Dental Radiology Electron-Target Interaction

Dental Radiology 3nd stage
Lec. 2 The x-ray beam ‫ حوراء الخزاعي‬.‫د‬
Electron - Target interaction

Electrons traveling from the filament (cathode) to the target (anode) convert a small percentage of their
kinetic energy into x-ray photons by the formation of bremsstrahlung and characteristic radiation.
A. Bremsstrahlung radiation: the primary source of x-ray photons from an x-ray tube, are produced
by the sudden stopping, breaking or slowing of high-speed electrons at the target. When the electrons
from the filament strike the tungsten target, x-ray photons are created if they either hit a target nucleus
directly (rare) or their path takes them close to the nucleus. If a high speed electron hits the nucleus of a
target atom, all its kinetic energy is transformed into a single x-ray photon. (Total absorption has
occurred). Most high-speed electrons have near or wide misses with the nuclei. In these interactions, a
negatively charged high-speed electron is attracted toward the positively charged nucleus and loses
some of its velocity. This deceleration causes the electron to lose some kinetic energy, which is given
off in the form of a photon.
B. Characteristic radiation: Characteristic radiation occurs when an electron from the filament
displaces an electron from an inner-shell of the tungsten target atom, thereby ionizing the atom. When
this happens, another electron in an outer-shell of the tungsten atom is quickly attracted into the void in
the deficient inner-shell. When the displaced electron is replaced by the outer-shell electron, a photon is
emitted with an energy equivalent to the difference in the two orbital binding energies.
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So, X- ray beam consist of many photons of different wave length because:
Electrons don’t give up all their kinetic energy in identical fashion.
Factors controlling the x-ray beam

I. Exposure Time
Changing the time controls the duration of the exposure and thus the number of photons generated.
When the exposure time is doubled, the number of photons generated is doubled, but the range of
photons energies is unchanged.
II. Tube Current (mA)
The quantity of radiation produced by an x-ray tube (i.e., the number of photons that reach the patient
and film) is directly related to the tube current (mA) and the time the tube is operated. The number of
x-rays produced depends directly upon the number of electrons that strikes the target. The number of
electrons is directly related to the tube current. In dental radiography use of 7-15 mA is required. A
setting above 15 mA is not recommended because of excessive heat production in the x-ray tube.
III. Tube Voltage (kVp)
Increasing the kVp increases the potential difference between the cathode and anode, thus increasing
the energy of each electron when it strikes the target. The greater the potential difference the faster the
electrons travel from the cathode to the anode. This results in an increased efficiency of conversion of
electron energy into x-ray photons, and thus increase the number and energy of photons.
Voltage Rectification
The current from common wall plug is 60Hz. The current direction changed 120 times each second.
The main supply to the X – ray machine of 240 volts has 2 functions:
a – Generate the high potential difference (kV) to accelerate the electrons across the X – ray tube via
the step up transformer.
b – Provide the low – voltage current to heat the filament via the step – down transformer.
However, the incoming 240 volts is an alternating current with typical wave form as shown:-
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sine –wave of the AC current
Half of cycle is (+) and other half is (-) but for production of X – ray only the positive half of the cycle
can be used because x-ray produced by acceleration of electrons from cathode to anode and cannot be
produced by electrons flowing in the reverse direction from anode to cathode (x-ray tube require a DC
current). Therefore, a certain electrical device called Rectifier must be provided for converting AC to
DC by elimination of the negative half of the cycle.
Rectification is accomplished with diodes which is an electronic device containing two electrodes that
allow electrons movement from cathode to anode in one direction only . so the x-ray tube designed to
be self- rectified.
IV. Filtration
An x-ray beam consists of a spectrum of x-ray photons of different energies, but only photons with
sufficient energy to penetrate through anatomic structures and reach the image receptor (usually film)
are useful for diagnostic radiology. Low-energy (long wavelength) x-ray contribute to patient exposure
but do not have enough energy to reach the film. To reduce patient dose, the less-penetrating photons
should be removed. This can be accomplished by placing an aluminum filter in the path of the beam
(added filtration). The aluminum preferentially removes many of the lower-energy (long waves)
photons with lesser effect on the higher energy photons that are able to penetrate to the film. Inherent
filtration resulting from absorption of x-ray as they pass through the x-ray tube and its housing.
Total filtration = inherent filtration plus external filtration (aluminum disks).
V. Collimation
A collimator is a metallic barrier with an aperture in the middle used to reduce the size and shape of the
x-ray beam and thereby the volume of irradiated tissue within the patient. The round collimator is a
thick plate of radiopaque material (usually lead) with a circular opening centered over the port in the x-
ray head through which the x-ray beam emerges. Typically, round collimators are built into open-
ended aiming cylinders. Rectangular collimators further limit the beam to a size just larger than that of
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the x-ray film. The size of the beam should be reduced to the size of the film being exposed to reduce
further unnecessary patient exposure. Some types of film-holding instruments also provide rectangular
collimation of the x-ray beam.
Inverse Square Law
The intensity of an x-ray beam at a given point (number of photons per cross-sectional area per unit
exposure time) depends on the distance of the measuring device from the focal spot. For a given beam
the intensity is inversely proportional to the square of the distance from the source. The reason for this
decrease in intensity is that the x-ray beam spreads out as it moves from the source. The relationship is
as follows:
Therefore changing the distance between the x-ray tube and patient has a marked effect of beam
intensity. Such a change requires a corresponding modification of the kVp or mAs to keep constant
exposure to film or digital sensor.
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X-ray interaction with matter (Absorption of X – ray)
x-ray are absorbed by any form of matter (solid, liquid, and gas), when photons reach an atom,
different types of interaction may occur depend on photon energy:
1. X-ray photons can pass through the atom without any change occurred to both of them.
2. Coherent scattering sometimes called classical scattering or

Thompson scattering occur by interaction of low energy x-ray
photon and atom . There is no loss of photon energy only changes
in direction (photon of scattered radiation)
3. Compton effect: occurs when a photon interacts with an outer shell electron of atom. It result in
ionization of atom (ejection of Compton recoil electron) , reduction of photon energy (there is some
absorption of photon energy by ejected electron which undergoes further ionization interaction within
the tissue) , and change in x-ray direction (scattered radiation ).
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4. Photoelectric effect: occur by X – Ray photon interaction with inner – shell electron of the tissue
atom (ex. From k shell) , the X – ray photon disappears and deposits all its energy this process is pure
absorption. Now the inner – shell electron is ejected with considerable energy (now called a photo –
electron) in to the tissue for further interaction with other electrons of other tissue atoms. So this high –
energy ejected photo electron behaves like the original high energy X – ray photons interact and eject
other electrons as it passes through the tissues, these ejected electrons are responsible for the majority
of ionization interactions within the tissue and the possible resulting damage attributable to the X –
rays.
Definition of terms used in X – ray interaction:-

Scattering: - change in direction of photon with or without a loss of energy.
Absorption: - deposition of energy i.e. removal of energy from the beam.
Attenuation: - reduction in the intensity of X – ray beam caused by absorption and scattering
attenuation = absorption + scattering.
Ionization: - removal of an electron from neutral atom.
Half Value Layer
A useful way to characterize the penetrating quality of an x-ray beam by its half-value layer
(HVL). The HVL is the thickness of an absorber, such as aluminum, required to reduce by one
half the number of x-ray photons passing through it. As the average energy of an x-ray beam
increases, so does it HVL. The term quality refers to the mean energy of an x-ray beam. Half
value layer measures the intensity of a beam.
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X-ray measuring units:
1. Traditional Units
-radiation or gamma
radiation which will produced in one cc of air ions carrying one electrostatic unit of either sign.
tissue.
or tissues.
) : is the unit of quantity of radioactive material and not the radiation emitted by that
material.
2. International system of units SI Units

\kg) : 1 C\kg = 3876 R
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Lec.5 Intra oral radiographic techniques ‫ حوراء الخزاعي‬.‫د‬
Introduction
Intraoral radiographic examinations are the backbone of imaging for the general dentist. Intraoral
radiographs can be divided into three categories:
1-Periapical radiograph 2- Bitewing radiograph 3- Occlusal radiograph
Periapical radiography
Periapical radiography describes intraoral techniques designed to

show individual teeth and the tissues around the apices. Each film
usually shows two to four teeth and provides detailed information
about the teeth and the surrounding alveolar bone.
Indications:
1) Detection of apical infection.
2) Evaluation of apical cysts and other lesions within alveolar bone.
3) Assessment of periodontal status
4) Evaluation of fracture of the teeth and associated alveolar bone
5) Assessment of presence and position of unerupted or impacted teeth.
6) Assessment of root morphology.
7) During endodontic.
8) Pre implant bone evaluation.
9) Evaluation of implant postoperatively.
10) Evaluate root apex formation.
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Ideal positioning requirements for periapical radiography
The ideal requirements for the position of image receptor and the X-ray beam, relative to a tooth
include:
 The tooth under investigation and image receptor should be in

contact or, if not feasible, as close together as possible
 The tooth and image receptor should be parallel to one another
 The image receptor should be positioned with its long axis
vertically for incisors and canines, and horizontally for
premolars and molars with sufficient image receptor beyond
the apices to record the apical tissues.
 The X-ray tube head should be positioned so that the beam
meets the tooth and image receptor at right angles in both the
vertical and the horizontal planes.
 The positioning should be reproducible.
Periapical radiographic techniques
The anatomy of the oral cavity does not always allow all these ideal positioning requirements to be
satisfied. In an attempt to overcome the problems, two techniques for periapical radiography have been
developed: 1. The paralleling technique 2. The bisected angle technique.
1. Paralleling technique
Theory
1. The film packet is placed in a holder and positioned in the mouth parallel to the long axis of the
tooth under investigation.
2. The X-ray tube head is then aimed at right angles (vertically and horizontally) to both the tooth and
the film packet.
3. By using a film holder with fixed film packet and X-ray tube head positions, the technique is
reproducible.
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The anatomy of the palate and the shape of the arches mean that the tooth and the film packet cannot be
both parallel and in contact. The film packet has to be positioned some distance from the tooth. To
prevent the magnification of the image that this separation would cause, a parallel, non diverging, X-
ray beam is required. This is achieved usually by having a large focal spot to skin distance, by having a
long spacer cone or beam-indicating device (BID) on the X-ray set.
Diagram showing the position the film packet has to occupy in the mouth to be parallel to the long axis of the tooth,
because of the slope of the palate.
Diagrams showing the magnification of the image that results from using A: a short cone and a diverging X-ray beam and
B: a long cone and a near-parallel X-ray beam.
A variety of film holders has been developed for this technique could be Rinn XCP instrument (X-
extended, C-cone, P-paralleling). The choice of holder is a matter of personal performance.
Different holders will vary in cost and design but essentially consist of basic components:
 A mechanism for holding the film parallel to the tooth that also prevent bending of film.
 A bite block or platform
 An x-ray beam –aiming device, this may or may not provide additional collimation of the beam.
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SNAP-A-RAY
Bite block
Advantages of the paralleling technique
• Geometrically accurate images are produced with little magnification.

• The periodontal bone levels are well represented.
• The periapical tissues are accurately shown with minimal foreshortening or elongation.
• The crowns of the teeth are well shown enabling the detection of approximal caries.
• The horizontal and vertical angulations of the X-ray tube head are automatically determined by the
positioning devices if placed correctly.
• The X-ray beam is aimed accurately at the center of the film — all areas of the film are irradiated and
there is no coning off or cone cutting.
• Reproducible radiographs are possible at different visits and with different operators.
• The relative positions of the film packet, teeth and X-ray beam are always maintained, irrespective of
the position of the patient’s head. This is useful for some patients with disabilities.
Disadvantages of the paralleling technique
• Positioning of the film packet can be very uncomfortable for the patient, particularly for posterior
teeth, often causing gagging.
• Positioning the holders within the mouth can be difficult for inexperienced operators.
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• The anatomy of the mouth sometimes makes the technique impossible, e.g. a shallow, flat palate
• The technique cannot be performed satisfactorily using a short focal spot to skin
distance (i.e. a short spacer cone) because of the resultant magnification.
• The holders need to be autoclavable or disposable.
A Patient positioning (maxillary central incisor). B Diagram of the positioning. C Plan view of the
positioning. D Resultant radiograph with the main anatomical features indicated.
2. Bisected angle technique
Theory
The theoretical basis of the bisected angle technique can be summarized as follows:
1. The film packet is placed as close to the tooth under investigation as possible without bending the
packet.
2. The angle formed between the long axis of the tooth and the long axis of the film packet is assessed
and mentally bisected.
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3. The X-ray tubehead is positioned at right angles to this bisecting line with the central ray of the X-
ray beam aimed through the tooth apex.
4. Using the geometrical principle of similar triangles, the actual length of the tooth in the mouth will
be equal to the length of the image of the tooth on the film.
Vertical angulation of the X-ray tube head

The angle formed by continuing the line of the central ray until it meets the occlusal plane determines
the vertical angulation of the X-ray beam to the occlusal plane (X-ray beam direction in a vertical
plane). Plus vertical angulation: when the beam is tipped down ward. Minus vertical angulation: when
the beam is tipped upward.
Diagrams showing the effects of incorrect

vertical tube head positioning. A
Foreshortening of the image. B
Elongation of the image
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Horizontal angulation of the X-ray tube head
It is the x-ray beams direction in a horizontal plane. In the horizontal plane, the central ray should be
aimed through the interproximal contact areas, to avoid overlapping the teeth. The horizontal
angulation is determined by the shape of the arch and the position of the teeth.
Advantages of the bisected angle technique
• Positioning of the film packet is reasonably comfortable for the patient in all areas of the mouth.
• Positioning is relatively simple and quick.
• If all angulations are assessed correctly, the image of the tooth will be the same length as the tooth
itself and should be adequate (but not ideal) for most diagnostic purposes.
Disadvantages of the bisected angle technique
• The many variables involved in the technique often result in the image being badly distorted.
• Incorrect vertical angulation will result in foreshortening or elongation of the image.
• The periodontal bone levels are poorly shown.
• The shadow of the zygomatic buttress frequently overlies the roots of the upper molars.
• The horizontal and vertical angles have to be assessed for every patient and considerable skill is
required.
• It is not possible to obtain reproducible views.
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• Coning off or cone cutting may result if the central ray is not aimed at the center of the film,
particularly if using rectangular collimation.
• Incorrect horizontal angulation will result in overlapping of the crowns and roots.
• The crowns of the teeth are often distorted, thus preventing the detection of approximal caries.
• The buccal roots of the maxillary premolars and molars are foreshortened.
A b
Patient positioning for maxillary central incisors in bisected angle technique (a) supported by figure (b)
supported by type of film holder called Rinn Greene Stabe bite block
Diagrams showing the general requirements of the film packet position (periapical film) for A anterior and B
posterior teeth.
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Continue…. Intra oral radiographic techniques ‫ حوراء الخزاعي‬.‫د‬
Bitewing radiography
Is that intraoral technique which allows the clinicians to evaluate initial lesions by passing the primary ray
perpendicular to the long axis of the respective teeth. Bitewing radiographs take their name from the original
technique which required the patient to bite on a small wing attached to an intraoral film packet. An individual
image is designed to show the crowns of the premolar and molar teeth on one side of the jaws. It is also called as
interproximal radiographs. This includes the crowns of the maxillary and mandibular teeth and alveolar crest on
the same film.
Basic rules of bitewing techniques

Film placement- the film must be placed to cover the prescribed area.
Film position- the film must be positioned parallel to the crowns of both the upper and lower teeth
and stabilized by biting on the film holder or tab.
Vertical angulation- the central ray must be directed at 5ْ-8ْ
Horizontal angulation- the central ray must be directed through the contact areas between the teeth.
Film exposure- the x-ray beam must be centered on the film to ensure that all the areas of the film
are exposed and thus partial image or cone cut is avoided.
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Indications for bitewing technique:
In the diagnosis of interproximal caries.
Detection of secondary caries under the restoration.
To study the height of the pulp chamber.
To check the health of inter-dental alveolar bone in health and periodontal disease.
In the diagnosis of pulp stone.
To detect calculus deposits in inter-dental areas.
To determine if restoration is fractured.
Relationship of deciduous to the permanent teeth in children with mixed dentition.
Film holders
❖ Benn Reproducible film packet holder
It is a modification of Rinn-XCP film holder used in periapical

radiography
*Conclude advantages and disadvantages for film holder

❖ Bite tab
It is made up of paper loop.
*Conclude advantages and disadvantages for Bite tab
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Occlusal radiography
The occlusal radiography is intraoral radiographic techniques taken using a dental (X-ray) set where the image
receptor is placed in the occlusal plane. The film packet 5.7*7.6 cm.
Indications of occlusal radiography
assessment of the upper anterior teeth for children unable to tolerate periapical holder.
Detecting unerupted teeth, supernumeraries and odontomes.
To visualize a relatively large segment of a dental arch.
To identify expansion of cortical plate in case of any pathology such as cysts, tumors, and osteomyelitis.
Assessment of fractures of anterior teeth, alveolar bone, and maxilla and mandible.
To demonstrate maxillary sinus, and localization of object.
In patients with trismus…
During orthodontic procedure.
Detecting salivary stones …where?
Types of occlusal projection

1. Maxillary occlusal projections
2. Mandibular occlusal projections
Maxillary occlusal projections include:
a) Upper standard occlusal

b) Upper oblique occlusal
c) Vertex occlusal.
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A - Upper standard occlusal
This projection shows the anterior part of maxilla and upper anterior teeth. The technique involve:
1. Patient position …………. occlusal plane horizontal and parallel to the floor.
2. Film placed …..on the occlusal surfaces of lower teeth …. patient asked to bite together gently… the
film place centrally in the mouth (the long axis crossways).
3. X-ray tube positioned above the patient in the midline directed downward through the bridge of
the nose at 65˚ - 70˚ to the film packet.
A .Diagram showing the position of the film packet in relation to the lower arch. B. Positioning from the front; note the use of the
protective thyroid shield. C. Positioning from the side. D. Diagram showing the positioning from the side.
B – Upper oblique occlusal

This projection shows the posterior part of maxilla and the upper posterior teeth. The technique involve:
1. Patients position …….. occlusal plane horizontal and parallel to the floor.
2. Film placed on the occlusal surfaces of lower teeth with long axis anterior posterior it placed to the
side of the mouth under examination and patient asked to bite gently.
3. X-ray tube positioned at the side of patients face directed downwards through the cheek at 65 - 70˚ to
the film.
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C- Vertex occlusal
This projection shows a plan view of teeth bearing area of maxilla from above to assess the bucco - palatal
position of unerupted canines. The technique involve:
1. The patient is seated with occlusal plane horizontal and parallel to the floor.
2. The film placed on the occlusal surfaces of lower teeth with its long axis anteroposteriorly and patient
asked to bite on to it.
3. X-ray tube is positioned above the patient in the midline directed downwards through the vertex of
the skull.
Mandibular occlusal projection:
A. Lower 90˚ occlusal (true occlusal). B. Lower standard occlusal. C. Lower oblique
occlusal.
A. Lower 90˚ occlusal (true occlusal):

This projection used to show a plan view of the tooth bearing area of mandible and the
floor of the mouth. * The technique:
1. Patient tips his head backward as far as comfortable, where it is supported.
2. The film placed centrally into the mouth on the occlusal surfaces of lower teeth with
long axis crossways and patient bite gently on the film.
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3. X-ray tube placed below the patients chin in midline centering on imaginary line
joining the first molar at 90˚ to the film
A. Diagram showing the position of the film packet (white pebbly surface facing downwards) in relation to the
lower arch. B. Positioning for the lower 90° occlusal from the side. C. Diagram showing the positioning from the
side
B. Lower standard occlusal:
This projection is taken to show lower anterior teeth and anterior part of mandible. *
Technique:
1. Patient is seated with the head supported and occlusal plane horizontal and
parallel to the floor.
2. Film placed centrally into the mouth and the long axis anterioposterior then asks
him to bite on the film gently.
3. X-ray tube positioned in midline centering through the chin point at 45˚ to the film
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C. Lower oblique occlusal:
This projection shows the submandibular salivary gland on the side of interest. The
technique:
1. Patients head is supported and rotated away from the side under investigation and is
raised.
2. The film placed on occlusal surfaces of lower teeth over to the side under investigation
with long axis anterior posteriorly then he bite on the film gently.
3. X-ray tube directed upwards and forwards toward the film from below and behind the
angle of mandible and parallel to the lingual surface of the mandible.
A. Diagram showing the position of the film packet (white pebbly surface facing downwards) in relation to the lower arch for the
LEFT lower oblique occlusal.B. Positioning for the LEFT lower oblique occlusal from the side. C. Diagram showing the positioning
from the side and indicating that the patient's chin is raised and that the head is rotated AWAY from the side under investigation.
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Lec.7 ‫ ﺣ ﻮ ر اء اﻟ ﺨ ﺰ اﻋ ﻲ‬. ‫د‬
Introduction
Extraoral radiography is defined as examination of the head and facial region using films located
outside the mouth. They allow the dentist to view large areas of the jaws and skull on a single
radiograph not covered by intraoral films. It is also useful when patients are unable to open their
mouths for film placement. Extraoral radiographs do not show the details as well as intraoral films.
Extraoral radiographs are not adequate for detection of subtle changes such as the early stages of dental
caries or periodontal disease. There are many types of extraoral radiographs, some types are used to
view the entire skull, where as other types focus on the maxilla and mandible.
Skull views
True lateral skull
This projection shows the skull vault and facial skeleton from the lateral aspects. This is used when a
single lateral view of the skull is required not in orthodontics or growth studies. The image receptor is
positioned parallel to the patient's midsagittal plane. The site of interest is placed toward the image
receptor to minimize distortion. The film is adjusted so that the upper circumference of the skull is half
inch below the upper border of the cassette. The central ray is directed perpendicular to the cassette and
the midsagittal plane and towards the external auditory meatus.
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Indications:
v Fractures of the cranium and the cranial base.

v Middle third facial fractures, to show possible downward and backward displacement of
maxilla.
v Investigation of the frontal, sphenoidal and maxillary sinuses.
v Condition affecting the skull vault:
1- Paget's disease 2- Multiple myeloma 3- hyperparathyroidism 4- Conditions affecting the sella
turcica, as tumor of pituitary gland in acromegaly
Postero-anterior of the skull (PA skull)
This projection shows the skull vault, primarily the frontal bones and the jaws. The image receptor is
placed in front of the patient, perpendicular to the mid sagittal plane and parallel to coronal plan, so
that the canthomeatal line is perpendicular to the image receptor. Central ray is directed at right angles
to the film through the mid sagittal plane through the occipit.
Indications:
Fractures of the skull vault. Investigation of the frontal sinus. Conditions affecting the cranium:
1- Paget's disease 2- Multiple myeloma 3- hyperparathyroidism 4- Intracranial calcifications
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Anatomical landmarks in PA projection
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Towne's view (anteroposterior view)
Observe occipital area of skull. Neck of condylar process. Film position- cassette perpendicular to
floor, Long axis-vertically. Position of patient- back of patients head touching film. Canthomeatal line
perpendicular to film. Central ray 30 degree to canthomeatal line and passes it at a point between
external auditory meatus. It is primarily used to observe the occipital area of skull.
Submento-vertex (SMV)
This projection shows the base of the skull, sphenoidal Sinuses and facial skeleton from below. The
image receptor is positioned parallel to patient's transverse plane and perpendicular to the mid sagittal
and coronal planes. To achieve this, the patient's neck is extended as far backward as possible, beam is
perpendicular to the image receptor, directed from below the mandible toward the vertex of the skull,
and centered about 2 cm anterior to a line connecting the right and left condyles.
The indications:
v Destructive/ expansive lesions affecting the palate, pterygoid region or base of skull.
v Investigation of the sphenoid sinus.
v Assessment of the thickness (medio-lateral) of the posterior part of the mandible before
osteotomy.
v Fracture of the zygomatic arches, to show these thin bones the SMV is taken with reduced
exposure factors (Jug handle view).
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Projections for mandible

Two views for mandibular projection:
1- Lateral oblique projection
a. Mandibular Body Projection: for demonstration premolar-molar region and inferior border of
the body of the mandible. Head tilted to the side to be examined with the mandible protruded. Film is
placed against the patient's cheek and centered over the first molar. The lower border of the cassette
should be parallel to the inferior border of the mandible and at least 2cm below it. The X-ray tube 2cm
below angle of the mandible directed toward the first molar region of cassette side.
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b. Mandibular Ramus Projection: to view the ramus from the mandibular angle to the condyle for
examining the third molar region of both the maxilla and mandible. Head tilted towards the projected
mandible. Film is placed over the ramus of the mandible to the far posterior to include the condyle.
Lower border of the cassette 2cm below the inferior border of the mandible. The tube 2cm below the
inferior border of the first molar region on the tube side toward the center of the ramus on the cassette
side.
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Indications: 1 – Position of impacted third molars 2– Fractures of the ramus,

condyle, or body of the mandible (but not symphysis)
2- Postero-anterior of the jaws (PA jaws or PA mandible)
This projection shows the posterior parts of the mandible. It is not suitable for showing the facial
skeleton because of superimposition of the base of the skull and the nasal bones.
The indications:
• Fractures of the mandible involving the following sites:

1- Posterior third of the body 2- Angles 3- Rami 4- Low condylar neck
• Lesions such as cysts or tumors in the posterior third of the body or rami to note any medio-
lateral expansion
• Mandibular hypoplasia or hyperplasia
• Maxillofacial deformities
The cassette is placed in front of the patient, so that the median sagittal plane should be perpendicular
to the cassette. The head is then adjusted to bring the orbito-meatal baseline perpendicular to the
cassette. The cassette should be positioned such that the middle of cassette, is centered at the level of
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the angles of the mandible. The central ray is directed perpendicular to the cassette and centered in the
midline at the levels of the angles of the mandible.
Standard occipitomental
This projection shows the facial skeleton and maxillary anrta., and avoid superimposition of the dense
bones of the base of the skull.
Indications:
1. Middle third facial fracture

2. Coronoid process fracture
3. Maxillary, Ethmoidal and Frontal sinuses.
The patient is positioned facing the film with the head tipped back
so the radiographic baseline is at 45 degree onto the film, the so-
called nose-chin position. This positioning drops the dense of the
base of the skull downwards and raises the facial bones so they can
be seen. The x-ray tube head is positioned with the central ray
horizontal (0 degree) centered through the occipit.
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30-degree occipitomental (30-degree OM)
This projection also shows the facial skeleton, but from a different angle from the 0oOM, enabling
certain bony displacements to be detected.
The main clinical indications include:
1- Middle third facial facture 2- Coronoid process fracture 3- Maxillary and frontal sinuses
The patient is in exactly the same position as for the zero-degree OM, the head tipped back,
radiographic baseline at 45 degree to the film, in the nose-chin position. The ray- tube head is aimed
downwards from above the head, with the central ray at 30o to the horizontal, centered through the
lower border of the orbit.
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PA Water's view
The image receptor is placed in front of the patient and perpendicular to the mid sagittal plane. The
patient's head is tilted upward so that the canthomeatal line forms a 37degree angle with the image
receptor. If the patient's mouth open, the sphenoid sinus will be seen superimposed over the palate. The
central beam is perpendicular to the image receptor and centered in the area of maxillary sinuses.
Indications
1– Evaluation of the maxillary sinus 2– Evaluation of the frontal sinus 3– View of orbit and nasal
fossa
10
Caldwell's modification: Caldwell's view (or Occipitofrontal view)
is a radiographic view of skull where the X-rays is angled 20 degree to orbitomeatal line which is
perpendicular to radiographic plate. It is commonly used to get better view of frontal sinuses. The
patient's forehead is placed against the image detector, petrous ridge is below orbits, image size: 24 x
30 cm. The beam travels posterior to anterior (PA) direction, angulated by 15-20 degrees, 80-85 kVp at
25 mAs. Structures seen:
frontal sinus, ethmoidal sinus, orbital rim, medial orbital wall, zygomatic bone, nasal bone, nasal
septum, and mandible.
11
con. Extraoral radiography ‫ ﺣوراء اﻟﺧزاﻋﻲ‬.‫د‬
Introduction
The tempromandibular joint is one of the most difficult area to investigate radiographically. This fact is
underlined by the many types of investigations that have been developed over the years. Several plain
radiographic projections and the modern imaging modalities are used for showing different parts of the complex
joint anatomy.
Sagittal view coronal view
In TMJ Radiography, we should be able to identify:
• External auditory meatus of the ear. • Articular eminence.
• Articular fossa. • Mandibular condyle. • The neck of condyle.
The articular disk appears radiolucent so it can be seen by specialized imaging techniques.
Pathological lesions of TMJ which seen by radiographs
• Fractures • Benign and malignant tumor • Arthritic changes • Ankylosis • Disk displacement and
perforation • Hypertrophy and osteolytic changes in condyle.
Diagnostic imaging of the tempromandibular joint
To provide as much diagnostic information as possible about the joints, a wide range of investigations has been
developed. These can be subdivided into:
1- Conventional radiographic projections 2- Other techniques and investigations.
The choice of imaging technique will depend on: the specific clinical problem, whether hard or soft tissues
will be imaged, radiation dose, cost, availability of the imaging technique, and the amount of diagnostic
information provided by the technique. There have been considerable advances in imaging technology to reduce
radiation dose and availability of imaging continues to improve.
1
Conventional radiographic projections
1) Panoramic projection. 2)Transcranial projection. 3)Transpharyngeal projection.
4) Transorbital projection. 5) Reverse Towne's projection. 6) Submentovertex projection.
7) Conventional tomography.
1-Panoramic projection
The panoramic projection is often included as part of the examination because it provides an overall view of the
teeth and jaws, provides a means of comparing left and right sides of the mandible, and serves as a screening
projection to identify odontogenic diseases and other disorders that may be the source of TMJ symptoms. Gross
osseous changes in the condyles may be identified such as asymmetries, extensive erosions, large osteophytes,
tumors or fractures. The panoramic view should not be used as the sole imaging modality and should be
supplemented.
Panoramic image with right condylar hyperplasia Panoramic image with malignant tumor in the condyle
2-Transcranial projection
The transcranial view provides a sagittal view of the joint. The radiographs are taken of both right and left side
in both the open and the closed position. The transcranial view can be used to examine the joint for fracture with
marked dislocation and for gross arthritic changes, particularly in the lateral part of the joint.
2
3-Transpharyngeal projection
This projection depicts the medial aspect of the condyle and is taken with mouth open only. This view is
effective for demonstrating destructive changes of the condyle but less valuable for productive changes, it may
also be of value for diagnosis of condylar neck fractures, but information about the temporal component of the
joint is not available.
4-Transorbital projection
This projection provides an anterior view of the TMJ, perpendicular to transcranial and transpharyngeal
projections. X- ray beam is directed from the front of the patient through the ipsilateral orbit and TMJ of
interest. The patient opens the mouth maximally to position the condyle at the sum with the articular eminence
and avoiding superimposition of the articular eminence on the condyle. This view is useful for visualize the
condyle fractures.
5-Reverse Towne's projection
This projection shows the condylar heads and necks.
3
Submentovertex (baseler) projection
This view is useful for viewing condyles, zygomatic arch, lateral wall of the orbit, sphenoid and maxillary
sinuses and pterygoid plates and the structures of the base of the skull. A submentovertex (basal) view may
be used to determine the angulations of the condylar head long axes in order to “correct” the angulation of
the tomographic images.
Conventional tomography
Imaging of the TMJ itself is best accomplished by the use of tomography, which has the advantage of depicting
the TMJs in thin layers or slice increments. The film and x-ray source are in motion, which blurs structures that
are not in a predetermined plane of focus. The joints can be imaged in different orientations, achieving the aim
of producing views perpendicular to each other. Normally, several image slices in the sagittal (lateral) and coronal
(frontal) plane are made. Sagittal images provide information on condylar position with respect to the glenoid
fossa and can be taken at various mandibular positions. Most commonly, sagittal views are exposed with the teeth
in the closed (maximum intercuspation) and maximum open positions.
Other techniques and investigations
1) Computed tomography
a) Conventional, medical CT
b) Cone-beam CT
2) Magnetic Resonance imaging
3) Arthrography
4) Ultrasonography
4
Introduction
Panoramic imaging is a standard procedure to survey the whole dental status. It shows a two-
dimensional view of a half-circle from ear to ear. Panoramic radiography is a form of
tomography; thus, images of multiple planes are taken to make up the panoramic image. In
panoramic imaging the patient’s jaws and facial bones are scanned with a narrow x-ray beam,
which rotates around the patient producing a sharp image layer.
(Focal trough)
A panoramic image shows a curved layer of the jaws including tempromandibular joints (TMJ).
Panoramic x-ray devices produce a wide range of two-dimensional clinical views e.g. adult pan,
pediatric pan, TMJs, segments (partial panoramic view of a selected region in the dentition),
sinuses, bitewing.
In panoramic imaging, the patient's dental arch must be positioned within a narrow zone of sharp
focus known as image layer. The image layer is a three-dimensional curved zone, or "focal
trough" where the structures lying within this layer are reasonably well defined on final
panoramic image. Objects outside the image layer are blurred, magnified or reduced in size and
are sometimes distorted to the extent of not being recognizable.
5
Composition of panoramic radiography equipment

Dental panoramic radiography equipment consists of a horizontal rotating arm which holds an
X-ray source and a moving film mechanism (carrying a film) arranged at opposite side. The
patient's skull sits between the X-ray generator and the film. The X-ray source is collimated
toward the film, to give a beam shaped as a vertical blade having a width of 4-7mm when arriving
on the film, after crossing the patient's skull. Also, the height of that beam covers the mandibles
and the maxilla regions. The arm moves and its movement may be described as a rotation around
an instant center which shifts on a dedicated trajectory.
The manufacturers propose different solutions for moving the arm, trying to maintain constant
distance between the teeth to the film and generator. Also, those moving solutions try to project
the teeth arch as orthogonally as possible. It is impossible to select an ideal movement as the
anatomy varies very much from person to person. Finally, a compromise is selected by each
manufacturer and results in magnification factors which vary strongly along the film (15%-30%).
The patient positioning is very critical in regard to both sharpness and distortions. Normally, the
person bite on a plastic spatula so that all the teeth, especially the crowns can be viewed
individually. The whole orthopantomogram process takes about one minute. The patient’s actual
radiation exposure time varies between 5.5 to 22 seconds.
Patient positioning
6
To obtain diagnostically useful panoramic radiographs, it is necessary to properly prepare
patients and to position their heads carefully in the image layer. Persons who are to undergo
panoramic radiography usually are required to remove any earrings, jewellery, hair pins, glasses,
dentures or orthodontic appliances. If these articles are not removed, they may create artifacts
on the image (especially if they contain metal) and reduce its usefulness. There is also a need for
the person to stay absolutely still during the 18 or so second cycle it takes for the machine to
expose the film. For this reason, radiographers often explain to the person beforehand how the
machine will move.
Types of panoramic radiography equipment

There are two kinds of film moving mechanisms, one using a sliding flat cassette which holds
the film, and another using a rotating cylinder around which the film is wound. There are two
standard sizes for dental panoramic films: 30 cm × 12 cm and 30 cm x 15 cm. The smaller size
film receives 8% less X-ray dosage on it compared to the bigger size.
Dental X-rays' radiology is moving from film technology (involving a chemical developing
process) to digital X-ray technology, which is based on electronic sensors and computers. One of
the principal advantages compared to film based systems is the much greater exposure latitude.
This means many fewer repeated scans, which reduces costs and also reduces patient exposure
to radiation. Lost X-ray can also be reprinted if the digital file is saved. Other significant
advantages include instantly viewable images, the ability to enhance images, the ability to email
images to practitioners and clients, no darkroom required and that no chemicals are used.
7
Panoramic images are valuable diagnostic tools in these clinical tasks
• Impacted wisdom teeth diagnosis and treatment planning
• Periodontal bone loss and periapical involvement.

• Assessment for the placement of dental implants
• Orthodontic assessment. pre and postoperative
• Diagnosis of developmental anomalies such as cherubism, cleidocranial dysplasia
• Carcinoma in relation to the jaws
• Temporomandibular joint dysfunctions and ankylosis.
• Diagnosis, and pre- and post-surgical assessment of oral and maxillofacial trauma, e.g.
dentoalveolar fractures and mandibular fractures.
• Other diagnostic and treatment applications.
8
Panoramic radiography by far is a very popular and widely accepted technique. A part from the
routine uses, it is also used for dimensional and angular measurements. One of the shortcomings
of panoramic radiographs is image distortion. Magnification or distortion is an inherent property
of panoramic machine. The position of an object between the x-ray source and the film is
responsible for magnification seen on radiograph.
Principal advantage of panoramic radiography
• Broad coverage of facial bones and teeth

• Low patient radiation dose
• Convenience of examination for the patient (films need not be placed inside the mouth)
• Ability to be used in patients who cannot open the mouth or when the opening is restricted
e.g.: due to trismus
• Short time required for making the image
• Patient's ready understandability of panoramic films, making them a useful visual aid in
patient education and case presentation.
• Easy to store compared to the large set of intra oral x-rays which are typically used.
Disadvantages
1. The resultant image does not resolve the fine anatomical structures (caries, periodontal
disease)
2. There is also some magnification and overlapped images of teeth in the molar region,
however the angular relationships are accurate.
3. The cost of a panoramic x-ray machine is 2-4 times the cost of an intraoral machine.
9
1
‫ ﺣﻮراء اﻟﺨﺰاﻋﻲ‬.‫د‬ Normal radiographic anatomy
Introduction
The radiographic recognition of disease requires a sound knowledge of radiographic appearance of

normal structures. Intelligent radiologic diagnosis cannot be attempted without an appreciation of a wide
range of variation on the appearance of normal anatomic structures. Similarly, it should be recognized
that most normal patients demonstrate many of normal radiographic landmarks, but it is a rare patient
who shows all of them. Accordingly, the absence of one or even several such landmarks in any
individuals should not necessarily be considered abnormal.
Radiolucent
Radiolucent refers to that portion of a processed radiograph that is dark or black. A structure that
appears radiolucent on a radiograph lacks density and permits the passage of the X-ray beam with little or
no resistance. For example, air space freely permits the passage of dental X-rays and appears mostly
radiolucent on a dental radiograph.
Radiopaque
Radiopaque refers to that portion of a processed radiograph that appears light or white. Radiopaque
structures are dense and absorb or resist the passage of the X-ray beam.
Common Landmarks in Maxilla and Mandible
A. Radiopaque landmarks
1. Enamel: is the most homogeneous radiopaque structure in human

body. It is the outer layer of teeth, whiter than dentin, thins at CEJ.
2. Dentin: less radiopaque than enamel, has the same radiopacity as bone.
3. Cementum: It has the same density as dentin, because the decreases

contrast between dentin and cementum, in most areas of the root
surface cannot be seen radiographically.
4. Alveolar crest: the gingival margin of the alveolar process that

extends between the teeth is apparent on radiographs as a
radiopaque line known as alveolar crest, normally 1.5 mm from
CEJ of adjacent teeth.
5. Cancellous bone: also called trabecular bone or spongiosa. The

trabeculae appear radiopaque and the marrow space appear
radiolucent. It lies between the cortical plates of both jaws.
6. Cortical bone: also called compact bone. This bone without

marrow spaces. It appears more dense as compared to cancellous
bone. Examples of it, the lamina dura, lower border of mandible......
7. Lamina dura: is a dense cortical bone surrounds the tooth socket

as thin radiopaque layer continuous with the shadow of cortical
bone at the alveolar crest.
B. Radiolucent landmarks
1. Pulp: it consists of
a. pulp chamber: It is the radiolucent area in the crown of the teeth,
the size is larger in children as compared to adults
b. pulp horns: finger like projections in the coronal portion of the pulp
directed toward the cusp. b
c. Root canal: It is the radiolucent area presents in roots of the teeth a
and extends up to the apex of tooth. The pulp canals of a developing c
tooth root diverge and walls of the root taper to a knife edge. A
radiolucent area is seen surrounding it in the trabecular bone,
surrounded by a thin layer of hyperostotic bone. It is the dental
papilla with its bony crypt. Its radiographic evaluation helps in
determining the stage of maturation of the developing tooth.
2. Periodontal ligament space: PDL composed primarily of collagen, it

appears as a radiolucent space between the tooth root and the lamina dura.
Maxillary Landmarks
1. Anterior nasal spine: is located at anterior and inferior portion of the

b
nasal cavity. Located in the midline 1.5-2 cm above the alveolar crest. It
a
appears V-shaped radiopaque bony composition.
2. Nasal septum: It is vertical bony wall that divides the nasal cavity into
right and left nasal fossae, appears as vertical radiopaque portion.
3. Floor of nasal cavity: It is bony wall appears as dense radiopaque

band above the maxillary incisor.
4. Inferior concha: appears as diffuse radiopaque mass (hazy image)

within the nasal cavity. It may extend almost to the septum or fall short
by a considerable distance.
5. Nasolabial fold: It is seen in the periapical region of premolar as

radiopaque oblique line. The image of the fold becomes more prominent
with age.
6. Zygomatic process and zygomatic bone: On periapical radiograph

zygomatic process of maxilla appears as a U-shaped radiopaque line.
Zygomatic bone appears as diffuse radiopaque band extending
posteriorly from the zygomatic process of maxilla, only the inferior
portion of this bone appears on the radiograph and is present as grey and
white shadow, extend from the bicuspid or first molar area and backward
beyond the limit of film.
7. Pterygoid plate: The lateral and medial pterygoid plates lie

immediately posterior to the tuberosity at the maxilla. They cast a single
radiopaque homogeneous shadow without any evidence of trabeculation.
7
8. Maxillary tuberosity: is a rounded bony prominence present posterior 8
to third molar area. h
9. Hamular process: It may be seen as radiopaque hook-like projection

posterior to the maxillary tuberosity. The length, shape and density are
variable.
10. Floor of maxillary sinus and maxillary sinus septa: The borders of
maxillary sinus appear on periapical radiographs as a thin, delicate
radiopaque line. Sometimes one or several radiopaque lines traverse the
image of the maxillary sinus, maxillary sinus septa. The junction of
maxillary sinus and nasal cavity appears as inverted Y-shaped area apical
to canine.
1. Intermaxillary suture: or median palatal suture or median suture appears as

thin radiolucent line in the midline between two portions of maxilla. Sometimes
there is funnel shaped widening at the anterior end. The narrow radiolucent
suture is limited by two parallel radiopaque border of thin cortical bone of each
maxilla. Less distinct radiographically with age.
2. Nasal fossa or nasal cavity: pear shaped radiolucent area above the apices of
central incisor projection. The radiopaque line extending bilaterally from the
anterior nasal spine.
3. Incisive foramen: also called anterior palatine foramina. It is the oral

terminus of the nasopalatine canal. It lies in the midline on palatal side of central
incisor teeth. It may appear round or heart shaped or inverted pear, with smooth
or very irregular or well demarcated margins.
4. Nasopalatine canal and foramen: It can be recognized as two radiolucent

area above the apices of central incisor in the floor of nasal cavity, round or oval
outline depending on angle of projection.
5. Lateral fossa: also called incisive fossa or canine fossa, appears as diffuse
radiolucent area between the canine and lateral incisor.
6. Nasolacrimal canal: It may be visualized on periapical radiograph of

canine at the apex as radiolucent area when steep angulations are used.
It is usually ovoid in shape. In occlusal radiograph appear in molar
region
7. Maxillary sinus: It appears as radiolucent area above the apices of

maxillary molars. The dark shadow of the antrum is not uniformly
dense as there is difference in the thickness of the walls and the width of
the sinus.
Mandibular Landmarks
1. Genial tubercle: A ring shaped radiopacity below the

apices of mandibular incisor. It is well visualized on
occlusal radiograph.
2. Mental ridge: It may occasionally be seen as two bilateral radiopaque

line sweeping forwards and upward towards the midline superimposed on
apical root of anterior teeth.
3. Mylohyoid ridge: It appears as radiopaque band which runs diagonally

downwards and forwards from the area of third molar to premolar region at
the level of the apices of posterior teeth.
4. External oblique ridge: It is seen in the posterior periapical radiograph

superior to mylohyoid ridge as radiopaque line of varying density and
length

5. Inferior border of mandible: Occasionally it can be seen as dense,

broad radiopaque band of bone.
6. Coronoid process: It appears as a triangular radiopacity with its apex

directed superiorly and anteriorly superimposed on third molar region.
7. Lingula: It gives a radiopaque shadow, which

sometimes is projected into the area of radiolucency of
the mandibular foramen.
1. Symphysis: It is seen in infant as a radiolucent line through the midline

of the jaw between the images of developing deciduous central incisor.
2. Mental fossa: It appears radiolucent just like submandibular gland fossa.
3. Mental foramen: it may appear as a round, slit-like or irregular partially

or completely corticated radiolucency located in the apical region of
premolar.
4. Mandibular foramen and canal: the foramen appears as a round radiolucent area behind the
lingula in the ramus which continuous forward with IAC which is a dark linear shadow with
thin radiopaque superior and inferior borders.
5. lingual foramen: a small radiolucent dot in the periapical area of

mandibular anterior region.
6. Nutrient canal: seen in the anterior mandible, running vertically from the
inferior dental canal directly to the apex of tooth or into interdental space.
7. Submandibular gland fossa: It appears as a poorly defined radiolucent

area with sparse trabecular pattern, limited superiorly by mylohyoid ridge and
inferiorly by lower border of mandible.
RESTORATIVE MATERIALS
• Radiopaque (R-O): silver, amalgam, gold, silver points, stainless steel pins, gutta-percha,
stainless steel crown, orthodontic appliance, metal wire, zinc phosphate cement.
• Radiolucent (R-L): silicates, composite, calcium hydroxide base, porcelain.

10

Panoramic Anatomy
11
16
12
2
5 15 13 17
10
6 7 9
8
14
19
1
24
23 21
18
3
44 4
25 42
41 32
20
22
27
40 26 31
29
33
37
39
35
30 28
43 38 36 34
Panoramic Anatomy Key

1. maxillary sinus 25. sigmoid notch
2. pterygomaxillary fissure
26. medial sigmoid depression
3. pterygoid plates
27. styloid process
4. hamulus
28. cervical vertebrae
5. zygomatic arch
6. articular eminence 29. external oblique ridge
7. zygomaticotemporal suture 30. mandibular canal
8. zygomatic process 31. mandibular foramen
9. external auditory meatus 32. lingula
10. mastoid process 33. mental foramen
11. middle cranial fossa 34. submandibular gland fossa
12. lateral border of the orbit 35. internal oblique ridge
13. infraorbital ridge 36. mental fossa
14. infraorbital foramen 37. mental ridges
15. infraorbital canal 38. genial tubercles
16. nasal fossa 39. hyoid bone
17. nasal septum 40. tongue
18. anterior nasal spine 41. soft palate
19. inferior concha 42. uvula
20. incisive foramen 43. posterior pharyngeal wall
21. hard palate 44. ear lobe
22. maxillary tuberosity 45. glossopharyngeal air space
23. condyle 46. nasopharyngeal air space
24. coronoid process 47. palatoglossal air space

11

12

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Radiographic diagnosis of lesions ‫ ﺣﻮراء اﻟﺨﺰاﻋﻲ‬.‫د‬
(Common lesions of teeth and surrounding tissue)

1-Dental caries
Is multifactorial disease with interaction between three
factors, the tooth, the micro flora and the diet. Radiography
is useful for detecting carious lesions because the caries
process causes demineralization of enamel and dentin. The
lesion is seen in the radiograph as a radiolucent zone
because the demineralized area of the tooth does not absorb
as many x-ray photons as the unaffected portion.
Examination with conventional intraoral film
The bitewing projection is the most useful radiologic examination for detecting caries
Interproximal caries
Radiographic detection of carious lesions on the proximal surfaces of teeth depends on loss of
enough mineral to result in a detectable change in radiographic density. The shape of the early
radiolucent lesion in the enamel is classically a triangle with its broad base at the tooth surface
spreading along the enamel rods, but other appearances are common.
In moderate interproximal caries, the lesion radiographically doesn’t extend into the
dentinoenamel junction but increase in the size of the radiolucent area while in advanced
interproximal caries there is mushroom or arrow shaped radiolucent appearance with its base on
the dentinoenamel.
1
Occlusal caries (pit and fissure caries)
Carious lesions in children and adolescents most often
occur on occlusal surfaces of posterior teeth. The classic
radiographic appearance of lesions extending into the
dentin is a broad-based, radiolucent zone, often beneath a fissure.
Facial, buccal and lingual caries

Smooth surface caries form of these lesions depends on their
location and dimension. They may be round, oval or semilunar
well demarcated radiolucent area.
Root caries (cemental caries)
is defined as saucer-shaped or scooped-out radiolucent

area around the cementoenamel junction.
Recurrent or secondary caries

Radiographic appearance depends on the location of the
lesion and amount of the decalcification on it, sometime it is
not possible to detect them due to the radiopaque restorations
may obscure them. The newer form of calcium hydroxide
produces a thin radiolucent line whereas secondary caries
produces a diffuse radiolucency.
Restorative and base material

Amalgam and gold appear radiopaque. Aesthetic restorative materials were not radiopaque but
later use with radiopaue materials because the zinc in their content. Zinc oxide-eugenol and zinc
phosphate cements are radiopaque materials. Calcium hydroxide materials are radiolucent but
barium, lead or zinc add now to make them radiopaque.
2
2-Periodontal diseases
Radiographs play an integral role in the assessment of periodontal disease. They provide unique
information about the status of the periodontium. Radiographs aid the clinician in identifying the
extent of destruction of alveolar bone, local contributing factors, and features of the periodontium
that influence the prognosis. It is important to emphasize that the clinical and radiographic
examinations are complementary. The normal periodontium is characterized by an alveolar crest
level 2mm below the cementoenamel junction.
Adult periodontitis
Initial periodontitis
becomes obvious as a local disappearance of the radiopaque cristae
and/or the lamina dura. Lesions smaller than 3 mm in depth.
Moderate periodontitis
Horizontal bone loss: implies that the interdental bone loss is

horizontal and thus equal for buccal and lingual and approximal
aspect.
Vertical bone loss: implies that the bone loss occurs at
different rates on buccal and lingual bone plates thus one side
being resorbed more than the other creating 2 bone levels, which
can be visualized on the radiograph.
3
Advanced periodontitis
Periodontal breakdown in this stage is widely spread over the entire dentition. The bone level is
in the middle or apical third of the root. If molars or premolars are involved detection of furcation
involvement becomes very obvious.
3- Dental anomalies
a-Alteration in tooth size
Macrodontia: increase in size of affected tooth
(larger than normal). The shape of the tooth is
usually normal
Microdontia: decrease in size of affected

tooth ( these small teeth are frequently
malformed).
b-Alteration in the tooth structure

Amelogenesis imperfecta:
Hypoplastic: normal density of enamel but thin band (thickness is abnormal).
Hypomaturation: density of enamel is same as that of dentine and (thickness is normal).
4
Dentinogenesis imperfacta
There is constriction of the cervical portion of the tooth that gives the crown a bulbous
appearance. The roots are usually short and slender. There may be partial or complete
oblitration of pulp chumber. Root canals may be absent or if present they appear thread like.
Dentine dysplasia
Type I: Deciduous teeth are affected severely, where the pulp is almost oblitrated and roots are
markedly short or abnormally shaped.
Type II: pulp chamber may exhibits significant enlargement and apical extension thistle tube-
shaped or flame -shaped canals.
Regional odontodysplasia
Teeth are very poorly mineralized.Thin enamel and dentine

surrounding an enlarged radiolucent pulp, resulting in a pale
wispy image of tooth-gost like appearance.
5
Enamel hypoplasia
Only severely involved teeth will be detected in panoramic radiography and there may be
difficulty in distinguishing it from other disorders affect the enamel.
C-Alterations in shape of teeth
Gemination: Enlatged notched crown (clefts

in the crown), 2 pulp chambers, and single
root and pulp canal.
Fusion: There are 2 separate pulp chambers
and root canals.
Dilaceration
When the roots are bending mesially or distally, the

condition is readly apparent on an intraoral
radiograph, but when buccally or lingually bending
appearance like a bull’s eye. The periodontal ligament
may be seen as radiolucent halo.
6
Dens in dente: In coronal variety is greater radiodensity present where infolding of enamel
occurs (the lining of the infolding enamel more radiopaque than surrounding structure
….inverted teardrop-shaped radiolucency)
Enamel pearl: Enameloma is a smooth, round radiopaque structures. In contrast to the dentine
and cementum in the furcation area, enamel pearl has a radiodensity comparable to other enamel
structure.
D-Alterations in number of teeth

Missing teeth: Anodontia, Oligodontia, Hypodontia
Supernumerary teeth: Hyperdontia, mesiodens.
7
E-Alteration in eruption of teeth
Premature eruption : natal and neonatal teeth.
Roots are not seen on the radiograph and the teeth
are very small to represent the normal teeth.
Delayed eruption Impacted teeth
F- Resorption of teeth
• Internal resorption: there is irregular • External resorption: root becomes blunt
widening of pulp canal and pulp chamber. in appearance smooth resorption
The margins are sharp and well defined.
G- hypercementosis H- Pulp stone

There is blunting and rounding of apex of root.
Cementum is accumulated around the root
8
Oral and maxillofacial radiology Third stage
Radiographic diagnosis of lesions ‫ ﺣﻮراء اﻟﺨﺰاﻋﻲ‬.‫د‬
(Common lesions of teeth and surrounding tissue) -Part 2
4-Inflammatory lesions
Inflammatory lesions are by far the most common pathologic condition of the jaws. The jaws are
unique from other bones of the body in that the presence of teeth creates a direct pathway for
infectious and inflammatory agents to invade bone by means of caries and periodontal disease.
The interpretation of the periapical region on radiograph can be difficult due to:
Limitation of the imaging system
Anatomic complexity
The lag between the symptom and signs and radiographic evidence of disease
It is reported that 30-60% of mineral loss is required to produce radiographic evidence of

disease and this amount of demineralization would take approximately 10 days to occur.
Reversible pulpitis
There is no radiological evidence of the disease.
Irreversible pulpitis
There is no radiological evidence of the disease until there is periapical lesion.
Acute apical periodontitis (acute apical abscess)
It may be appeared normal radiographically and after 10 days might be a slight widening of the
periodontal ligament space.
1
Chronic apical periodontitis
Apical granuloma
Apical cyst
Chronic apical abscess
Condensing osteitis
Periapical granuloma: are the most common periapical radiolucencies

encountered in dental practice and constitute approximately 50% of all
periapical radiolucent lesions. Radiographically the lesion is not fully
dark but it has a grayish appearance, circular or ovoid radiolucent area
less than 1.5 cm in diameter.
Chronic apical abscess: at the beginning the only radiographic

sign may be a widening of the periodontal ligament space. The
lesion may have a radiolucent appearance with ill-defined borders
and it is difficult to differentiate from apical granuloma or radicular
cyst
Condensing osteitis: lesion is localized and present as increased band of radiopacity associated
with root of tooth. In some cases, periodontal ligament is widened. Margin is well defined.
2
Pericoronitis
Most common radiographic features of pericoronitis of mandibular 3rd molar, is distal bone loss
semilunar or circumferential in shape. There is no radiographic sign of pericoronitis when the
lesion confined to the soft tissue.
Osteosclerosis
Radiopaque lesion, can be solitary or multiple. Radiopacity varies
from thickening of trabeculae to ground glass appearance.
Boundaries either well defined or ill defined. The size from 2 mm to
2 cm.
Alveolar ostitis
the radiograph shows the sharply
defined dead sclerotic lamina dura
Osteomyelitis
Acute osteomyelitis first no radiographic changes, later slight decreased density of the involved
bone, loss of sharpness of trabeculae. In time bone destruction becomes more profound,
radiolucency in one focal area or scattered throughout involved bone.
Chronic osteomyelitis usually a gradual transition is seen between the normal surrounding
trabecular pattern and dense granular pattern. Its periphery may be more radiolucent and have
poorly defined border. Most of the lesions consist of more radiopaque or sclerotic bone pattern.
3
A close inspection of the radiolucent region may reveal an island of bone or sequestrum within
the center.
Garre’s sclerosing osteomyelitis
There is focal area of well calcified bone proliferation, smooth and

has got laminated appearance which called onion peel appearance.
5-Cysts of the jaws

Cyst is defined as a pathologic cavity filled with fluid and is lined by epithelium. Cyst can also
be defined as fluid or semi-fluid filled pathologic cavity lined by epithelium more often occurring
in the jawbones than in any other bones. They are thought to arise from the rests of odontogenic
epithelium remaining after tooth formation.
Dentigerous cyst: Is the most common type of developmental odontogenic cyst making
about 20% of all epithelium-lined cyst of jaws. It appears as well-defined radiolucency with
sclerotic borders seen at CEJ of unerupted tooth which is absent (sclerotic border) in case of
infected cyst.
4
Odontogenic keratocyst: It makes about 3-11% of

the entire odontogenic cyst. It is most commonly located
in molar ramus area of the mandible. It appears as round or
oval unilocular or multilocular radiolucency.
Lateral periodontal cyst: this cyst appears as radiolucent area

situated laterally at the middle third of the affected tooth, oval or round in
shape, with the size as small as less than 1 cm in diameter to large lesions
seen in botryoid type. The associated tooth is vital. Borders are sclerotic,
well defined surrounding the radiolucency sclerotic border is absent in case
of infected cyst.
Calcifying epithelial odontogenic cyst (Gorlin’s cyst): It

showing features of cyst as well as that of solid neoplasm. Cyst may be
unilocular or multilocular, radiopaque small foci can be seen within the
radiolucent area. Sometimes large calcified material occupies the lesion.
Radicular cyst: It is inflammatory type of odontogenic cyst which appears as a common

sequela associated with bacterial invasion and death of dental pulp. Radiolucent area at the apex
of tooth with well demarcated margins.
5
Residual cyst: there is radiolucency in the periapical area of extracted tooth. It is well
circumscribed, unilocular and surrounded by hyperostotic border. Cyst may displace mandibular
canal, adjacent teeth.
Nasopalatine cyst (Incisive canal cyst): appears as an area

of midline radiolucency between roots of upper central incisor in
nasopalatine canal. Round, oval, or irregular in shape.
Aneurysmal bone cyst: destructive lesion appear as

radiolucent area may have multilocular (soap bubble)
appearance. Extensive expansion of cortical plate is distinct
feature of this cyst
6- Tumors of the jaws

Odontogenic tumors
Ameloblastoma: is the most common true neoplasm of odontogenic origin. It is aggressive
type of neoplasm. Radiograph exhibiting unilocular and multilocular (soap bubble)
radiolucency, well defined border, 80% in molar- ramus region of mandible.
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Radiograph illustrating extensive lesion of
mandible associated with impacted teeth
Ameloblastoma has a tendency to invade the bone and surrounding soft tissue causing
perforation, tooth displacement and often tooth resorption.
Adenomatoid odontogenic tumor: was considered to be a variant

of ameloblastoma. at least 75% of this tumor occur in the maxilla, the
cuspid region is the usual area involved in both jaws.
Calcifying epithelial odontogenic tumor (Pindborg tumor)

Appear as diffuse or well circumscribed unilocular radiolucency. Radiopaque calcifying foci are
seen within the radiolucency. Sometimes associated with unerupted tooth. The most
characteristic and diagnostic finding is the appearance of radiopacities close to the crown of the
embedded tooth.
7
Odontoma Odontoma are the most common odontogenic tumor. It is on two type:
compound odontoma (occur in anterior maxilla)

appears as radiopaque tooth like masses.
complex odontoma (found in the mandibular first and

second molar area) appears as small shapeless,
irregular dense solid masses of calcified tissue
Ameloblastic fibroma: usually develop in

premolar –molar area of mandible as unilocular or
multilocular radiolucency. Commonly associated with
unerupted tooth, which may locate coronal to the tooth.
odontogenic myxoma
May present mottled or honey comb appearance same as
in ameloblastoma. It appears as multilocular radiolucency
with curved or straight and coarse or fine septa. Most
common site posterior region of mandible.
8
Benign cementoblastoma
It appears as well-defined radiopaque area with well-corticated

border attached to the root portion of tooth. Surrounded by
well- defined radiolucent band inside the cortical border
7- Diseases of bone manifested in the jaws

Fibrous Dysplasia periapical cemental dysplasia
Mostly in mandibular anterior teeth
Finger print pattern around the roots of the first molar
Have three stages: early-
Orange-peel pattern
radiolucent, mixed- (radiolucent and
Granular or ground-glass pattern radiopaque( more radiolucent) ,
mature-(radiolucent and radiopaque(
Cotton wool pattern
more radiopaque)
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Oral and maxillo facial radiology Third stage
Intraoral localization techniques

(parallax technique) ‫ ﺣ ﻮ ر اء ﻧ ﻮ ر ي‬. ‫د‬
These are methods used to locate the position of a tooth or an object in the jaw .The dental
radiograph is a 2D picture of a 3D object. It depicts the object in the superio-inferior and
antero-posterior relationship or depth of the object.
Indications
Foreign bodies
Impacted teeth
Unerupted teeth
Retained roots
Salivary stones
Broken needles and instruments
Root positions
1- Buccal object rule (tube shift technique)

The basic principal is that the relative position of the radiographic images of two
separate objects changes when the projection mode is changed. A different
horizontal angle is used when trying to locate vertically aligned images.e.g. root
canals. A different vertical angulation is used when trying to locate a horizontally
aligned image. e.g. mandibular canal.
Method:
Two radiographs of the object are taken first using the proper technique and
angulations as prescribed and the second radiograph is taken keeping all other
parameters constant and equivalent of those of the central ray either with different
horizontal or vertical angulation is used.
1
Interpretation
When the dental structure or object seen in the second radiograph appears to have
moved in the same direction as the shift of the position indicating device(PID), the
structures or object in question is said to be positioned lingually. If object appears
to have in a direction opposite to the shift of the PID, then the object is positioned
buccally. SLOB Rule- Same side Lingual Opposite side Buccal
2
2.Right angle technique

Here two projections are taken at right angles to each other, which helps to localize
an object in the maxilla or mandible.
Method
¢ A periapical radiograph is taken to show the position of the object superio-
inferiorly anterio-posteriorly.
¢ An occlusal radiograph is taken which will show the object’s bucco-lingual
and antero-posterior relationship.
¢ The two radiographs when studied together help to localize the object in all
three dimensions.
3

Dental Radiology Electron-Target Interaction

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Dental Radiology Electron-Target Interaction

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Dental Radiology 3nd stage

Lec. 2 The x-ray beam ‫ حوراء الخزاعي‬.‫د‬

Electron - Target interaction

Factors controlling the x-ray beam

II. Tube Current (mA)

III. Tube Voltage (kVp)

sine –wave of the AC current

Inverse Square Law

2. Coherent scattering sometimes called classical scattering or

Definition of terms used in X – ray interaction:-

2. International system of units SI Units

Periapical radiography describes intraoral techniques designed to

 The tooth under investigation and image receptor should be in

Periapical radiographic techniques

Advantages of the paralleling technique

• Geometrically accurate images are produced with little magnification.

Disadvantages of the paralleling technique

2. Bisected angle technique

Vertical angulation of the X-ray tube head

Diagrams showing the effects of incorrect

Advantages of the bisected angle technique

• Positioning is relatively simple and quick.

Disadvantages of the bisected angle technique

• Incorrect vertical angulation will result in foreshortening or elongation of the image.

• The periodontal bone levels are poorly shown.

Basic rules of bitewing techniques

Vertical angulation- the central ray must be directed at 5ْ-8ْ

❖ Benn Reproducible film packet holder

It is a modification of Rinn-XCP film holder used in periapical

*Conclude advantages and disadvantages for film holder

It is made up of paper loop.

*Conclude advantages and disadvantages for Bite tab

Indications of occlusal radiography

Types of occlusal projection

Maxillary occlusal projections include:

a) Upper standard occlusal

B – Upper oblique occlusal

Mandibular occlusal projection:

A. Lower 90˚ occlusal (true occlusal):

B. Lower standard occlusal:

C. Lower oblique occlusal:

True lateral skull

v Fractures of the cranium and the cranial base.

Postero-anterior of the skull (PA skull)

1- Paget's disease 2- Multiple myeloma 3- hyperparathyroidism 4- Intracranial calcifications

Anatomical landmarks in PA projection

Projections for mandible

Indications: 1 – Position of impacted third molars 2– Fractures of the ramus,

2- Postero-anterior of the jaws (PA jaws or PA mandible)

• Fractures of the mandible involving the following sites:

1. Middle third facial fracture

30-degree occipitomental (30-degree OM)

The main clinical indications include:

Caldwell's modification: Caldwell's view (or Occipitofrontal view)

Sagittal view coronal view

In TMJ Radiography, we should be able to identify:

• External auditory meatus of the ear. • Articular eminence.

• Articular fossa. • Mandibular condyle. • The neck of condyle.

Pathological lesions of TMJ which seen by radiographs

Diagnostic imaging of the tempromandibular joint

1- Conventional radiographic projections 2- Other techniques and investigations.

1) Panoramic projection. 2)Transcranial projection. 3)Transpharyngeal projection.

4) Transorbital projection. 5) Reverse Towne's projection. 6) Submentovertex projection.