opt. 2

Patient Positioning Devices -Continued

TMJ Images

Panoramic

TMJ Programs

Forehead and Temple Supports

Red Frankfurt and Mid Sagittal Light Lines33

TMJ Lateral - Medial

LateralLateral

Medial Medial

TM 1.1 TM 1.1TM 1.2 TM 1.2

closed closedopen open

TMJ Head Positioner and Stabilizer

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Support : 1 800 659 5977 opt. 2, opt. 2

Patient Tilted

AIR (to remove have patient swallow just before image is taken)

Hyoid shadowHyoid shadow

Positioning Errors

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Pan with Necklace shadowand too much smile

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Lead blocker– does this office use a Lead Apron? OR was this patient In a wheelchair with metal bar on headrest? Necklace shadow

Poor Patient Positioning plus artifacts

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Metal around Neck causes ARTIFACT

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Patient with Metal around neck (like necklace) causes artifact on image

Always have patient remove necklace that lays above C7/T1 vertebra.

Wrong

Right

=L

Interfereswith beam

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Cephalometric image Lateral Full Skull Ceph View with Landmarks

SIDEXIS XG

Nasion

Orbital

Anterior Nasal Spine

Subspinale

Pogonion

Pterygomaxillary Fissure

Sella Turcia

Porion

Basion

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Ceph tracing Anatomy

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