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12 Radiology

12 Radiology

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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)

1

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 s€nsor, 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 lin€ar. Ar€r 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 s€miconductor active pix€l 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 l€ss 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
Cop).dght O 201 I -20 l2 - Dental Decls

. Indirect digital imaging
. Direct digital imaging

.

Storage phosphor imaging

Cop)right O 201 I -20

12

- Dmtal Decks

inslanr or rcal timc imagc production and display. Thcsc numcrical assignmcnts translatc into 256 shades of gra!. and chcnrical proccssing that transfoffns thc latcnt imagc into a visible onc.as. Film displays higher resolution than digilal rcccpfors wilh a rcsolving powcr ofabout l6lplmm (lnrcs puirs/nil/td"/"r'l. Thc human eyc is ablc to detect approximatcly 32 gray lcvcls. an image appears on the computer screen. Digital imaging Dircct digital imaging has dislinct advantagcs ovcr lilnt in Icrms ofcxposurc rcduclion. a reusable imaging plate coated with phosphors is used instead of a sensor with a fiber optic cable. Film-based imaging consists ofx-ray inieraction with clcctrons in thc lilm cmulsion. imagc cnhanccmcnt. Analog imagcs arc charactcrizcd by continuous shadcs ofgray liom onc arca to the next betwccn thc cxtrcmcs ofblack and \lhitc. and display ofihc visiblc imagc on a computcr scrccn. and cnsurc thc barrier is nol damagcd during paticnt imaging proccdurcs. tilm is a rclativcly ineflicicnt radiation deiector ard.n to propcrly prcparc. a wireless digital radiography system. cotrvcrsion ofanalog data to digital data. indirect digital imaging. displayiDg. and are then placed in a scanning device. The sensor then transmits the image to a computer monitor Within seconds of exposing the sensor to an intraonl x-rays.d rcsolution. climlnation ofprocessing chcmicals.cvcnt crossconta- Three methods of obtaining a digital image currently exist: direct digital imaging./ru e ?l?nents). The plates are similar in every way to conventional intraorul film.5 ninutes depending upon the system and certain variables. Software is then used to enhance and store the image.Thc usc oircctangular collimation and thc highest speed lilm arc mcthods thal rcducc rudiation cxposurc. When the light strikes the phosphor material. an existing x-my film is "digitized" using a CCD camera. dccr. collimation. a complementary metal oxide semiconductor/active pixel sensor (CMOS / AP. In this method. or a charge injection device /C/Dl. Data acquircd by thc scnsor is communicatcd to the conputcr in analog tbmr. sensor. and sloring diaeirrosiic infbrmation. and then displays it on the computer momtor . lt is cslinatcd that l0-207o ofdcntal practitioncrs usc digital imaging tcchnology in thcir dcntal practicc. computcr proccssing. paticnt educatjon utility. To produce a direct digital x-ray image. and thcy form words eight or morc bits in lcngth c^llcd bytes. three components are necessary: an x-ray machine. These plates store the energy from incoming x-rays. Thc vohagc of thc output signal is nrcasurcd and assigncd a numbcr trom 0 fbld. rclatcd to lhe amount oflight that can pass through thc imagc ai a spccific silc. and a computer monitor The images are captured using a solid-state detector or sensor such as a charge-coupled device {CCDJ. s. including size. Thc analog-tc./ // arc uscd to rcprcscnt data. energy is released as a light signal in an electronic waveform and is converted to a digital image by the computer. covcr. The CCD camera scans the image. Computcrs opcraic on thc binary number systcm in which hvo digits /0 dr. production ofa lalcnl inragc. Thc actual amount ofcxposurc rcduction is dcpcndent on a numbcr offactors including film spccd. 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. The scanner stimulates the stored x-ray infonnation by subjecting the plate to a laser light. rigidity and placement. Dircct saliva contact with thc rcccptor and clcctrical cablc must bc avoidcd to p. Thc total nunrbcr ofpossible bylcs for 8-bit languagc is 28 = 256. but takes from 30 seconds to 5. and pcrfccl scm iconduc tor chargc Iransfir. . \ote: Infection controlprcscnts anolhcr chal lcngc forclinicians using dircct digitalimaging. radiographic fi1m providcs a mcdium for rccording. rcquircs rclatively high radiation cxposurc.t/ to 255 (\'hit?) according to thc intcnsity ofthc voltagc. The image can not instantaneously be viewed on the monitor.S/. However. Thcsc two charactcrs arc callcd bits (bi ar) digit). and relakcs. Carc nccds to bc tak. Each shadc ofgray has an optical dcltrsity klarknet. thickness. Filmbascd inragcs arc dcscribcd as analog images. highcr inilial systcm cost. and storage phosphor imaging. Digital or electronic imaging As such.has bccn availablc lbr morc lhan a dccadc.digital converter translbrms analog data into numcrical dala bascd on thc binary numbcr systcm. CCD scnsors cannol bc :t.ri1i/cd. A third method ofobtaining a digital image is storage phosphor imaging. digitizcs or converts the image. . . The essential components ofan indirect digital imaging system include a CCD camera and computer. and con\ cnicnt sloragc. thus.nsor arca. Thc primary disadvantages includc drc rigidily and thickncss ofthc sensor. The plates are described as "wireless" because they are not connected via cable or wire to the computer. In this system. 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. unknown scnsor lifcspan. Chcmicals ar(} nccded to process the image and arc olicn drc sourcc of crrors and rctakcs.

th€ longest target-film distance and shortcst object-Iilm distance are used. The first statement is false. Panoramic instead ofa full mouth series Copyflglu a<i 2011.2011 .ar 20ll-l0ll . the second statement is true .RADIOLOGY Dig Rad You have a patient who is extr€m€ly concerned about the radiation erposure he will receive when he gets intraoral pictures taken. To limit image rnagnification. . Both statements are true . E-speed films F-speed films . The first statement is true. .Dental Decks .Dental Decks 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 shad€s of gray is termed low contrast and is said to hiye a long contrast scale. You let him know that if he wants the least exposure then you will use: . the second statement is false . Both statements are false 5 Cop)righr r. Digital radiography .

fie less ima-ge enligcml. an_d T and rhc x-ray \ _.al \pot on the tungsten target) and the film lr is dercrmincd by the length ofrhe posirion_indicating dc_ . a tonger plI) ::i :ir{eafilm distance result in less image magnillcetion. bct*een adiacsnt areas on an x-ray. 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. short_scale con_ lionl the usc ofa lor{. Long-scrle contrast: is an x-ray that shows many densities. This translates into less radiation exposure for the patient.ra:. . . contrsst is thc difrercnce in degrccs ofbrackncss wrth many shades ofgray and few areas . ' \-rai besm: to minimiTe dimensional disro(ion. or nany shades ot gray. or converted into "digital" fom.Tu.: l: more image magnification. ' :i object-film distanc€: is the distance berween_the object bcing rrdiographed /r7€ r.r.er kilovoltage range. As a resuft. 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. because the sensor is more sensitive to x-rays than dental frlm. When a longer pID is used. The sensor is used instead of intraolal film. A dimensional 'object-film alignment:10 minimize dimensionaldistortion gles to the tooth but not to thc film.s ir.One ofthe positive features ofdigital radiography is that it requires less radiation than conventional radiography. In digital radiography. The literature emphasizes that the x-ray unit must have the ability to ..tt bc on the film. panoramic and cephalometric images rray also be obtained. objec!firm dis_ :. 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. the x-ray beam musr be directed perpendicurar !o rhe :oo:h and rhe film.t thcre decrease In objecl_frrn' distance rcsurts in a decrease in magnitication.o rcrms arc us€d ro dcscribe is an x-ray that shows only tno densities. 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. ond a shortcr pID and target-tilo distance re_ j. - \lagnificationretirstoarar1iographicimagcthatappearsr". Digital radiography systems are not limited to intraoral images. more parallei ra1.i.-/irm distdn. a sensoq or small detector is placed inside the mouth ofthe patient to capture the radiographic image. rhc middle ofrhe x-ray bicanr i:-r. Foreshortening rcsultsfrom excessive verti{:al angulation when the x-ray bcarn is perl ac:rdtcular to rhe film but not thc toorh.. :he appearance :rast results ofthc rooth.ro1[/ Thc closer rhe proximiry ofrhe toorh 10 rhc film. L All direct and PSP digital radiography systems use a conventional dental xliotce:' ray unit. :c rtl:o ttlletl ptD).t: reduce exposure times to 0.. areds olblack and white.e) is thc distance bctween the source or-r-rays Uo. Long_scale con_ ' short-scal€ contrast: rrast results from the usc ofa higher kilovotage range. High contra.. .t describcs an x_ray with man! black and white areas and ferv shades ofqray.. Low contrast describes 3r r-rav ofblack and white.01 seconds to reduce the likelihood of oversaturating the sensor.::r:c:esulti ln an increas€ in imagc magnification.g"'@ ir::j The intase magnification on a dental x_ray is influenced bv the: ' TarqeFfifm dist^nce (a!ro La\etl sorrLel. 3. 2.h :he object rather than thc diverging x_rays from the pcriphcry olthe beam.

Enamel . None ofthe above 7 Coplright O 201 I -2012 - Ddtal Decks . Bone . The state . Dentin .De. Maxillary sinus space 6 Copright @ 201 I -20 12 . Amalgam . The patient . The dentist ..tal Deck .

the radiographs are viewed as ifthe viewer is looking directly at the patient. Note: Patients may refuse dental x-rays. the number and type of .Radiopaque structures/materials: . Radiopaque structures appear white on the processed film .g. Example: Least to most radiopaque: periodontal ligament space.. Important: Based on the orientation ofthe embossed d. however. The dental record must include documentation of informed consent and the exposure of radiographs (e. amalsam.filn. dentin. Allow radiation to pass through. . howeveq the dentist must decide whether an accurate diagnosis can be provided and whether treatment can providec. Legally. Dense materials such as metals. ilh the raised or convex side oJ the dot.er/. ZOE. Less dense materials.facing the vieu'erl and lingual m o.|[]'ting (with the depressed or concave tide oJ the dot Jacing the vielr. which includes having a copy ofthe radiographs forwarded to another dentist. have a right to reasonable access to the dental radiographs. and bone Radiolucent structures/materials: .ot (i(lenti/ication dot). Patients do. Remember: No document can be signed by the patient that releases the dentist from liability. dental radiographs are the property of the d€ntist. Note: With the labial mounting method. Radiolucent structures appear gray to black on processed filfir . More radiation penetrates the structure and reaches the film . including soft tissue and air space Note: Radiographs show shading from black to white fr?os/ radiolucent to most radiopoque).s. The labial mounting method is recommended by the American Dental Association. **+ Dental radiographs should be kept indefinitel"v. with the right quadrants in the left side of the film mount and those ofthe left quadrants in the risht side ofthe film mount. dentin. Less radiation penetrates the structure and reaches the film . the rationale. that is. enamel. there are two methods ofmounting radiographs: labial mounting fi. absorbing very little ./or exposure and the interpreto tiotl). enamel.

O:000. Tell the patient that bite-wing x-rays should be taken once a year . Agree with the patient . None ofthe above 8 Copyrighr O 2011. Joenlannucc' andLauraJansen: Dentrl Rrdiography: Principles and Techniqles:Thnd Edilion. Tell the patient that dental x-rays are taken only when needed as judged by each patient's needs .wing x-rays because it has been six months since the last nlms were taken. Denral Decks Identify the structure below that the arnows are pointing to: Reprirted fronHaring. 9 Copyright O 2011-l0l: .Denral Decfts . wirh permission fron Elsevier. Your hygienist should respond in which manner listed below? .Your dental hygienht has a patient who states that she needs bite.2012 .

Note: Occult diseases (/br example. t)?e and frequency ofdental x-rays are determin€d 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. Remember: For a pediatric patient who is caries free (and asy-mptomatic).) is a srnall hook-like projection olbone extending from the medial pterygoid plate ofthe sphenoid bone.Decisions about the number. o 2000. The hamulus is located posterior to the maxillary tuberosity region. small carious lesions. pain in one or more teeth or possible impacted teeth need more frequent radiographic examinations than patients without such problems. tooth mobility. Note: Patients who have tooth decay. There are guidelines published by the ADA that aid a dentist in prescribing the number. width and shape from patient to patient. The maxillary tuberosity appears as a radiopaque bulge distal to the third molar region Reprinred from Haring. It usually exhibits a bulbous point. On the radiograph its image is seen in proximity to the posterior surface ofthe tuberosity ofthe maxilla.!-sts qnd tumors) are those presenting no clinical signs or symptoms. Remember: Caries is an exception to the above rule because ofits much higher prevalence as comnared to occult cvsts or tumors. type and frequency of dental x-rays. Because occult disease in the perioral tissues is so rare (except Jbr caries). periodontal disease. It varies greatly in length. *ith pemission from Ekevi€r . Joen Iannucciand LauraJansen: DentalRadrography:Prin' ciples and Techniques: Ttird Edilion. every x-ray taken should be evaluated for these lesions. The hamulus lalso known as the hamular proc'ess. the first bite-wing radiographs should not be taken until the spaces between the posterior teeth have closed. 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. . but sometimes the point is tapered. However.

' 11 Copynglu a 2011'2012 ' Denral Decks . The incisor region ofthe mandible . ''Cornesy Dr Sluan C.RADIOLOGY NormalAnat The image ofthe coronoid process of the mandible often appears in periapicrl x-rrys o{: . $'l'ne. UCLA SchooloiDenrisfy. The molar region of the maxilla 10 Coplaight ie 20ll-201: . The incisor region ofthe maxilla . The molar region of the mandible .DeDtal Decks NormalAnat Identify eech structure that the arrows 1-8 point to in the anterior region ofthe maxilla.

The opaque line -) Anterior wall of maxillary sinus 3. 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. The opaque 5.nDg.l l lr-gienr \r. The radiolucent .sive canal) 2. The opaque line Lamrna dura line -+ Border ofrnaxillary sinus line -+ Periodontal ligament space 8. which may be seen below. or in some instances. The opaque -) Nasopalatine lossa line -) -) Floor ofnasal fossa structur€ -+ Soft tissue tip ofnose 6.As the mouth is opened.sitir permissioi frcn El!e!rer l. It is evidenced by a tapered or triangular radiopacity. superirrposed on the molar teeth and maxilla. The opaque 7. the process moves forward.ura Jansen Lind: Rldiograph'c tlle Dent. 10 199.1. The coronoid process appears as a triangular-shaped radiopacit_v. Joen Iannuccilnd L. The opaqu€ lin€ -+ Lateral wall ofnasopalatine canal (inci. Ifrenretdtio ior Repnnred liom H. 'Ihe radiolucent structure 4.

' 13 CoDright C 20ll-2011. "Coudesy Dr. UCLA School of Denrisrry " 12 CopyriShr lil20ll'?01: ' DenEl Decks Identify each structure that the . Stuan C.Dertal Decks . Whi1e. UCLA School of Denrirry. Stuan C.NormalAnat Identify each structure that the rrrows l-7 point to in th€ anterior region ofthe ''Counesy Dr.rrows l-5 point to in the mandibular molar region. wlrire.

The opaque line -t + Lateral wall ofnasopalatine canal 3. The radiopaque linss + Nutrient canal 2. The rediopaque + Incisive/l. The radiolucent 4. The radiolucent space 5. Th€ oprque Inferior border ofrnandibular canal d. The opaque line line -t + Bony trabecular plate 3..lasopalatine foramen tissue tip ofnose line -+ Soft 7. The opaque lin€ -+ Intermaxillary suture Floor ofnasal fossa llne 5. The radlolucent structure 6.1. The opaque structur€ + Anterior nasal spine 2. The radlopaque + Submandibular gland fossa structure + Inferior border ofmandible . The oprque structure -t Alveolar crest 1.

UCLA School ofDenrisrrv ' 't4 Coplrighr r. "Counesy Dr Stuart C. "Counesy Dr Sruan C. Whne. ' 15 Copyriglrt O 20ll l0l: DenElDecks .!' 201 l-l0l: . UCI-A School ofDcntistry.NormalAnat Identify each structure that the arrows 1-8 point to in the maxillary molar region.Denral Dccks RADIOLOGY Identify each structure that the arrows I -7 poina to in the mandibular incisor region. Whire.

The opaque 7.1. The opaque 4. The radlolucent 6. The radiolucent line -+ Periodontal ligament space 3. The opaque mass 3. The opaque mass 5. The opaque 6. The opaqneline + -+ Film holder Genial tubercles circle + -t Lingual foramen -) Bony trabecular plate 7. The opaque 5. The opaque line + + + + + + + Anterior wall ofmaxillary sinus Inferior concha Floor ofnasal fossa 2. The radlolucent sprce Marrow space . 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 8. The opaque mass 4. The opaque structure + Lingual cusp of lst premolar 2.

Identify each structure that the arrows 1--4 point to in the mandibular premolar region.2012 . wltite. UCLA School of Dentisrry " Copyrighr C 20ll-2012 .Dental Decks Identify each structure that the rrrows 1-3 point to in the msndibular premolar rsgion. ''Counesy Dr Stuan C. "Courtesy Dr Snran C. UCLA School of Denlistry" 16 Copy ighr C 2011. Write.Dental Decks .

Large radiolucent space -> .l. The radiolucent space -+ Mental foramen Submandibular gland fossa 3. The radiolucent line -+ 2. The opaque line -) Cemento-enameljunction 2. The radiolucent space Periodontal lisament Mental foramen sDace -) 3. Large radiolucent space 4. Dark -+ Submandibular gland fossa dot -+ Film clin mark 1.

Den6l Decks ." 18 Copyrig|t aa 20ll-l0l: . UCLA School of Denrisrry.Denral Decks }IOLOGY Identify each structure that the arrows 1-6 point to in the maxillary canine region. White.Identify each structure that th€ arrows 1-7 point to in the maxillary premolar region. 19 lO 201 ' CoplriShr 1. ''Coudesy Dr Stuan C. ''Counesy Dr Stuart C. \lhne. UCI-A School of Denrisln.2012.

The opaque + + Maxillary sinus line -+ Floor ofmaxillary sinus Inferior border ofzygomatic process ofthe maxilla 6. The oprque -) + -) + Lateral wall in nasopalatine canal Ala ofnose Anterior wall ofmaxillary sinus 5. The opaque 4.1. The oprque line Lingual cusp of lst premolar . The radlolucent space 5. The opaque llne + Lingual cusp offirst premolar 1. The radiolucent space -t Maxillary sinus 6. The opaque mrss -+ Inferior concha 2. The opaque 3.The opaqueline -) + Anterior wall ofmaxillary sinus Floor ofnasal fossa 4. The opaque line 3. The opaque line -+ Floor ofnasal fossa line line line 2. The opaque structure 7.

Whire. UCLA SchoolofDenrsln. UCLA S.hool of Dentinry Copyrighr rr " 20ll-l0l: .Denlal Dccks .l Dects RADIOLOGY NormalAnat Identify each structure that the arrows 1-3 point to in the mandibular incisor region.RADIOLOGY NormalAnat Identify each structure that the arrows 1-6 point to in the maxillary molar region. 20 Copvrighl C 20ll ?01: Denr. w]rne. ''Coudes) Dr Sruan C. ''Counesl Dr Stuan C.

The opaque spot -+ Film holder Mucosa over maxillary ridge 6.1. The lucent line -> Periodontal ligament space ofpalatal root 5. The radiopaque mass -+ Genial tubercles . The opaque 4. The radiopaque 2. The opaque region -+ l. The opaque line -+ DEJ 2. The radiolucent masses --> Mandibular tori circl€ -+ Lingual foramen 3. The lucent line -+ Periodontal ligament space line -+ Lamina dura 3.

UCI-A SchooIoIDcntistry. Stuart C whrte.RADIOLOGY NormalAnat Identify each structure that the arrows 1-4 point to in the mandibular incisor/canine region.' Copyrighr ill 20ll l012 DenralDectr RADIOLOGY NormalAnat Identify each structure that the arrows 1-8 point to in the maxillary incisor region. Wh're. UCLA 23 School ofDenristry. Cotlright ilt 20ll-10l2 . ''Councsy Dr Sruart C.Denral Decks . *Counesy Dr.

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

RADIOLOGY NormalAnat ldentify each structure that the arrows l-9 point to in the maxillary incisor region.Dental Dccks RADIOLOGY NormalAnat Identify each structure that the arrows 1-12 point to in the maxillary canine region. UCLA School ofDentistry.Dentel Decks .!l20ll-20ll . "Counesy D' Sruan C. Whire. Whre. UCI-A School of Dcnrisrry 24 Coplright r.- 25 Copyri8hr !12011 :0ll . ''Counesy Dr Stuan C.

The oprque structure 9. The oplque structure 8. Tooth numb€r? 4. The radiolucent + Periodontal ligament space 7. The radiolucent 9. The opaque line -+ DEI .1. The lucent 5. The opaque line 5. The opaque structure + Alveolar crest 8. The radlolucent space 4. The opaque + + l0 Larnina duxa materhl -+ Dentin llne 6. The lucent structure Pulp canal space line -+ Periodontal ligament 6. The rsdiolucent line 3. structure structure + + Pulp canal Pulp chamber mtterid + Enamel The oprque clrcle + Premolar buccal cusp over raised film dot 12. The opaque materiol + + + -t Dentin Bony tabecular plate Bony marrow spac€ 2. The lucent sprce -t Marrow space l. The opaque 11. The lucent structure -+ Alveolar crest -) Enanel + Pulp chamber + Trabecular plate 2. The opeque line + Lamina dum 7. The opaque line 3. The radiolucent 10.

While. UCLA School o i Dent istry. ''Courtesv Dr Stuan C.NormalAnat Identify each structure that the arrows 1-8 point to in th€ maxillary premolar region.] 20ll 2012 ' Denral Decks . UCLA CopyriShr i." CoDrighr al:0ll ?012 Denral Decks NormalAnat Identify each structur€ that the arrows 1-15 point to in the partial panorex. Whire. C.

The black 5. The radiolucent space + Pterygomaxillary fissure 7. The opaque line + Infrao6ital rim 5. The oprquc msss -) Hyoid bone .1. The opaque llne -) Air in nasal fossa 2. The lucent + + line + Periodontal ligament space Lamina dura 8. Tooth number? -+ 3 2. The opaque line + Border ofinfraorbital canal 6. The oprque llne + Inferior border ofmandibular canal 13. The opaque mass + Zygomatic arch 9. The lucent sprce 15. The opaque mass + Ear lobe 12. The opaque line + lnferior border ofmandible 1. The oprque line + Posterior wall of maxllla (maxillary sinus) 10. The opaque 7. The opaque line + Pterygoid spine ofsphenoid bone 8. The opaque line + Nasal septum 3. The oprque line + Posterior wall of zygomatic process of maxilla 11.. The black dot + Film dot marks line + PLS for Kodak Ektaspeed plus film Lamina dura 6. The opaque line + Lateral wall ofnasal foss4 medial wall ofmaxillary sinus 4.lYhat material is this? -+ Silver amalgam 3. The opaque rnsss + Anterior nasal spine 14. Whrt ls thls oprcity? + Plastic bite block 4.

Both statements are thlse 29 Copyrighr C 20tl. The first statement is false. Both statements are true . the second statement is false . 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. UCLA C.l DeLrr RADIOLOGY The pattern of stored energy on an exposed film is t€rmed tbe latent image.RADIOLOGY NormalAnat Identify each structure that th€ arrows 1-13 point to in the partial panorex. the second statement is true .t\ric rr ' -'nll l0 I Dcnr. while. . The first statement is true. energized silver halide crvstats to trlack metallic silver. C.t0l: Dcnrit Dccks .

raxillary sinus structure -+ Soft palate 7. 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. The developer solution softcns the film emulsion during this proccss.1.ferred to as ghost image) oval -+ Mental foramen The diffuse opacity -+ -+ Shadow ofcervical spine Submandibular gland fossa 12. Note: Elon. . .ing the development process br removing lhe alkali accelerllor. acts quickly to produce a visible radiographic inage.. . The opacity -+ Articular tubercle The purpose oflilm processing is trlofoldi .' developing solution contains the following: . The lucent 11. it chemically changes thc photosensitivc siher halide crystals in the film emulsion lldtent image). . It softens geiatin ofcmulsion. Gives detail to the x-ray image. It scncraics the many shadcs of gray. The opaque line -+ Hard palate/floor ofnasal fossa 3. The opaque line (dots) 10. The opacity -> Tipof nose 2. The opaque line -+ Dorsum oftongue 9. The opaque line 5. sodium sulfite. The radiolucent space -+ Air between the soft palate and the dorsum of tongue 8. The opaque -+ Orbit Hard palate/floor ofnasal fossa Floor of n. The broad lucency 13. Film processing involves the following 5 steps:( I ) immerse film in developer (2) rinse film in water bath (rinsing dilutes lhe de*loper slott. \-rat. s hereas nonexposed areas will become radiopaque. -+ Shadow of opposite mandible (re. An accelerator an alkalt (sodium carbonate) activates thc dcveloping agents and maintains the alkalinity ofthe developer at the correct value. Prevnting neutralizution ofthe acidfxer) (3) immerse film in fixcr (4) q'ash film in watcr bath and (5) dry the film. such as potassium bromide. which is a chemical compound that is capablc ofchanging the exposed silvcr halide crystals to black mctallic silvcr. for example. it produces no appreciablc cffcct on thc unexposed silver halidc crystals in the emulsion. The opaque line 6. 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. also kno\r'n as metal. energized silver halide crystals to black rnctallic silver. prevents the developer solution from ox- idizing in the presencc ofair. An lntioxidant preserrativ€. Important: Exposed arcas will becomc radiolucent. The lucent area 4. A restrainer.\ developing agent. this is refened to as reduction. The function offixing solution is lo stop developmcnt and remove remaining unenergized. Importanti The function ofdeveloping solution is to remove the ha)idc portion ofthc enposed. At the same time. To conven thc latent (invisible) imagc on the film into a visible imagc proccss -der'eloping . unexposed silvcr halide crystals ftom the film emulsion. The fixer hardens thc film emulsion during thc proccss. Noter Thc optimal iemperature for thc dcvcloper solution is 68oF. such as hydroquinone.

Fixing agent . Preservative 30 Coplright O 20ll-2012 Dental Deck5 . Increase the kvp setting 31 Coplrighr O 20ll-2012 .''. Hardening agent .' L-' Which ingredient of lixer solution fuDctions to remove ill unerposed and underdweloped silver halide crystals from the trlm emulsion? . Acidifier . Increase the mA setting . Replenish the developing solution . Decrease the temperature Increase the temperature ofthe developing solution ofthe developing solution . .Denral Dects .

. Fogged (See Jigute #l). j\ote* 2.X-. the sizc ofthe films processed.8 oz. Fig #! AI prctures . 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].ay fixing solrtion conlains thc following: . a walcr bath is used to wash the tilm. . 3. the rcmaining unexposed silvcr halide crystals darkcn upon exposure to light and obscure ahe imagc. which is containcr dividcd into compartmcnts for thc dcvclopcr solution. An antioxidant preservative. It shoflcns drying timc and protccts the cmulsion fionr l'ollowing lixation. 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. and the tempcrarure ofthe solution l. fix. Seetigure #3). Thc fixing agent f. walcr bath. Ntanual processing is a simplc mcthod uscd to dcvclop. and fixcr solution. Thc hardener agcnt used is potassium alum. whcn the film is impropcrly cicarcd. and wash dcntal x_ray films lhc csscntial piecc ofcquipmcnt rcquircd for manual proccssing is a proccssing lank. Thc final step in rhc film proccssing is the drying ofthc films. thnsufaE ions atd sil\. Low solutio levels will appear as: developcr cut-off fJll?lg. Fixing timc is always at lcast twice as long as thc dcvcloping limc. As thc dcvcloping solution g€ts weaker. is bct$ccn 68'F and ?0'F. 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..7rirg ager.e.eprinFd from Hanng. Safelighting providcs illumination in thc darkroom lo carry out proccssing activities safely without cxposing or damaging the film. The following factors affcct the life ofa developing solutionl the clcanliness ofthe tanks. tnical timc in developer is 5 minutcs. rinsc. I vhile boftler SeeJigure #?or {ixer cut-offfs/rdight hlack border. the number of films processcd. film storage or outdated films. nnsc lor 30 seconds. is also uscd in the fixer solution. Iiilms nay be air-dricd at room Ienpcraturc in a dus! lrec area or placcd in a hcated drying cabinct. Notel Thc optimum tcmpcraturc lbr ihc devclopc. is madc upofsodium thiosulfate orammonium thiosulfate and is commonly called hwo. thcrc would bc no cbangc in contmst or dcnsity. 4. wirh both automalic and manual processing. Light spots on film may result from contact with thc fixer beforc processing (Seefgrre film may also result from improper #1). 1. $itb pemission iom Elsevier .These solutions also need to be changed on a regular basis.. thc samc prcservativc uscd in thc dcvclopcr solution. lt shrinks and hardcns thc gclatin in lhc film cmulsio affcr it has been softcned by the accclcmtor in thc developing lolution.rnpldi€r. Thc essential piccc ofcquipmcnt required for automatic processing is thc automatic processor. Thc GBX-2 safelight filter by Kodak with a l5-watl bulb at lcast 4 fcct from thc workinq surfacc is rccommendcd. sodium sulfite.1. Joen Iannucci and Laura Jdsen Lrnd: Rad iogrnphic Inrerprerltion for lhe Dotal Hygienisl. 5. lt prevcnts thc chcmical dctcrioration ofthc fixing aSent. Yellowish-brown film will result from insufficient tlxing or rinsing 2. Developer spots appear dark or black (See Jigure #5). which automalcs all film proccssing steps . the films will get lighter. ''&r! L tf u ariea radiograph werc proccsscd a sccond rime. . and the tanks need to be scrubbcd and cleancd as well. offrcsh dcvclopcr and fixcr should bc added per gallon of solution per dr]. The purposc ofthc fixing agcnt is to remove or clear all unerposed and underd€veloped silver halide crystrls liom thc film emulsion.er thiosurli?re. /e.This stcp is ncccssary to thoroughly rcmovc all cxccss chcmicAls (i. from thc cmulsio . . Thc chcmical "clcars" thc film so that thc black silver rmagc produccd by the dcvclopcr bccomcs distinctly pcrccptiblc. O 1993.

Aft€r processing a film. Overlapped films . Inadequate development time . Developer cut-off . Fixer cut-off . you notice that is rppears too dark What is the most likely caused of this problem? . 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? . Static electricity Coprigh O 201 I -20 12 ' Dental Decks . Developer solution too cool .

- 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 tim€r or lhermometer - Replace faulty timcr or thcnnometer - concenEated developer solution ' Replcnish dcveloper with fresh
Sudden t€mperature 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^'

l

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

Dental Decks .2012 . Osteoradionecrosis .. Latent period . None ofthe above disease 37 Coplriglrt €i 201l-2012. Rampant periodontal . Denial Decks . Recovery period . Cumulative effects 36 Cop)ri8hr O 201 1. Period ofcell injury . Bisphosphinate related Osteonecrosis ofthe jaw .

decades.'n. diflerent kinds of lculienia and utdrads). eL. including in lhe thyroid. ioni:dtkr1. associated with small amounts ofradiation absorbed repeatedly over a long period oftimc.)ppor_erl /o nen.tth). changes in ccll tunction or abnormal mitosis ofcellsThe r€covery p€riod is the last event in the sequcnce ofradialion injury Some cells rccover fioni the radiation ir1jury..g. Thc clinical complications that occur in bone following inadiation relate to lhe marked reduction in vascularity and the consequcnt d. lhc use ofsystemic antibiolics is recommended.Radiation induced solid canccrs.rracleristic changes kolled the aute rddiation slndtomc) th develop. and h). lllitotic delay occurs afier irrldiation ofa population ofdividing cells. hypovascular tis\ue.s /proNromnted cell de. The cell nucleus is morc sensitive to radiation than the cytoplasm. r|hi.. which are quitc different irom thal secn when a relatively small volume oftissue is exposed. Shorl-term effects: ellecls ofradiation ir1 a that appear within minutcs. Radiation elTects on rells: . ius(le. I lonever. the obsenable effects ofradiation are not visible immediately aftq cxposurc.Pcnons younger than 20 ycars ofage are more al risk for solid tumors and leukcmias than adults . Cellular injury may result in cell death.Repeated low levcls ofradiarion erposure are linked to thc induction ofcancer. ."\. Thc period ofcell injury fbllo$ s the latent period. Osteoradionecrosis is morc common in the mandible than in thc maxilla. 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. Note: Damage to lhe blood lessels /d-f.h cdure hirth defets. and genctic defects. . ihe I Hs ofORN arc hypocellu)ar bone. and salivary glands..and pos!ilradialion extractions lnd periodonta] disease. especially ifthe radiation is "low level. Radialion causcs cell death by damaging chromosomcs! preventing successful mitosis and also by apposit. These effects are not applicable !o dentistry. Carcinogenesis: .es. . the absorption of radiation occur rapidly at thc molecular level. Long-1€rm effects: effects of radiation that appear aftcr years. brain. If cxrracting afler radiolherupy. a lat€nt period occurs. . Radiation effects can be classified amounts ofradialion absorbed as cithcr: . \otc: No effccts on en'lbryos or fetuses have been shown from low doses used in denlal rldiography. . Somatic eflects are those seen in the irradiated individual.r. Damage !o the nucleus allccts thc chro' mosomes con{aining D\A and resuhs in disnlplion ofcell division. Thc mosl conlmon faclors precipitating osleoradionecrosis arc pre. or \r'eeksl associated with largc short period oltime. Late somatic effects: . . predisposes a patient 1o thc developmen! of osteoradionecrosis Histopathologically.l breaks do\.Thc incidence ofleLlkcrnia bther thdn CLL) rises following cxposure ofthe bonc marrow lo radialion . As a result.lree rudi(al fornalion) lhal lollo. This may occur spontaneously or fbllowing a loolh extraclion or denture sore and is kno\\ n as osteorrdionecrosis.s for lifetime. thcre are ch. Instead. The cumulative effects ofrepealed radialion exposure can lead to various serious health problems le. genetit nutatiotis whi. Embryos and fetuses are considerably more radiosensitive than adults bccause mosl embryonic cclls are relatively undifferenliatcd and rapidly mitotic." Note: The eflects ofradiation exposure are additive and rhc damagc that rcmains unrepaired accumulatcs in the tissues. .Radiation-induccd cancers are not distinguishable from cancers produccd by odrer causcs. carcinogenesis. following exposurc.poxic tissue and bone To prerent osleoradionccrosis: extract all hopelcss tceth three weeks prior to bcadineck radiation trcattncnl. \l'hich in tum may lead !o disruprion ot cell lirnction or cell death. depending on the tohl dose olradiation received and the amount of time it look to receive the dosc. varying amounts of time are required fbr these changcs to alter cells and cellular functions. generally appeer 10 or more yean aftcr exposure and elevdled risk remai. 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: . The latent period is the pcriod of time between radiation exposure and the ons€t ofsymptoms. The most important are radialion-induccd cancers. When the whole body is exposed to low or moderate doses of radialion. becausc oflhe richer vascular supplv to the nra\illa and lhc fact that lhe nandible is morc frequently inadialcd. . Cell recovery involvljs enzymatic repair of sirgle-strardcd brcaks of DNA. It may be short or lonc. or generations.h leuds to r\trious caxilonar. days.Chemical reactions /e. birth abnormalities. Prenatal irradiation may lead to dcadr or lo spccific devclop menlal abnonnalilies depcnding on the stage of developmcnl at the tine of irradialion.g.crcased capacity oflhc bonc to resist infection. .

Both statements are false 38 Coplrighi o 201l'2012 Dental Decks . the . Tirne (sec) . the second statement is false . Both statements are true second statement is true .. kvp . The first statement is false. All of the above 39 Coplrighr O 20ll-2012 . The first statement is true.Dental tr€cks .mA .

At the cnd oftherapy the mucositis is usually most severe. Bone: lhc primary damagc to maturc bone rcsults from radiation-induced damagc to lhe fine vasculature.The oral cavity is irradiated during the course oftreating radioscnsilivc oral malignant tumors. Radiation therapy for malignant lesions in the oral cavity is usually indicated when the lesion is radiosensitiv€. Radiation cariesi is a rampant lonn ofdentaldecay that may occur in patients who have received a course ofradiotherapy. 2. rendering the turnor cells morc radiosensitive.ith the fomation ofa white to yellow pseudomembralne ldesquamated epithelial larcr). in turn. and increased viscosiLv. 4. . . sho*. \\ hrch is normally already sparse in a dense bone such as the mandible. Ndvanced. ln addition.tube cut-rent). or deeply invasiv€ and cannot be approached surgically. . This. and is usually complete by about 2 months. . .To increase film density. often leading to radiation caries. The numb€r of electrons (vhich determines the quantity o-fx-rals producedl is controlled by the temperature of the tungsten filament (milliumperage setting). an indication ofn€crosis. the endosreum become atrophic. fi€ extent ofreduced flow is dose-dependent. As therapy continues. The carious lesions result lronl changes in the salivary glands and saliva. Digital units use a range from 8-40 kvp. the more electrodes are enitted and available to form the electron stream (the x-ra1.' l. Salivary glands: during the first lew weeks ofthenpy thcre is usually marked and progtessive loss ofsali\'ary secretion.ity. Therapeutic doses cause extensive degeneration ofnormal histologic architccture oftaste buds. Taste buds: arc sensitive to radiation. A higher kilovoltage produces x-rays with greater energy Ievels. has a very important effect on the x-rays produced at the focal spot. decreased pH. reduced buffering capacity. Note: Setting the x-ray machine for a specific milliamperage actually means adjusting the filament temperature to yield the current flow indicated.ing a lack ofosteoblastic and osteoclastic acti\. Another vahrc offractionation is that i1 increases the mean orygen tension in an inadiated rumor. Teeth: inadiation ofteeth with therapeutic doses during their development severely tetards their growth. The milliamperage range for dental radiography is 7-15 mA. you should increase mA. you should decrease the source-object distance. . xcrostomia that has persisted belond a year is lcss Iikely to show significant retum of function. The hotter the filament. Oral mucous membranes: by the end of the sccond weck ofthempy the mucous mcmbrancs bcgin to show areas ofrcdness and inflammation (zac. The intensity of x-rays produced at a particular kilovoltage depends on that number. \\+ich are believed ro havc an iiheritantly grcatcr capacity for recov€ry than tumor cells. and swallo$'ing is difliculr and painful. In dental radiography. Patients often notice a loss oftastc acuity during the second o.rrr'ti9. lhe mucous membmne begins to break down. 3. 5. the quality ofthe x-ray beam is controlled by kVp. The kilovoltage has nothing to do with the number of electrons that compose the stream flowing from cathode to anode. r Note*. third week ofradiotherapy. The mouth becomes dry freloslomldl and tender. After inadiation the mucosa bcgins to heal rapidli. including reduced tlo(. Subsequent to irmdialion lhere may be a replacement ofnormal marrow with f'atty narrow offibrous connective tissue. The kilovoltage range for most dental x-ray rnachines is 65-100 kV. u. kVp and time. Fractionation ofthe totalx-ray dose into multiple smalldoses provides greater tumor destruction than would be possible with a largc single dosc. 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). Also. usually squamous cell carcinoma. secondary infection by Candida albicans is a common complication.Inthe x-ray tube the number ofelectrons flowing per second is measured in milliamperes. Fractionation also allows incr€ased cellular r€pair of Dolmal tissues. \ote: Aduh reeih are vcry resistant to the direct effects ofradiation exposure. shorter wavelengths and more penetrating ability. Importrnt: Salivary changcs hav€ a profound influence on thc oral microflora and secondarily on the dentition. Radiation effect on oral tissu€s: .

Decreased density . One-eighth . More latitude . One-fourth as intense as intense as intense as intense . Four times . Eight times 40 Coplright O 201l-2012 .Dental Dects . A longer scale ofcontrast 41 Cop)aiglit O 20ll 2012. A shorter scale of contrast .. Denial Decks .

Incrcasing kilovoltage reduces subject cont ast (and the longer lhe scdle ofcontt?saJ. a thickness of4 x-ral beam is said to have a layer determines the Measuring the half-value necessary to decrease its intensity by one-half.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. \Iovement: a loss of image sharpness occurs ifeither the film or the paticnt moves during x-ray cxposute. Thc sha. Detcnninillg the velocity ofthe electrons to the anodc Sharpness refers to thc capability ofthe x-ray film to reproduce the distinct outlines ofan objcct. the source-to-film distance is reduced by one-half. the intensity by one-halfis beam that reduces would be mm of aluminum half-value of4 mm. The following mathematical formula is used to calculate the Inverse Square Law: original intensity new tance.ilh thick jaws.l. unclcar area that sunounds a radiographic image is termcd the penumbra. iro"ase I ilovoltage) . The "spread out" beam is less intense.tm (approxinateb'2 mm) placed n ofa change in kilovoltage is a changc in the penetrating power ofthe x-rays. but morc ofthe less pcnctrating rays which were also produced at the lower kilovoltage are omitted.0 mm:and is determined bt rhe manufacturer ofthe equipment. Detcrmining the quality ofthe x-rays produced . Altering contrast quality ([or patienls v. morc pcnctrating x-rays produced. il rs . the resultant beam is four times as intense. = new distance2 intensity original distance': Remember: The intensity ofthe radiation is inversely proportional to the square ofthe disthe path ofthe x-ray For example. whcreas slowcr film contains smaller crystals that produce more image sharpness. when the PID length is changed from 8 to l6 inches. open-cndcd cylinder and also by decreasing thc distance betwceil the object and the film. lmporlant: The smaller the focal spot area. Remember: Kilovoltagc controls the speed ofelecOne effect trons.pness ofa film is influenced by three factors: . Important: Changing the distance between the x-ray tube and the patient thus has a marked effect on beam intensity. The emulsion offastcr film contains larger crystals that produce less image sharpness. When the PID length is changed from l6 to 8 inches.nversely proportional) is that the x-ray beam spreads out as it moves from the source. For example. Important: The thickness of alumrrr. The fuzzy. if an termed the half-value layer. . or. the sharper the inlage appears: the larger the focal spot arca. Fitm composition: sharpness is relative to the size ofthe crystals found in the emulsion.m and radiograph by: .6 mm: to 1. The reason for this decrease in intensity frtr. The higher the half-value layel the more penetrating the beam. decreasing kilovoltagc incrcascs subject contrast fard rhe shorter lhe scale of conlrasl. The focal spot concentrates the electrons and crcatcs an cnor_ mous amount ofheat. Conclusion: kilovoltage influences the x-ray be. this small area convcrts bombarding electrons into x-ray photons. A ccrtain lack oi imagc sharpness is prescnt in every dental x-ray. in othcr s ords. penetrating quality of the beam. . Focal spot siz€: the tungsten target ofthc anode senes as a focal spot. The intensity of an x-ray beam at a given point is dependent on the distance ofthe measuring device from the focal spot. According to the Inve6e Square Law. The size ofthe focal spot ranges from 0. the greater the loss of imagc sharpness . the sourcelo-film distance is doubled. According to the Inverse Square Law. Note: Image sharpness can also be improved by increasing the distance between the focal spot and thc object by using a long. to how well the smallcst dctails ofan object are reproduced on a dental x-ray. the resultant beam is one-fourth as intense. A second effect ofan increase in kilovoltage is that not only are neu'.

mA .Dental Decks . Negative anode .'kVp . Positive anode . Positive cathode . Denial Decks .2012. Whether the film is a one-film packet or a two-film packel t2 Coptr'glt @ 2011. Exposure time . Negative cathode 43 Coplriglt O20ll-2012 .

thcretbrc. Tungsten target: scrv€s as a focal spol and convcrts bombarding clectrons into x-ray photons . or cxposurc limc is incressed . thc grcalcr Ihc latiludc. Reducing lhc distancc bctwccn thc focal spot and thc film also increases thc dcnsit) Note: Thc thicker thc objcct or thc grcatcr its dcnsity. is thc ability ofan x-ray to rccord scparalc structurcs that a. hcavy mctal housing that conlains thc x-ray tubc thal produccs dcnlal x-ray!.t.r a vi4 rar. lcad-lincd cylindcr that cxtends from thc opcning ofthc mctal housing ofthc tubchcad. rftr.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 . Thc r-ral tubehead is a tighlly scalcd. or cxposurc timc is decreased . collimator and PID.5-mn thick alurninum placcd in thc path ofthc x-ray bcaml they filtcr out non' pcnctrating. Thc fastcst dcntal speed is thc amounl ofradialion rcquircd 1o prodlcc a radiographic film cuncntly availablc is F-spccd. a negative cathode. kVp. *** lncrcasing nrillianrpcragc rcsults in an increase L Radiographic Notc. longcr wavclcngth x-mys . The anodc in€ludcs thc following .j ften light) to 2 l|e^ dort.ard drc tungstcn targcl ofthe anode . Radiographic not(le /o/-nrrre) is thc appcarancc ofuncvcn dcns./ and Ir is thc intcnsity of thc lighl transmittcd through thc lilm. dcnsir. it aims and shapcs thc x-ray beam Thc x-rar" tube is thc hcarl ofthc x-ray gcncrating systcm.Density rcfcrs lo thc ovcralldarkncss r/b/d(izer. thc opticaldcnsit_v ofcnamcl is about 0.. thc smallcr thc laiitudc and the lowcr thc contrast. Not€: ln a \\.eaded-glass housing: is a leaded-glass vacumm tubc that prevents x-rays liom cscaping in all dircclions. Thc pw' ^node pose oithe anode is to convert elcct. Sharpness is thc ability ofan x-ray lo dcfinc an cdgc prcciscly. l. (ot poriti\. or marks or scratchcs fiom rough handling.. thc anode con\cr(s lhc electrons into x-ravs. . .L. which produccs clcctrons \vhcn heatcd . Thc cathode includcs thc ibllorling: ./.c closc logcthcr. l. kvp. thc morc thc x-ra] bcam is attcnuatcd and lhc lighter thc rcsultant image will bc. Lead collimator: is a lcad platc wilb a central holc that fits dirccily ovcr thc opcning ofdrc mcial housing whcrc thc x-rays cxit. tilm ofslandard 2. La{itudc is. .ons into x-ray photons.).ty ofan cxposcd radiographic film. thc rangc ofradlation intensitics that a film is capablc ofrccording. 60 impulscs occur in I second. Thc highcr thc contrast. 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. Dcnsity will decrease as mA. Bcyond thcsc cxtrcmcs thc imagc is usually too light or 1oo dark to bc diagnoslically uscful.0. 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 . ljxposurc tnnc is mcasurcd in impulses bccausc x-rays arc crcalcd in a scrics ofbursts or pulscs rathcr than a continuous skcam.l Rrdiographic artifact$ arc dcfccts causcd by cnors in film handling or crrors in film proccssing.. and a positive rnode. Aluminum di$ksl shccts of0.1. Position-indic:rting device (PID)r is an opcn'cndcd. Thc clcclrons pro duced in rhc nega(i!e cathodc arc accclcratcd loward thc posjlivc anodc./: consists ofa tungsten wire lilament in a cup-shapcd holdct nradc of molybdenum.phy thc uscful rangc ollilnr dcnsilics is approximatcly 0. Thc componen! pans ofthc tubchcad includc the following: . Thc blackening oflhe fi1rn Nflcr x-ray cxposurc is cxprcsscd in tcnns ofits optical densit!: D = log l0 (lo. dcntin is about L0. Rcsolulion.a. 5. 6.v.bcam and dirccts thc bcam across thc tube lo*.llollbdenum cup: tbcuscs thc clcctrons into a narro$.Insulating oil: .cll-cxposcd and proccsscd radiograph. ii rcstricts lhc sizc ofthe x-ray beam . Cathodc /r/ r€gdrtrt. thercforc. It consists ofa lead-glass housing. Dcnsit_v will increase as mA.}{illiamperrge: the quantity or numbcr of x-rays produccd in thc numbcrofx-rays produced and an increase in lhc tcmocralurc of thc filamcnt. Transformer: is thc dclicc that altcrs thc voltagc ofincoming clcctricilv .t ?l?(rod4r consisls ofa waftr-thin tungstcn platc cmbcddc'd in a solid coppcr cord. or rcsolving powcr.Thc film characlcristic thal js ihc rcvcrsc ofcontrast is film latitude. Electrons arc produccd in thc cathode and acceleratcd toward thc anodc.l1) whcrc l0 is thc rnlcnsity ofincidcnt light /e. and soli lissuc 1s about 2. Tungsten filament: is a coilcd wirc madc oftungstcn. r1e. ofa radiograph: . The purposc oflhc calhodc is to supply the electrons nccsssary to gcncralc x-rays. 3. 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. In roulinc radiogr. Copper stem: funclions to dissipatc thc hcat away from thc tungstcn largct . Exposure time: thc lcngth of time x-rays are produccd and patient is cxposcd to lbcm. Onc inrpul\c occurs clcry 1160 ofa second.

An atom with equal numbers ofprotons and electrons . Molybdenum cup 44 Coplrighr O 201 I -2012 . A neutral atom that loses an electron and becomes a positive ion . Copper stem . Filament . Vacuum . None ofthe above 45 Coplrighr @ 201 I -2012 .D€ntal Drcks . A neutral atom without a nucleus .D€ntal D€cks ..

Particulate radiationr arc iiny particlcs ofmattcr that posscss mdss and lra!cl in straight lincs and al high spccds. Ionizalion dcals \\'ith electrons only and rcquircs sufticicnt encrgy ro ovcrcomc thc electrostatic lbrcc that binds thc clcctron to the nuclcus.ReFinrcd ti.nuc.ation is capable ofproducing ions and can bc classificd inlo two groups: . Thc atom consists oal\vo parls: . with a nlass of I and . x-r!!-s. Elccrrons arc maintaincd in thcir orbits by thc electrostalic forceJ orallraction.ny negatively chargcd particlcs ihal havc vcry little mass.m Haring. L. from FheYler. Elcctrons rravcl around thc nuclcus in $cl1-dcllncd paths known An atom contaiis a maximum ofsevcn shclls. Thc indamcntal unil ofmaller is thc atom.. nicro$avcs. dissipating hcat tiom thc tungstcn krgct and rcducing thc risk ofrnclring lhc largct- Matter is anything lhat occupics spacc and has mass.i and l-lura Ja. thc greai€r rhe loss nfdcfin:(ion and r\c greater lhe lo\r oI rhc .alltr. Joen Ia. wirh pennr$io. otonts) ot c thode rays (strcams ol hi!:h-spe. llfectrons: can bc class classificd as beta particle.haructcrizcs clcctromagnctic mdiations as discrctc bundics ofcncrg-v called photons or quanta.nsen Denhl Rt drgrdphl: tnncrples ard Techniqoes: Ihid ldiron '! 1000.rn: Dental RxdioErdy Princlties rnd Tec|' .e Lharyes) ]nd electrons /neg.l ek'( trcDs thut origindte in an .n ftonr Flsc\icr Refrinted no'n Haring. $nh t. UV rays. X'. A ccntral nucl€us: is composcd of protons and neutrons. P and Q. Alpha particles: arc cniltcd from thc nuclci ofheavy mctals and cxisl as t\\'o protons and nculrcns.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. $avclcnglh. Protons carry positiv€ clcctnc!l chargcs.!/. . Thcrc arc lbur typcs: .'. cach localcd at a spccific distanc€ lion1lhc nuclcus and rcprescrtrng diflcrcnt cncrgy lcvcls. infrarcd light. visiblc light. O. Ionizing rad.) .nnss. Thc wave concept characterizes cleckomagnctic radialion as lvavcs and focuses on thc propenies ofvelocit]'. Thc particle concept (Q d. N{.?/a'.cxamflcs includc coirnic rr] \ camma ruyJ.rrally.stoppcd by its impact on thc tungslcn larscl. Neutrons: are accclcratcd pariiclcs with a mass of I and no clectrical chargc a chargc of+l . thc K shell is locatcd clos' est ro rhe nucleus and has $c highestenergy level. . A neutrrf atom conlains an cqual numbcr of protons (posi!i.roen lrn nuccr trnd Laura J. or occur nah. or thc proccss ofconvcning an elom inlo ions. ol lhc imalc : Copper rs uscd Io hous!' thc anodc bccausc it is a good thcrmal conduclor.\ue\: lhinl Ldilron O 1000. Orbitin8 electrons: arc t. rlhcn mattcr is altcrcd. lldst nnring ?l. spccifically hydrogcn nuclci. rn clcctron wcrghs approxas imatcly 1/1800 as much orbits or shells as a prolon orncutron. and radio wavcs. An aton that gains or loscs an clcclron and bccomes electrically unbalarccd is known as an ion.cttotlj eniuetl lon the tt (k'tts ol rddioactir.\ tut nh. This is known as ihc binding energy ofan clcctron. $ithout clcclrons . An atorn with an incomplclcly Ullcd outcr shcll is clcctrically unbalanccd and aiicmpls 1o capturc an clcclton from an adjaccni atom.rr4i. 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. !{hcrcas ncutrons cary no clcctrical chargc and arc slightly hcavicr than lhc proton . Ionization js thc producrion ofions. Atoms arc capablc ofconibining wilh cach olhcr 1o lbrm molcculcs.1tun l2orr) . bclwccn thc posilivc nuclcus and thc ncgativc clcctrons. energy rcsulls. radar $avcs. Thc shclls arc dcsignatcd wift lhe lclters K. Electromagnetic radiation: can bc dcfined as lhc propagation ofwarc-likc cncrg)" /r'rrorlr l../ through spacc or mattct Illcctromagnctic radiations arc manmade.hartnc. Protonsi arc accclcrated paniclcs. and frcqucncy. N.

The first statement is falsej the second statement is true . Both statements are true . 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€? . Characteristic radiation 47 CopFighr O 201 l'2012' Dental Decks .20 | ? . Coherent scatter .. Both statements are false a6 Coptright .O 20 I 1. General (Bremsstahlung) radiation . The first statement is true. Compton scatter . the second statement is false .

000 ! olts. morc spccilically.^l (Rrcnsstrfihnrg or braking radiation: a fomi ofradialion lhat occurs lrhcn speeding clcctrons are slosed bccausc ofihcir intcraclions with thc nuclei oftarget alofis. A transformer is a dcvjcc that is uscd to cithcr incrcasc or dccrcasc lhc vollagc in an clcctrical circuil. Amperagc is thc rncasurcncDl ofthc number ofelectrons nroving through a conductor Current is measu.cs as a voltagc compcnsator that corrccis for miror flu!tuations in the currcnl I Thc milliamperage f/r. Note: ID thc produclion ofx-rays.) or tube current swltch on thc control panel regulates thc tempcr. thc tradilional unit is lhe /ad . Not all x-ra)s produccd in thc x-ray lubc arc thc same.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 \. and is controllcd by thc milliampere settings.cd in amperes or milliamperes /rr. 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). this flo$'is known as thc clcctric currcn(. The clcctric currcnr is tcnned direct currcnt frcl whcn thc clcctrons flo$. Auto-transformer: scn.rp/l. Charactcristic radiationr is produccd wien a high-spccd clcctron dislodgcs an inncr shell elcctron liom thc tungslcn alonl and causcs ionization ofthat atom.casc the voltag€ from the I l0 or 220 linc roltagc lo thc 65." . Transfbrncrs altcr thc \oltagc ofthc incoming eleckical currcnt and then routc lhc cleckical cncfgy to thc x-ray tubc. 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.tura of \ot{* th€ filament and thus thc number ofelectrons emitted.rtcd whcn thc primary bcam inlcracls u'ith mattcr li tl tal rd' .adtheteeth).000-100. Thc Iilament circuit uscs J to 5 volts. the qualit) ofthe r-ray beam is controllcd by kvp.. L Thc livp control sclccts voltage from diftcrenl levels on thc autotransformcr and applies it across Ihc primary winding ofthc slcp-up transtbrmcr . Thc kinctic cn crgy of rhc clcctrcns is converted to x-ray pholons via onc oft$o mcchanisns: . bofi thc lmpcrage and volfagc can bc adjuslcd on thc contfil pancl (mA aditstDrctt dnd kI? adiusttrcrt s\\itthes). 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. In lhc production ofdcntal x-ra)'s. Gene. This cnsrLrcs that lhc current is alwa]s flor}ing in thc samc dircclion. Step-up transformer: is used to inc. 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.Tube current or mA controls thc numbcr ofphotons gclcratcd //. l'oltage is the meas rcment ofelectrical force thal causcs clcctrors lo movc fron a ncgativc pole to a posili\'e oDc.NoteiSccondaryisless primary radialion.n which thc elcctrons flow in tl4o opposite dircctions. (lomplom scaitcr accounts ibr 6270 ofihc scaitcr that occurs in diagnostic radiography Photoelectric absorption is onc ofthe intcractions ofx-radjation \\'ith mattcr.krutoitklud(skesolitissu(softheheud. A bsorbed dose: is a m casurc matl tcr Thc SI unit is thc gr"d-r.in one direction through lbc co duclor Thc lcnn alternating current /-. 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. thrce transfbrmers arc used to adjusl lhc clcctrical circuils: . Secondarr r!diation reicrs to x-radialion that f Jn. 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. Electrical encrgv consists ofa flow ofclcctrons through a conductor. Thc tcmr braking radiation. Two electrical circuits arc uscd in lhc production ofx-rays:a lolrrvoltage or filamcnt circuil and a high-voltage circuit. 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. 5. and is conlrollcd by thc lilovoltage settings.lngc in cncrly.llcctricity is thc encrgy that is uscd (o make x-rays. shcll . Effective dosc: is uscd to cstimalc lhc risk in humars.rlersitt ol the bru ..'/ (Sv) . Voltagc is measured in volts or kilovolts /krr. Most x-rays arc produccd in lhis lpprorimately 707o ofthc x-ray cncrgy produced at thc anodc can be classificd as gcncral radiation . rcLrs to thc sudden stoppnrg or slowing ofhigh-speed eleclrons hitling the tarSet in thc anodc. regulatcs thc llo\\. In dcntal x rays. ofclcckical currcnt to thc filament ofthc x-ray tubc.li ].14) dcscnbes a currcnt .|. providcs thc high voltagc rcquircd lo accclcratc clcctrons and to gencratc x-rays in thc xray tubc. Thc unil ofcfteclive dose is thc Str'r'l?. liom cathode to anode.000 to 100.+. 2. Thc cflcct ofchanging timc is sinply 1l) control thc "quanlily" ofthe ex?osutc (the nunbcr ol phoIotts sencratel). 3n x-ray photon intcracb with an or' brtrl . Thc quantity of radiation produccd by an x ray tubc is dircctly proponional 1o lhc tubc currcnt /rr. The unit is thc 8c(quercl(Bq) . Thc high-r'oltage circuit uscs 65. Erposure: is a measurc ofradiation quantily. Dclennining the qurntily ofrudiation exposufc or dosc is tcrmcd "dosimetr).rr] beam is olicn rcfcrrcd to as thc primary bcam or useful beam..1/.000 \0lts rcquired .rratrng lhan is crc. Radioactiritr: is thc decav ratc ofradioactivc matcriai. but rot thc beam cncrgy.1cctron. .1/ cxposurc timc.t.thehotrcsolth"skull. 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 . A circuit is a palh of clcctrica I currcnt.

Tubehead seal 48 Copyright O 201 l-20 | 2 . . Denral Decks . oit . The radiation we rec€ive from outer space is called terrestrial radiation or terrestrial rays. Both statements are false 49 Cop)rlghr C 20ll 20ll. the second statement is true . We afso receive exposure from man-made (artificial) radiation.All ofthe following rre components of inherent liltration EXCEPT one. radiation used to diagnose diseases and for cancer therapy. The first statement is false. Unleaded .Dental Decks Rad Protection Man has always been exposed to natural radiation arising from the earth as well as from outside the €arth. Which one is the EXCEPIIOM . The first statement is true.A glass window leaded cone . Both statements are true . the second statement is lalse . such as x-rays.

.5 to 1. and ingested radionuclides 111%/.tt. or persons who work with radiation. or 0. 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. today. 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 insulating oil.1 rem/year (. vrelds an a\erage annual E ofabout 3 msv.S. Erternal: exposure in this category is due to cosmic and terrestrial (/iom lie rolll rtdiation or that originaling in thc cnvironment.5 mm of aluminum for up to 70 kVp and 2. consumer and industnal products and sources d9'o/. longer wavelength x-rays are harmful to the patient and are not useful in diagnostic radiography. . .0 rem/year (0. Important: Govemment regulations require total filtration to be equal to the equivalent of 1.S. Longer wavefength *** The radiation wc rcceive liom outer space is called cosmic radiation or cosmic rays. no brsis exists to assume that it is zero.ta. 3. low-energy xrays from the x-ray beam. of rJhich dental x-ray examinations are rcspottsible for only 2. l.:. Exposure and dose in radiography: The goal ofradiatiorl protectjon procedures is to minimize the exposure of ofllce perconnel and patients during the radiographic examination. takes place when the primary beam passes through the glass window of the x-ray tube. a Radiation protection standards dictate the maximum dose ofradiation that an individual can receive. The total x-rays (those produced ut lower kilovollages) are easily atrsorbed. Although the risk involved with dental radiography is extremely small in comparison with other risks such as smoking or consumption of fatty foods. Inherent filtration: aluminum.. . Thc maximum permissibl€ dose /MPD.There are two types of filtration used in the dental x-ray tubehead: . The purpose of the aluminum disks is to filter out the longer wavelength.5% ofthk alerage ual t-ru! diagnosrt etporrle/. The IUPD for an occupationallv e!posed pregnant woman is the same as that for a nonoccupationally exposed pcrson.Internal: sources ofintemal radiation include inhaled mdon fi6z.:.1 rem/year (. resulting fiom extemal and intemal sources.05 Sv. . Naturaf r:rdiation /rackgrourul rarliation)t is by f'ar the largest contributor (8J%) to the radiafion exposufe ofpeople living in thc U.. Note: The primary risk from dental radiogEphy is radiation-induced cancer./ 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.0 tnm of . is 5.. Filtration of the x-ray beam results in a higher energy and a more penetrating useful beam. These sources contribute about l670 ofthe radiation exposure lo lhe population. Filtration reduces patient dose. The yearly MPD for occupationally cxposcd pcrsons. . The philosophy ofradiation protection currently used in practice today is based on the principles ofALAR{ (As Low As Reasonabb' Ac hierah le ). The low-energy. filtration ofthe x-ray beam before it reaches the patient consists of the inherent filtration plus the added filtration. population.5 mm of aluminum for higher voltages. and the tubehead seal.60 mSv or l77o ofthe annual radiation exposure !o the U. . and nuclear medicine f4?ir.0001 Svlyear). 2. Artificial radiation yields an average annual E ofaboul0.. Shorter wavelength x-rays (those produced at higher kilovoltages) penetrate objects more rcadlly (the!-Jbt"m the image on theJilm). decreases contrast and incr€as€s the density of film. Sources of radiation exposure: . Background radiation./year). 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. .r-olcq'. The inherent filtration of the dental x-ray machine is equivalent to approximately 0.' '.0001 Sv/year). ArtificiAl radiation lnan-made radiation)i Ihese may be categorized into tbree major groups -medical diagnosis and treatmcnr (11%.

Filtration . Collimation .D€ntal Decks . the second statement is true . Barrier placement 5t CoplriSht O 201l-2012 ' Dmtal Decls . Both statements are true . The first statement is true. Discrimination . the second statement is false is false. The first statement . Both statements are false 50 Cop)right O 201l-2012 ..

is uscd to dircct thc x-ray beam.velength (high ener'gl. A rectangular collimator resfficts the size ofthe x-ray beam to an area slightly iarger than a sizc 2 InrrdL.3\ packcl irl place tbr the palicnt. Lead aprons and collars. or cone.Scr m'\ value to high€st possible value ifvariablc. Wlen x-rays exit from the pointed cone. Low encrgy rays add only to thc total amount ofradiation the patient receives. . they penetmte the plastic and produce scatler radiation. Long (16-inch) *** Thc long PID is preferred because less divergence of the x-ray bcam occlrrs.r. By doing Ihis )ou are increasing the source-film distance and rcducing patient exposurc as \r'cll as inlproving imagc . but reduce thc radiation to surrounding tissues duc to x-ray bcam divcrgcncc.l tniverssl prccauliohs) at all tim€s!:! \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 . The positioning-indicating device /P1Dl.\diust exposure time to achieve optimum density Important: nrA and exposure time are inversely relatcd. pointed plastic cone. Of the three r-vpes of PlDs. PID is prclcrrcd because it produces less divcrgence oflhe x-ray beam. . These devices do not reduce thc amount of radiation rcceivcd by thc exposed tissucs. increasing the overall quality ofthe beam. considerabJy Iargcr than a size 2 intraoral film. nalicnls cxf'osure ro 3 mitrimum . or bolh when exposiDg €diographs. A collimator may have either a round or rectangular opcniDE. Lead diaphragms placcd within the cone ofan x-ray tubehcad . long wavelength flox. Both rectangular and round PIDS are commonly available in n\. F-spced fitm or digiral imaging for pcriapical and bite$ing radiographs . A circular collimator produces a cone-shaped beam that is ?.' f.\ll ofthe lbllowing reduce the amount ofradiation to thc patient: .. Remember: The x-ray beam consists ofmany different $'avelengths. . Lcaded thyroid collars are recommendcd in individuals undcr 30 years ofage. The use of rrre earth intensifying screens for all panoramic and cephrlomctric radiography .o lcngths: . If a film must be held in place by someonc else (/br d clliki). Conical: appears as a closed. The short w.r:. milliamperage. fcdcral regulations require that thc x-ray beam be collimated to a diameter of no more than 2. Collimating an x-ray beam: using a r€ctangular collimator siSnificandy reduces patlenl exposure . . To climinatc cone-produced scattct radiation. rays have great penetrating powcr.. The operator should never remain in lhe room hold_: :-:: \-. AII dental personnel should lvcar film badgcs thal moniior :\.75 inches 17 cD. Increased flhmtion using an aluminum disk .erergl. Important: wtcn using a circular collimator. Open ended and lead-lined rectangular or round PIDs: arc uscd that do not producc scatter tadiation.75 inchcs /7 czrl in diameler. Operator protectioni Radiation exposure to the opcralor can be reduced by standing at least six feet a\\'ay. Using a long 116 ircl. :::ac :h. al$ays remcmber!o maintain prop€r infection controf /appl.r. the rectangular type is most effective in rcducing patient exposurc. the exposure time nust bc adiusred to maintain diagnoslic density ofa film. \lllen altering mA.\ . . \otei The opemtor must avoid the primary x-ray beam by positioning lhemselves at a 90 ro l-15 degree angle ro ihe beam. .r:c a l.nI and havc him or her hold rhe film.cI'irg of ?0 lo c0 k\ p lecn. . Short /8-i. _::. Therc are three basic types ofPlDs: .ed shield. the conrcal PID r\ no longer used in dcnliqlrv. and dre time ic:tings on thc control panel ofthc dcnlal x-ray machine. Frlrn-holding devices are also eflective in reducing a patient's exposufe to x-radistion . Aluminum discs are used to filter out the useless long wave rays. rays have low pcnctrating po\r'er and do not rench ihe fiJm in reasonable quantitics since thcy are atlenuated by the soft tissues. lloiages. lvlany statcs mandate lhe use ofa lead apron on all patients. Note: On some machines the kvp peak and orA :eirings are presct by the manufacturff and cannot be adjusted.ral film anJ \rgnificantll rcduccs paticnl c\lo\urc .r. taking and processing of dentr I radiographs. Iligher mn sefiings produce a beam \\ ith morc crlergt and increasc the intensity ofthe x-ray beam. 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. Use E-speed film.rr. as it exits from the PID and rcaches thc skin ofthe patient.

An improper horizontal angulation is used 52 CoDright O20ll-2012 .Dental D€ck . Central ray direction . Film-object distance . The film is placed backwards in the mouth . An improper vertical angulation is used ..D€nbl Deck . Source-film distance . The film is bent . Film parallelism Copright O 201l-2012 . Focal spot size .

rlr thol(ri refnnred fionr HlrlngIIf .ciples. t_igure #2.Figure #1. \ .nd Te.hniques:Ihrd F. 5. The film dcmonstrates a doublc cxposure.lannuccr and Laura J. Note: The size ofthe focal spot influences radiographic definition or sharpness. Thc bcnt tilm appcars distorted. J. 2. . keep the film parallel to the structure being radiographed. i.ennjrion liom Elsevier Joc. Figure #4. Direct the central ray at as close to a right angle to the film as anatomical structures ll ill allorv. Use the longest source-film distance that is practical in the panicular situation. As far as is practical.dilion O :000. Movcmcnt rcsulls in a blurred image. Use the smallest focal spot that is practical. . The operator cannot control the size ofthe focal spot.nsen: DerialRadiography: Iri. Five rules for accurate image formation when taking x-rays: l. A rcversed film appcars light lvith a hcrringbonc cfiect. Place the film as close as possible to the structure being radiographed. They are inversely proportional. Figure #3.

In film #2. What is the spacial position of the circular object in these radiographs? . The object lies between the second premolar and the first molar . The object lies lingual to the first molar . Either ofthe above 54 Copyrighr C 20ll l0ll Denlal Decks RADIOLOGY Tech The two radiographs below were taken with the buccal object rule in mind.Dental Decks Film #2 . The object lies directly apical to the first molar Film #l 55 Copyright C:01l -1012 . lncorrect horizontal angulation .RADIOLOGY Tech A periapical of the left maxillary canine shows an elongated tooth which does not capture the apex of the canine. The object lies buccal to the first molar . \yhile taking the periapical of the left maxillary canine. the x-ray tube was directed from a mesial angulation. the operator had an: . Incorrect vertical angulation .

Vertical angulation is directing x-rays so that they pass vertically through the part being examined. lf the tube is shifted and directed from a more mesial direction. thc images a. and the object in question appears to have moved mesially with respect to the reference point. *** Ilthe . Figure #1. it is called negative angulation. Joen Iannucci and Laun J$sn: DenraL Radioelaphy: Principles and Tcchniquesl ftnd Ednion. Figure #2.. Excessive vertical angulation causes foreshortened images. object in question appears to move in the same direction as the x-ray tube. ifit is dirccted toward the cciling. it is on the lingual aspect. Ifthe venical angulation is too flat.r Horizontal angulation is maintaining the central ray at 0 degrees as the tube is n]oved around the head. /re root of a tooth. It then compares the object's position on the radiograph with respect to a r€ferenc€ point (e. rvilh I)emission frcm Eh. O 1000. If the vertical angulation is too stccp. Qpposite-guccal. This technique utilizes two radiographs of an ob- ject exposed with slightly different tube angulations. 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. lfit appears to move in the opposite direction as the x-ray tube. it is called positive angulation. Borh phoros rerrinred from Hlnng.il) plane. thc imagcs arc elongatcd. This is accomplishcd by positioning thc tubchcad and direction ofthc ccntral ray in an up-anddown (vertical) planc. The buccaf obj€ct rule falso called the tube shili technique) is used to determine an object's spatial position within the jaws.g. Conversely. This is accomplished by positioning the tubehead and direction ofthe central ray in a sideto-side (horizotlt. it lies on the buccal aspect ofthe reference object.vi. Important: lncorect horizontal tube angulation causes overlapping (teeth images are superimpo./. lmportant: Foreshortening (See fgurc #1) rcfcrs to a shortcncd imagc and elongation /Seefgzrc #2) refers to an elongated image. then the object Iies lingual to that reference point. it is on the buccal aspect. while insullicient vcrtical angulation causcs clongatcd images.c foreshoracned. Remember the acronym SLIQB -+ $ame-!ingual. Both are produced by an incorrect vertical angulation. 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.ed on eaclt otlrcr). ifthe tube is shifted mesially and the object in question moves distally..

Too little vertical angulation . Chin tilted too far downward . Beam not aimed at center of fihrl 55 CoDtighr e 201l-2012 . Head tumed slightly coplri8ht <) 20ll-201: Denral Dects . lncorrect horizontal angulation . a d€ntist realizes that she has too much overlap t etween the contacts of adjacent teeth. This is an error caused by: . Too much vertical angulation .Dental Decks RADIOLOGY Tech cause Which of the following positioning errors is the most likely ofthe reverse occlusal plane curve on the panorex below? .Tech After developing her bitewings. Chin tilted too far upward .

See figure #l . .Some errors often made when taking dental radiographs: .d une\posed ldear) ligur€ #1.\ cone'cur appears as. Jocn lannucci and Laura Janscn: Dcntal Rrdrograthy: Principles and Techniqu. Herringbone effect: zigzagged pattern appears on the film the film was placed backwards in the mouth. Figur€ #2. . Severe interproximal overlapping. See penditular - cLr\. Chin tilted too far downward: L Occlusal plane shows an excessive upward curve (look like a "big smile"). See figure trelow 2. reduces diagnostic quality of film to incorrect horizontal angulation (the central x-ray was not directed perp-dueto the curvature of the qrch and through the conldclt. the film not parallel to tbe long axis ofthe teeth or the occlusal plane not being parallel to the floor.e phoNi repnnled fron Hrrin-q. Overlapping: interproximal areas are overlapped. anterior teeth appear very distofied.. \rh |lemr$ion r. . 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. Improper filln placearca on } mcnt: no apices appear on ihis film (t Figure #3. Elongation (most common error): teeth appear too long be caused by too lit-may tle vertical angulation. Poor film placement: the film was not placed lhr enough back or not forward enough in the mouth.lncorecr horizontalangulation results in orerlapped conlactareas A :on. See figure #2 .s: Third Edrtion fro'n Else\ier aa *** Mandibular structures look narrower and maxillary structures look wider (looks Iike o "frotn").

Dental Decks IOLOGY Tech Which ofthe following is a major disadvantage of the paralleling technique? . . Exposure to secondary radiation .2012 .Tech The periapical x-ray below appears distorted. The image formed on the film will not have dimensional accuracy . periodontal bone height cannot be accurately diagnosed . Cone cutting . Overbent film . Patient had glasses on . An increase in exposure time is necessary due to the use of a long cone . X-ray arm drifted Tlnd Edition O ?000. An increase in exposure time is necessary due to the use ofa short cone 59 Coptrigh aC 20ll 201? Denral Deck. What is the most likely cause of this? . Copyflghr C 201I. Due to the amount ofdistortion.

Note: This is the preftred technique for making intraorcl x-rays. expos\ve /too long).l.: I)cnlal ltrdiogr! tht Pnncrpler and lechnquer: Thtrd Fdnlon t 1000. 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. Light films (undarexposetl /intage NOT dense radiographs cause: e ough)'.ars hght.rrepnnredlonHdnng. . An ovcrcxposcd rilln anp. \irh l]crni$ro. Dark fifms (overexposed / image too dense) . An incrcascd targetfilm distance //6 ir. A film holder lXCPl must be used to keep the film parallel to the Jong axis ofthe to()th . filn appean dark. A fbggcd film appcars gray and lacks dctail and contrast Techn'que!: Thi. incorrect rnilliamperage (too h igh). Central x-ray is directed perpendicular to both the tilm and thc long axis ofthe tooth . Clear films: were not exDosed to rudiation Figure #1.n fon llscvier The paralleling technique is based on the concept ofparalielism. Double exposure: hlm rvas used twice . Other names for this technique include XCP (extension tone paralleling te. Tbc ccntral ray is pcrpcndicular 1() thc loorh and fi1nl. Blurred image: patient movement or drifting ofx-ray arm . lannucci . See figure #3 . earrings. See figure #1 . film pJaced backu.erhfr. l'igure #3. incorrect kVp (too higlt).' * \'rlr. and longcone technique.equired. Poor contrast: incorect kVp (too high) . or rernovable prosthetic appliances.phl: rniciplcs a. Using a long cone (16 inclt tatEet-liln distonce) results in greater deflnition and less imase masnification. Film is placed parallel to the long axis ofthe tooth being x-rayed .d Edrlron. The object-film distance must be increased b keep the film parallel. and scntral ray of thc x-ray bcam in thc paralleling tcchnique.d rh rennl\sl. Positions of thc lilm. ircorTect milliamperage floo /onf or exposure (too short)a incorrect focal film distance.t is . Fogged {ilms: exposed to radiation other than primary beam.hnique). . Thc film arrd long axis oflhc tooth arc |arallel.n DentalRadrogi. This results in irnage magnification and loss ofdefinition . \n undcrcxposcd l-igure #2.Some other common errors made when taking dental . ReFnred tilJn lllrine. tccth. rtght-aflgle technique. Joe.nd Lnura Jrn5c. C : . Basic Principles: . cone too far from patient's f'ace.ards.JoerlanrucciandLauraJans. Artifacts:patient didn't remove eyeglasses. See figure #2 .

May not be able to judge the correct alveolar bone height 60 Coplrighr O20ll-2012 . Due to the use ofa short cone (which results in divetgent rays). the image is not a true reproduction of the object . lncreased exposure time ..Dental Decks .Dental Decks 6t CopFSh O20ll-2012 . Image on x-ray film may be dimensionally distorted (amount may vary) .

The following best describes the bisecting t€chnique: . The rule states that two triangles are equal ifthey have two equal angles and share a common side. With this geometrical Long axis of ihe film amangement. an angle is formed by the plane ofthe film and the long axis ofthe tooth .diography: Pflncitles and Techniquesr Thnd Ediiion. through the apcx of the tooth. At the point where the film contacts the tooth. 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. srlh pennnnon lrom Central ray of the X{ay beam aimed tfirough the toolh apax tong axis of the tooth Bisecting line Figure #1.g.O 2000. The dental x-ray film is placed along the lingual surface ofthe tooth . Vertical angulation A B Figure #2. . The person taking the x-ray needs to visualize a plane that bis€cts this angle. Both lrhoros r€prinred fton Haring. The bisecting technique (also knov'n as the short-cone technique) rs based on the geometric principal known as the rule of isometry. the length of thc tooth in the mouth is equalto the length ofthc image ofthe tooth on thc film.*** The exposure time is actually decreased. This plane creates two equal angles and provides a common is called the imaginary bisector -this side for the two imaginary equal tdangles. O 2000. thc pcriodontal bone levels will not bc represented accurately. The theoreticalbasis ofthe bisected angle technique. wilh p. but as shown.mssion fron Elsevier. . Joen llnnucci and Laun Jansen: Dental R. The central ray is positioned perpendicular to the imaginary bisector LOng axrs ot looth lmaganary Cenkal ray bisector Length of imag€ Reprinr€d frotn H.ri. Joen Iannucci and Laura Janscn: Dental RadiogrAphy: Princilles and Techniques:Third Edition. The angle between the long axes ofthe tooth and film is biscctcd and x-ray beam aimed at right angles to this linc.

the second statement is false . . . the second statement is false .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. Both statements are lalse 63 Cop)righr all 2011 l0l? Denral Decks . The first statement is true. Periapical radiographs are used primarily for detecting changes in the periapical and interradicular bone. The first statement is false. Both statements are false 62 Cop$i8hr lil 201 1. The bisecting techniqu€ is th€ preferred periapical exposure method for the demonstrrtion ofthe anatomic features of p€riodontal disease. The llrst statement is true.201 2. Both statements are true . Both statements are true . Denral Decls RADIOLOGY X-rays The occlusal film is the film ofchoice for the evaluation ofperiodontal disease. the second statement is true . The first statement is false. the second statement is true .

Horizontal bone loss: thc bonc loss occurs in a plane parallel to the CEJs ofadjaccnt tccth. ro JJ% /rrt is sccn. Caries that appear interproximally may be diflicult or impossible to detecr clinically. interproximal caries is typically seen at or just below the contact point.rdrg?.ith a clinical cxaminadon. smooth. 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. Instead.Radiography is uscful for the detcction ofdcntal carics because the carious proccss causcs tooth demin€ralization. and may be detected on radiographs.\'ed on a dental x-ray. they become elliptic or semilunar. and rampant caries.se: . dle lamina dura around thc roots oflhe (ccth appcars as a dense radiopaquc linc. As ihese lesions progress. Furcation involvcmcnt may also oc sccn. it spreads laterally and continues into dentin. which affects numerous teeth. Early lesions may be difficull to detect on the dental x-ray. 'Alveolar crest: the normal alvcolar crcst is located approximatcly 1. ADA Case Type I (gr'rgivr?r9r No bony changc sccn . Thc periapical radiograph is lhc film of choice for thc cvaluation of pcriodontal discasc. is sccn. oderute periodontitis)t Modcratc bonc loss f/.Note: ln horizontal bonc loss rhc crcst ofthc buccal and lingual cortical plates and the intervcning intcrdenlal bonc havc bccn rc.0 mm rpical to the Cf. Dcntal radiogmphs play an intcgral rolc in thc asscssmcnl ofpc. Thc radiographic appcarance ofhealthy alveolrr bone can be dcscribcd as tbllo$si . vertical (angular) ttone lo.\erc bonc loss f-r3% or rrol". Fqt A number ofcolor changes may be seen *. Because ofthe superimposition ofthe dersities ofnonnal tooth structure. thc alvcolar crcst appears pointcd snd sharp and is normall) \'ery radiopNque' In the postcrior rcgions. In hcallh.On a dental x-ray. mot surl_ace caries appears as r cupped-out or crater-shaped radioluc€ncy j ust below the CEJ. aud grooves. Thc patlcm ofbonc loss may bc horizontal or vcnical and thc distnbution may bc localized or gcncralizcd. . pits.iodontal discasc. circular radiolucent ar€a with sharp.amin! dura: in hcalth. Thc sbrpe and dcnsily varies between thc antcrior and poslcrior rcgions ollhc mouth.0 mm apical to thc CEJ and no longer appcars radiopaquc. well-d€fined borders. ADA case Type lV /ssverc peiodontitis).t greater passage ol is darker than the unaliected portion (more radiolucen. Bonc loss is so cxlcnsivc that thc rcmaining tccth show cxcessivc mobilily and dritling.. Because ofthe superirnposition ofthe dense buccal and lingual enamel cusps. or may show ar obvious cavitation. this timc lhe base ofthe dangle is along the DEJ and thc apex is point€d loward the pulp chamber. with little or no apparcnt changcs in thc cnamcl. Important: The classic radiogmphic appearance ofocclusal caries extending into dentin is a bmad-based. and bonc loss is sccrPatlern ofbone lossi . the alvcolar crest is no longer locatcd L5 to 2. rvhich appears as a radiolucenc! adjacent to an existing restoration.v. radiolucent zone. S. ' 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.rld/ . Occlusd surfaces may show dark stairling in rhe fissures. the alvcolar crest appears tlat. ADA Case Type II I f. Extcnsive horizontal and vcrtjcal dcfccts may bc prcs- . the ap€)r ot' the lriangle is seen al the DEJ. 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. often beneath a fissure. caries that involves the buccal or lingxal surface appears as a small. Clinicall. 2 size films for separate prcmolar and molar projections. thc alvcolar crcsl appears indistinct. \\hen vie'. orher radiosraphic appearances ofdental caries include: recunent caries. Note: The most useful adult bitcwing cxamination consists offour no. In the snterior rcgions./'. ADA Case Type If fedrb' peiodontitis)i Mildbonc loss /.J ofadjacent teeth. root surface cari€s is easily detected on exposed root surfaccs. and parallel to a line betwcen adjacent CEJ's. The carious lesion (the demircrali:ed ared ofthe tooth that alloN. As caries rcaches thc DEl. Thc paralleling technique is lbc prcfcrrcd pcriapical €xposure method for thc dcmonstralion ofthc anatomic fcaturcs ofDcnodontal discasc. it is continuous around thc root structurc and is 01 unifbrm thick- lflportant: With pcriodontal discasc.ith dental caries. of Classification of periodontal dise. On a dental x-my.si thc bonc loss do€s not occur in a planc parallcl to thc Cts's ofadjaccnt tcclh. The most common locations include rhe e\posed roots ofthe mandibular premolar and molar areas. As caries progresses inward through rhe enamel oflhe looth.tl is sccn . l.5 to 2. Another triangular configuradon is scen in denlin. it assumes a tri{ngular configuration. buccal and lingual caries are difficult to detect on a dental x-ray and ar€ best detected clinicall).. Thc alvcolar crcst in thc postcrior regions appcars slightly less rrdiopaquc than that in lhc anterior rcgions. Dcntal radiographs must bc used in conjunction $.

Which of the following projections is best for the examination ofthe rnaxillary sinus? . Waters projection . Lateral cephalometdc projection 64 Coplright rC 20ll ?01: Denral Decks RADIOLOGY X-rays At the dental clinic. Th€ patient has been in a bar fight where he was punched just below the right eye. The patient complains of "stuffiness'and feels more so when she bends ov€r to pick up stuff. The dentist suspects a zygomatic complex fracture. Lateral jarv projection .X-rays A small town dentist gets a phone call late on Saturday night from a patient of record. Waters projection . Submentovertex projection . an emergency patient arrives complaining of swelling associated with a carious upper left molar. Which ofthe following projections is best for this examination? . The dental clinic is equipped with conventional radiography. Submentovertex projection . Reverse Toivne projection . Reverse Towne projection .

. a sinus opacification.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.ntal Radiognphyr Pn. O 2000. a radiopaque growth or a loss of conical borders of sinus.ciples and Techniqu.s: Thnd Ednion.on q 2000. In this projection. occlusal. exits at the vertex. $ith pemision fron Ehelier .For this projection the neck is maximally extended and the film cassette touches the top ofthe head. and allows direct visualization ofthe base ofthe skull. Other useful projections include periapical.J@n lannucci and LauraJansenrD. The x-ray beam enters the head under the chin (near the mental tubercle of the mandible) and.r. It is also one of the best films for radiographic diagnosis of mid-facial fractures. The zygomatic arches stand out like rhe handles ofa jug on this view.diogrdph]: Pnnciples and Techiiques: Tlird Ed. Tip ol nose l'trom film tl X-ray unrt Film casselle Reprinled from Haling. lateral head. and Caldwell. mucosal hyperplasia. This view is used in conjunction with other projections. panoramic. Waters projection will exhibit either a radiopaque tllildl level. Ifone ofthe sinuses is diseased. Joen lannucciand Laun. Waters' projection is the most useful conventional radiographic technique to image the maxillary sinuses.]anrcnr Denlal R. the radiographic densities ofnormal maxillary sinuses are the same on both sides and equal to those ofthe orbits. ! Floor Film casse[e Re[inred lion Haring.

Waters projection .Dental D€cks . Evaluation of impacted teeth . which of the following proiections would best allow for this examination? . lesions. the patient gets up too fast.On the way out ofyour dental chair. Evaluation oferuption pattems and growth and development .Which one is the TXCEPTIOIW . Transcranial projection . Diagnosis ofearly carious lesions . Dental Decks Uses of the prnorrmic radiograph include Nll of the following EXCEPT oae. and conditions ofthe jaws . Examination ofthe extent of large lesions . Submentovertex projection CoplriShr O 201l. Suspecting bilrteral subcondylar fractures.?012 . and falls chin lirst onto your tiled operatory floor. Detection ofdiseases. feels dizy. Townes projection . Evaluation of trauma Coplriglu C 201 67 l-2012 .

whcreas structures outside ofthc focal trough appear blurred. movement ofthe x-ray nlbe and film and increased object-film distance. Areas ofbone destruction on condylar heads Repriiled fiom Harng. The paticn! must b€ positioned according to the manuf'acturer's rccommendalions for the positioning ofthe spine @erjictlr straighr. The following can be demonstrated on conventional TMJ radiographs: . O 1000. The numbcr and location of the rotational centers influence the size and shape of thc focal trough. Treatment planning /e spec ia lb' ort hodontic cases) .t. and periapical lesions. 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. Patients thal are unable to !olerate inlm-oral x-rays is tl.[ased on bite blo(k)and. \oter Ale^d apron must be placed on the patient and all radiodense objects must be r€mov€d from the head and neck region.lips (. Joen lannuccr and I -anra Jrnsen. Image quality: not as sharp due to intensilying screens .The patient lies on his back with the film under his head.pically used to supplement bite-wing and periapical films and is not for infraoml films. FrankJort pl^ne lpurdllelto the Jloor).ard to didgno. Other indications fot a panoramic radiogr:rph: . both ihe film and x-ray tubeh€ad are conneoed and rotale sim haneously around the patient during exposure. periodontal disease. wrth l]emission lion lllsc\ie. Focal trough limitations:objects ofinterest lhat are located outside the focal trough are not seen . thus giving good visualiza- tion of lhe condvlar area and rami.teeth (anterior teeth positioned in theloul trough indicated l)) the groove in the bite b/o. E\ aluation ofanomalies ' Edenrulous patients /ptior to construding. Important:The panoramic radiograph a substiturc Oiherdisadvantages of a panoramic radiograph: . Note: Apanoramic radiograph gives less detail and definition than periapical radiographs due io intensifying screens. Position ofthe condyles in the glenoid fossa . Bite-wing x-rays are requircd for the diagnosis ofcarious lesions r't . Rotational centers allow the image layer to confomr to the elliptical shape of the dental arches. The Townes projection is often ofvalue in assessing the status ofthe condyles. The Townes projection eliminates this superimposition. midsagittaf plane (petpendidtlar to the lloor).on. Distonion ofimage due to increased objecl-film distancc . Note: The "reverse Towne projection" is used to identify fractures of the condylar neck and ramus area.te In prnoramic radiography. De.d Techniques: Ihird iid'r.l RadiosEphy: Prnripks r. 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 x-ray source is from the front. but rotated 30 degrees from the Frankfort plane and is directed right at the condyles.lull aentrres) . aon+re lpositioned on the nol oflhe noulh).i). Eouiomcnt cost . The movcmcnt ofthc film and the tubehead produces an image through the process kno$'n as tomography. The range of antero-posterior movement ofthe condyles . *** The main drawback ofa panoramic radiograph is that thcre is a loss ofimage detail /il earl! carious lesions). The panoramic radiograph should not be used !o evaluatc caries.

RADIOLOGY X-rays Identify each structure numbered in the partial panoramic radiograph below? ''Counes) Dr Sruan C. Root bumout 69 Cotlrighr ill201l-10l2 . Cen ical bumout . Apical burnout . $}ne. UCLA School of Denlislry 68 Cop\righi " (l 20l l-201 1 . Coronal burnout . between the edge of the enamel and the adjacent crest of the alveolar ridge is called: .Denral Decks .Denral Dects RADIOLOGY X-rays A phenomenon caused by a relatively lower x-ray absorption on the mesial or distal aspect ofteeth.

Th€ opaque mass 2. Radiographs do not demonstrate the soft tissue to hard tissue relationships and therefore provide no information about the depth ofperiodontal pockets .r. and higher than its actual counterpan. Jans. Tle receptor on such a machine is either an array of charged-coupled devices /CCD. It is causcd by the normal configuration of the affected teeth decreased x-ray absomtion in those areas. The opaque mass --) Ear lobe -) Inferior border ofopposite mandible /dkd ghost image ofcontralaleral nalrdible) 15. edrings. Radiographs will lend to show less severe bone deshuction than is actually present .lilned a. Also. The opaqu€ J J Inferior concha sinus 3.(illarysinus Dorsum oftongue 8. 12.ni Denral RrdioSr. Borh phoios reprinted from uaring. and siafogaphy irftic. hearing aids. rhe sinuses. 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. can best be viewed by using a J cross-sectional occlusal x-ray. *ith penntrs. The fine of contrast The panoramic radiograph is excellent for third molar pathology as well as to observe the TMJ. orthodonti. necklaces.le ntoefiamel junction). A ghost imege is a radiopaque artifact seen on a panoramic film that is produced when a mdiodense object is penetrat€d twice by the x-ray beam. A ghost image rescmbles its real counterpart and is found on the oppo_ site side ofthe film. complete dentures. A sialolith which is located in Wharton's duct. removable tures. a ghost image results lhat obscures diagnostic information. The line ofcontrast Inferior border of pterygoid plares 9. O 20{0. The opeque mass 6. The opaque line -+ Hard palatc/floor of nasal fossa 7. the image is presented to you in the sam€ orientation as ihat ofthe perirprcal and bite-wing x-rays. with structures on the patient's right side positioned on your left. partfulde obj ects (e. antl napkin chains) are not removed before the exposure ofa panoramic film.liology in h.phy: Pnnciples and Techniques: Third Ednion. which results in Importanl: These radiolucencies should be anticipated \r'hen viewing x-rays ofalmost any tooth and should ca ous lesion. In this way. retainers. Th€ opaque line of contrasl 10. The opaqu€ line -+ Posterior wall ofmaxillary sinus Zygomatic arch 5. The earliest finc?ien.Theopaqueline ) Posterior wall of zygomatic process ofmaxilla 4. ora film-sized photostimulable storage phosphor plate (PSPJ ratberlhan \ote:vie\\ film.l. ef'eglasses.hich a salivaD'gla d is. The verticNl lin€ ofcontrast -+ Posterior wall ofnasopharynx Soft palate The opaque mass line -+ Medial wall ofmaxillary + -r r ll.on fron El*!M Limitations of radiogruphs: . Radiographs provide a two-dimensional view ofa three-dim€nsional situstion . lmporlant:lfall metallic or radiodense the panoramic x-ray as ifyou were looking at the patient. it appears indistinct. mild destructive lesions in bone do not caus€ sumcient alterations in density to be detectable . lrrger.g-. several manufacturers have developed direct digital acquisition panoramic machines. Joen lannucci lnd Laur. not be mistaken for a (lre c?r. The line ofcontrast --) Dorsum oftongue 13. Because of the relative diminished x-ray absorption. The opaqu€ msss -+ Calcified stylo-hyoid ligament 14. The opaque line Floorof ms. however. these arcas appcar relatively radioluc€nt with ill-defined margins. is a lechnique used in ra.l'ter an opaque st$stance is injected into lrs 1/l/. hairpins.

Due to her high caries activity.riglrt (l 20ll l0ll Derr.l Decks . which are the most useful in detecting interproximal caries? . you take a full mouth series.Dental Decls RADIOLOGY X-rays A pati€nt is coming into your office for the first time. Of these radiographs. You can see obvious carious lesions on the facial surfaces of multiple teeth when she talks. Periapical radiographs .RADIOLOGY X-rays dentify this view? What are its indications? How is the patient positioned? 70 Cop]_rigbr a:01l -l0ll . Bitewing radiographs . Occlusal radiographs 71 Cop).

The lateral cephalometric x-ray must be compared with "normal" lateral radiographs from an accepted norm.nward through the contacts and includc thc crowns ofthe maxillary and nandibuhr lcelh and thc ah. 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. This practicc is nol rccommcnded duc to thc curvaturc ofrhc arch making it difiicult ro opcn allcontactson onc film. numbcr"l film is utilizcd. ltrtical bitewirgs providc morc pcriodontal infonnation. I 1. 9.. Linear and angular measurements are obtained utilizing known anatomical landmarks in the lateral head radiography ofthe patient. Oncc thc individualhas sccond molars. long. lJ. Adjust horizontal angulation to dircct thc ccntral ray loward thc ccnlcr oflhc film. and Mand. widcning oi lhc pcriodontal ligamcnt space at (he apex ofthc intcrradicular bony cresl oflhc furc. \\ hcn taking bitewing radiographs.rc lbr ekh si. the film must bc placcd in cithcr! horizontal or vertical position and thc ccnIral ra\ should bc direclcd slightly do*. Thcsc films sho\. not root apiccs. No incidcnccs havc bcen report€d ofdamagc to a fbtus from dcntal x rays. Cephalometrics are useful in assessing tooth-to-tooth.Ifusingfourfilms. This will best demonstrate the growth of structures farthest from the plane and the point. Analysis ofcephalometric radiographs is not limited to the hard structures such as bone and teeth. a(ion is strong evidence that thc pcriodonral diseasc proccss involvcs thc firrcarion. 6. \ote: The lateral cephalometric is commonly used by orthodontists in evaluation of gro$ th and development.rvhilcthc orhL'. numbcr"0" ilm1iu5cd Ifrhc child has mixcd dcnlition. May includc thc palatc or floor oflhe mouth and a rcasonablc cxlcnl ofcontiguous lateral strxctures. *** Thc Thcsc x-rays show thc crowns ofboth N{ax. Howcvcr. 2. and tooth-to-bone relationships.onclllmimagcsthcprcmolararca. Occlusal rldiographs display a relatively large scgment ofthc dcntal arch. The larg€st intraoral film size is # "4". 5.:cs thc molar arca.-: Thc vcrtical angulation for bitcwing radiograpbs should b€ bchvccn +8 and +10 dcgrces.. I0. A izzy or indistinct imagc ofcrcstal bone is oftcn associatcd wjth carly pcriodonInrs. Somctimcs nvo. r'. Alv€olar bone resorption is best demonstratcd on bitoving x. Serial cephalometric films can show the amount and direction of growth. 3. bone-to-bone. radiographic cxamjnation tbr tbc prcEnant paticnt should bc consistcnt with the patienas necds. lhe qual ity of thc fo llo\r'ing must bc cxccl Icnl: dimcnsional accurac\'.rays.colarcrcsts. and solt tissue chin. The most common route I for furcation involvcment of thc maxillarv oermancnt first molar is fiom thc mesial sidc. one on cach sidc.cr iilms on cach sidc.l \trtical bitewing x-rals will show morc dveolar bone than traditional horizonlal bitewings. T\ o bitcwrngs arc usually taken on a child. 1n ordcr for thc fi lm 1o bc of diagnoslic usc./c/ instead oftwo nunrL. and oplimum contrast and clarity olthc imagc. two lo i'our numbcr fillnsarcconvcntionallyutilizcd. 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. primart rerson for taking bitcwing radiographs is to dctcct interproximal cari€s. ima.tecth. such as bory dc 1-rcrs 3nd furcalion involvcmcnt. Thc strndard fllm sizc is # "2". . lips. .crcslal bonc lcvcls as rvcil as intcrproximal arcas oi both archcs. "l ^: \ots!. 7. Thcy arc also uscful in mon iloring thc progression ofperiodontal disease. Superimposition in longitudinal cephalometric studies is generally on a reference plane and a registration point. lfthc child has primary dcntition only. The most stable area from which to evaluate craniofacial srowth is the anterior cranial base because of its early cessation of growth. Conccm about radialion protcction is most imponant for children bccausc oftheir greater sensitivity to irradiation. opcn contacts. but also includes measurements ofsoit tissue structures such as the nose. numbcr "3 ' lilms are Dtilizcd (o.

. Both statements are true is true . The first statement is false. the second statement . The processing solutions are absorbed more easily . Both statements are false 73 Cop)'right O 20ll-2012 . The image produced is less distorted . The flrst statement is true.Dental Decks .Denral Decks The use oflntensifying screens nequlres more rrdiation to expos€ a screen lilm and results in more radiation exposure for the patient . the second statement is false . The film has less sensitivity to radiation . The film requires less radiation exposure to make an image 72 Coplriglt O 201 I -20 l2 .

Den!al x-ray film packets have four basic components: . . . rare-eafih elenents lanthatum a Ll gu. Conventional calcium tungstate screens have phosphors that cmit bjue light. It is positioncd bchind the l'ilm to shield the film from back-scattered /. radiation that rcsults in film fog. 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. It l'unctions to prevent scatter radiation from rcaching the film during exposurc. a small raiscd bump kno&n as the identification dot is found. Thc primary purposc ofthe film base is to provide a stable support for the delicate emulsion.+. 3. It sencs to protect thc cmulsion surface from manipulation as wellas mcchanicaland processing damagc. a screen film is sandwiched bctwccn two intensifying screens and secured in a cassette. Note: A screen film is an cxtraoral Iiln that requircs the use ofa scrccn lbr exposure.) that emit grccn light ln ertraoral radiography. Intraoral x-ray film: is a double-emulsion typc of film. An intensifying screen is a dcvicc that transfers x-ray energy into visible lighti the visible light. . Adhesive layer: is a thin layer ofadhesive material that covers both sides ofthc film base. Protective layeri is a thin. and chenrical exposure. L Paper film rvrapperi within the film packet is a black paper protectivc shcet that covers the film and shiclds thc film from light. less radiation is required to cxposc a screen film. 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. \ot€ L Duplicating film is a special typc of photographic film used to makc an idcnlical copy ol'an intraoral or extraoral radiograph. is Llsed to suspcnd and cvcnly dispcrsc millions ofmicroscopic silver halide cwstals over the film base. it also provides strength. doublc-cmulsion film is used instead of single-emulsion lilm bccausc it requires less mdiation exposure to prodlice an imagc. Lead foil sheet: is a single piece oflead foil that is found within the film packct. During film proccssing. Tlrcsc scrcens intensify the cflcct ofx-rays on thc liln With the usc of intcnsilying screens. In one comer ofthe intraoral film. Silver bromide and silver iodide are two rypes of silver halide crystals fbund in film cmulsion. The raised bun]p is used to detormine film orientation.l. This decreases film fbg and increases the contrast of the radiographic image. lt is used in a darkroom and is not exposed to x-radiation. cxposcs thc screen lilm. the typical emulsion is 80 to 9970 silver bromide and I to loyo silver iodide. Gelatin: l. Wben exposed to x-rays.2 mm thick and is constructed to withstand hcat. prorcctr\e black paper. Thc newer rare earth screens have phosphors /r. . A grid is composcd of a scries of thin lead strips embcddcd in a matcrial 1e g . 3. outer package $ rapping: is a soft virlyl or papet wrapper that hermctically seals the film packet. It is a homogeneous mixfurc ofgelatin and silver halide crystals. 4. 2.recor. Tlc film packct may conlain one film or two films. moisnrre./dr-1.t. *** The use ol'inlensilying scrccns requires less radiation to expose a scrcen filn and rcsults in less radiation exposure fbr the patient. and the paticnt is exposed to less radiation. and lcad foil shcct. 4. 2. thc gclatin serves to absorb thc processing solutions and allows the chcmicals to react with the silver halide crystals. transparent coating plaoed over the emulsion. in tum./o/iiittrt. humidily. Important: Thc rarc earth screens arc more ellicient and requirc lcss x-ray exposurc and are considcrcd l'astcr. It scncs to attach the emulsion to thc basc. the emitted light thcn exposes the fiLn. the phosphors lluoresce and emit visible light in thc blue or green spcctrum.rrall. p/as ti4 that pcrmils the passage ofthc x-ray beam. An intensifying screen is a smooth plastic shcct coated with rninutc fl'torcsccnt crystals knou. Film is advcrsely affected by hcat.n as phosphors. Dental film should always be used bcforc thc expiration datc on the label.The x-ray film used in dentistry has four basic components: L Film base: is a flexible piece ofpolyestcr plastic that rneasurcs 0. Halide crystals: is a chemical component rhat is sensitive to radiation arld light.

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