• Radiation Biology
• Is the study of the effect of ionizing radiation on
living tissue, to understand the harmful effects
of x-radiation.
• Radiation Chemistry
• is a subdivision of nuclear chemistry which is
the study of the chemical effects of radiation on
matter; this is very different from
radiochemistry as no radioactivity needs to be
present in the material which is being
chemically changed by the radiation.
• example
– is the conversion of water into
hydrogen gas and hydrogen peroxide.
• Radiation injury
• Mechanisms of injury
• Theories of radiation injury
• Dose-response curve
• Radiation and Nonstochastic
• Sequence of radiation injury
• Determining factors for radiation injury
• X-RAY PRODUCTION: REVIEW
• X-rays are produced when the process of
ionization occurs in a target atom
• When an x-ray machine is activated, electrons
from the cathode will go to the anode. As they
reach the target, the high speed electrons will
stop and bombard the tungsten atoms. This
produces x-rays
• Inefficient since only 1% in the interaction of
the electron and the target atom produces x-
rays while 99% produces heat (that’s why the
copper stem is needed)
• After the x-rays are produced, they go off in
different directions. Those x-rays that come out
of the aiming cylinder will be considered useful
x-rays
• Useful x-ray beams: those with enough energy
to penetrate objects
• Occurs in the anode/tungsten part
• Occurs in 2 ways:
a. Bremsstrahlung radiation
primary source of radiation
There are 2 ways to get this reaction
• 1. direct hit interaction of the electrons on the
tungsten atom nucleus to give off a maximum
energy photon
• 2. if the electron passes very near to the
nucleus, the electron will slow down and then
be deflected in one direction. This generates a
photon with less energy compared to the direct
hit process (near-miss interaction)
Note: the closer the electrons pass to the nucleus, the
higher the energy generated
b. Characteristic radiation
minor radiation source
occurs when an electron hits an electron in the
inner shell, creating a vacancy and allowing the outer
electron to invade the vacant space, emitting a
photon.
Note: a higher energy is produced if the electron that is
hit is in the inner shell instead of the outer shell
Note: Brem’s has a higher energy since it can produce a
photon with an equal energy to the electron that was
hit.
Characteristic radiation can only produce energy
equivalent to
the difference in the two orbital binding energies of the
electrons that hit each other (less than Brem’s)
• INTERACTION OF X-RAYS WITH MATTER
The intensity of an x-ray beam is reduced by
interactions with the matter it encounters
X-ray photons are either absorbed or scattered
out of the beam
1. Absorption: photons ionize absorber atoms,
deposition of energy ~ Photoelectric Absorption
like characteristic radiation where there is
electron ejection and transfer
2. Scattering: photons are ejected out of the primary
beam; change in direction without energy loss
a. Coherent Scattering
- least frequent type of reaction
- no energy change just a change in direction
- photons bump to an outer shell electron
b. Compton Scattering
- most frequent type of reaction
- like coherent scattering wherein photons hit the outer
electrons. The difference is in Compton, the photon
loses part of its energy but still propagates
• COHERENT SCATTERING
• A form of electromagnetic wave in which the
photons share the same frequency and
wavelenghts are in the phase with one another.
• COMPTON SCATTERING
• Is the scattering of a photon after an interaction
with na charged particles, usually an electron
• the Compton effect: If it results in a decrease in
energy (increase in wavelength) of the photon
(which may be an X-ray or gamma ray photon).
Part of the energy of the photon is transferred
to the recoiling electron.
• Inverse Compton scattering occurs when a
charged particle transfers part of its energy to a
photon.
• Mechanisms of injury
• In diagnostic radiography, not all x-ray pass
though the patient and reach the dental x-ray
film; some are absorbed by the patient’s tissues
– Absorption
 x-ray can be absorbed by
matter; the absorption depends
on the atomic structure of
matter and the wavelength of
the x-ray
 refers to the total transfer of
energy from the x-ray photon
to patient tissues.
• Two specific mechanisms of radiation injury are
possible
• Ionization
• Free radical formation
• Theories of Radiation injury
• Damage to living tissues caused by exposure to
ionizing radiation may result from a direct hit
and absorption of an x-ray photon within a cell
accompanied by free radical formation.
 • Two theories are used to describe how
radiation damages biologic tissues
• Direct theory
Cell damage results when ionization radiation
directly hits critical areas, or targets, within the cell
• Indirect theory
Radiation injury suggests that x-ray photons are
absorbed within the cell and cause the formation of
toxins, which in turn damage the cell.
• Dose-response curve
• Can be used to correlate the “response,” or
damage, of tissues with the “dose,” or amount,
of radiation received.
• When dose and damage are plotted on a graph,
a linear, nonthreshold relationship is seen.
• Nonthreshold
– Dose-response curve suggests that no
matter how small the amount of
radiation received, some biologic
damage occurs
• Stochastic and Nonstochastic radiation effects
• Stochastic effects
– Occurs as a direct function of dose.
– Have a dose threshold
Example: Tumor
• Nonstochastic effects
Are somatic effects that have a threshold and
that increase in severity with increasing absorbed
dose
Example: erythema, loss of hair, cataract
formation, decreased fertility.
• Exposure of a latent period
• Latent period
– Can be defined as the time that elapses
between exposure to ionizing radiation
and the appearance of observable
clinical signs.
• Period of injury
– A variety of cellular injuries may result,
including cell death, changes in cell
function, breaking or clumping of
chromosomes, formation of giant cells,
cessation of mitotic activity, and
abnormal mitotic activity.
• Recovery period
• Cumulative effects
– Repeated radiation exposure can lead
to health problems
– Example
• Cancer, cataracts formation,
birth defects
• Tissue and radiation effect
• Determining factors for Radiation injury
• Total Dose:
– quantity of radiation received, or the
total amount of radiation energy
absorbed.
• Dose rate:
– rate at which exposure to radiation
occurs and absorption takes place (dose
rate=dose/time)
• Amount of tissue irradiated:
– areas of the body exposed to radiation.
• Cell sensitivity:
– damage occurs in cells that are most
sensitive to radiation, such as rapidly
dividing cell and young cell
• Age:
– children are more susceptible to
radiation damage than adults.
• Radiation effects
• Short-term and long-term effects
• Somatic and genetic effects
• Radiation effects on cells
• Radiation effects on tissues and organ
• Classification of Radiation effects
• Short-term
– Is a latent period, effects that are seen
within minutes, days, or weeks.
– are associated with large amounts of
radiation absorbed
• E.g. exposure to a nuclear
accident or the atomic bomb
• Acute radiation syndrome (ARS)
, Nausea, Vomiting, Diarrhea,
Hair loss, Hemorrhage
• Long-term effects
– Appear after years, decades, or
generation
– Are associated with small amounts of
radiation absorbed repeatedly over a
long period
• Classification of the body cells
• Somatic cell
– are all the cell in the body except the
reproductive cell
• E.g., Ova, Sperm
• Genetic cells
– is a nucleic acid that contains the
genetic instructions used in the
development and functioning of all
known living organisms and some
viruses.
• Classification of Somatic and Genetic effects
• Genetic effects
– Are not seen in the person irradiated
but are passed on to future generation.
– Radiation injuries that produce changes
in genetic cell do not affect the health
of the exposed individual
– genetic damage cannot be repaired
• Radiation effects on cells
• The cell or basic structural unit of all living
organisms, is composed of a central nucleus and
surrounding cytoplasm
• Not all cell respond to radiation in the same
manner
– Radiosensitive
• Is sensitive to radiation
– Radioresistant
• Is a resistant
• Radiation exposure
• Mitotic activity
– Cell that divide frequently or undergo
many division over time are more
sensitive to radiation
• Cell differentiation
 – Cell that are immature or are not highly amount of ionization that
specialized are more sensitive to occurs in air.
radiation • International System of Units (SI) Unit and
• Cell metabolism Common Unit Terminology
– Cell that have a higher metabolism are • Dose Measurement
more sensitive to radiation • Dose can be defined as the amount of energy
• Tissue and organ sensitivity to radiation absorbed by a tissue
• Critical organs exposed during dental • The radiation absorbed dose, or rad, is the
radiographic procedures in the head and neck traditional unit of dose.
region include the ff. • Unlike the roentgen, the rad is not restricted to
• Skin air and can be applied to all forms of radiation
• Thyroid gland • Rad
• Lens of the eye • A special unit of absorbed dose that is equal to
• Bone marrow the deposition of 100 ergs of energy per gram
• Radiation measurements of tissue (100 erg/g)
• Unit of measurement • Using SI units, 1 rad is equivalent to 0.01 joule
• Exposure measurement per kilogram (0.01 j/kg)
• Dose measurement • The SI unit equivalent to the rad is the gray (Gy),
• Dose equivalent measurement or 1 j/kg.
• Measurements used in dental radiography – 1rad = 0.1Gy
• Unit of measurement – 1 Gy = 100 rads
• Radiation can be measured in the same manner • Dose Equivalent measurement
as other physical concepts, such as time, • Is used to compare the biologic effects of
distance, and weight. different types of radiation
• Unit of measurement for time is minutes, for • The traditional unit of the dose equivalent is the
distance miles of kilometer, and for weight roentgen equivalent in man. Or rem.
pounds or kilograms, the International • Rem
Commission on Radiation Units and • Is the product of absorbed dose (rads and a
Measurement (ICRU) has established special quality factor specific for the type of radiation
units for the measurements • To place the exposure effects of different types
• The traditional units of radiation measurement of radiational on a common scale, a quality
include the ff. factor (QF), or dimensionless multiplier, is used
• The roentgen ® • Each type of radiation has a specific QF based
• The radiation absorbed dose (rad) on different types of radiation producing,
• The roentgen equivalent in man (rem) different types of biologic damage
• The SI (International System)units radiation • Example
measurement include the ff. – The QF for x-ray is equal 1
• Coulombs / kilogram (C/kg) • The SI units equivalent of the rem is the sievert
• The gray (Gy) (Sv).
• The sievert (Sv) – 1 rem = 0.01 Sv
• This text is uses both the traditional and SI units – 1 Sv = 100 rems
of measurement – Measurement used in Dental
• Two systems are used to define radiation Radiography
measurements • In dental radiography the gray and silver are
• Older system equal, and the roentgen, red, and rem are
– Is referred to as the traditional system, considered approximately equal
or standard system. • HOW IS RADIATION OR DOSIMETRY
• Newer system MEASURED
– Is the metric equivalent known as the SI • *The MPD or Maximum permissible dose is
system, or System International de’ formulated as the maximum dose of radiation
Unites (International system units) that in the light of present knowledge would
• Three quantities of radiation not be expected tp produce any significant
• Exposure radiation effects in the lifetime of an individual.
• Dose • *The MPD for non-occupational person is 0.005
• Does equivalent Sv/year while that of an occupational person is
• Exposure Measurement MPD=(Age-18)x 5 rem which is around 0.05 Sv
• Refers to the measurement of ionization in air per year.
produced by x-ray • UNITS OF MEASREMENTS
• The traditional unit of exposure for x-ray in the • *Curie (Ci) or SI unit becquerel (Bq): The
roentgen ® amount of radiation emitted by a radioactive
– Roentgen materials
• Is a way of measuring radiation • *Rad or SI unit gray (Gy):The radiation dose
exposure by determining the absorbed by a person or the amount of energy
deposited in humam tissue by radiation.
 • *Rem or SI unit sievert (Sv): The biological risk
of exposure to radiation.
• The amount of exposure dose in rem Dose in
sievert (Sv): ONE DENTAL X-RAY 15 mrem 0.15
mSv.
• Risk versus Benefit of Dental Radiographs
• X-radiation is harmful to living tissues
• Because biologic damage results from x-ray
exposure, dental radiographs should be
prescribed for a patients only when the benefit
of disease detection outweighs the risk of
biologic damage.
Infection control in dental radiology
Infection control procedures before exposure
Before bringing the patient into x-ray room clean and
disinfect all surfaces you will touch including chair and
counter
Cover these surfaces with plastic wrap
Gloves should be worn at all times
Operators must wash hands
gloves between patients
Operatory breakdown after taking radiographs
Leave the operatory neat and clean
Dismantle the instruments and place them in the
containers provided
Dispose of other contaminated items
Wipe all contaminated surfaces with a disinfectant do
not spray
Turn off x-ray unit and put tube head against the wall
Lead apron is cleaned and placed over the backside of
the chair
Disinfect the gloves before go to the darkroom
Darkroom infection control guidelines
Strip films from packets using gloves
Open film packet over the clean paper towel
Insert films in the processor with the gloves
Cont’d
Films should be handled as little as possible, preferably
by the edges.
After all films are in the processors, remove the gloves
and wash your hands
Handle processed film with clean hands
Panoramic and lateral ceph infection control guidelines
Use bite block baggie. Patient can remove the baggie
when the x-raying is completed
Before and after exposure wipe down the patient
positioning area and handles of the panoramic unit and
head- and ear- positioning devices on the lateral ceph
unit
Guidelines for Prescribing Dental Radiographs
Disease detection
To preserve and improve the patient’s oral health while
minimizing other health-related risks.
Radiographic examination is centered on several
factors:
Prevalence of the disease (s) that may be detected
radiographically in the oral cavity
Ability of the clinician to detect these diseases clinically
and radiographically
Consequences of undetected and untreated disease.
Common dental diseases will be considered
Caries
also known as tooth decay or cavity, is a disease where
bacterial processes damage hard tooth structure
(enamel, dentin and cementum).
Periodontal diseases
Diseases of the periodontium affect at least half the
population by age 50 and almost all by age 65.
Dental anomalies
abnormal formation of teeth may present as deviation
in number, size and composition
Occult disease
Are those presenting no clinical signs or symptoms.
Types of Radiographs
Intraoral radiographs
Are examination made by placing the x-ray film within
the patient’s mouth during the exposure.
Periapical radiographs
Periapical views (PA’s) show all of a tooth and the
surrounding bone. They are very useful for revealing
caries, periodontal disease, and periapical lesions.
Interproximal radiographs
Interproximal views (bitewings) show the coronal
aspects of both the maxillary and the mandibular
dentition as well as the surrounding crestal bone in a
region.
Occlusal radiographs
Are intraoral radiographs in which the film is positioned
in the occlusal plane
Extraoral radiographs
Are examinations made of the orofacial region using
films located extraorally
Panoramic radiographs
A broad view of the jaws, teeth, maxillary sinuses, nasal
fosse, and TMJs. They show which teeth are present,
the relative state of development, the presence or
absence of dental abnormalities, and many traumatic
and pathologic lesions in bone.
The profession emphatically recommends that dentists:
Make radiographs only after a clinical examination of
the patient
Order only those that will directly benefit the patient’s
diagnosis or treatment plan.
Guidelines for ordering radiographs
Previous radiographs
Most patients have been seen previously by a dentist
and have had radiographs made.
Administrative radiographs
Are those made for reasons other than diagnosis
Examples include radiographs obtained for an insurance
company or for an examining board.
Development of guidelines based on patient
characteristics
As the number of x-ray examinations available to
practitioners has increased (bitewing, occlusal,
practitioners, etc.)
Patient examination
Should be ordered only when there is a reasonable
expectation that they will provide information that will
be contributory to the diagnostic problem at hand.
Using FDA guidelines for ordering radiographs
FDA – Food and Drug Administration  Multiple Supernumerary teeth frequently occur
Is the idea that dentists should expose patients to in the premolar regions, in the mandible.
radiation only when there is a reasonable expectation DIFFERENTIAL DIAGNOSIS
that the resulting radiograph will benefit patient care  Multiple supernumerary teeth are associated
Two main concepts: with a number of genetically inherited
That the nature and extent of diagnosis required for syndromes including:
patient care constitute the only rational basis for  Cleidocranial dysplasia, Gardner's syndrome,
determining the need, type, and frequency of Pykodysostosis
radiographic examination MANAGEMENT
Because each patient is different, radiographic  Either remove a supernumerary tooth or keep it
examination be individualized under observation
ALARA  MISSING TEETH
ALARA stands for “as low as reasonably achievable”. (HYPODONTIA, OLIGODONTIA, ANODONTIA)
This principle means that even if it is a small dose, if  Hypodontia-absence of one or a few teeth
receiving that dose has no direct benefit, you should try  Oligodontia- absence of numerous teeth
to avoid it. To do this, you can use three basic  Anodontia-failure of all teeth to develop
protective measures in radiation safety: time, distance,  Result of numerous independent pathologic
and shielding mechanism that can affect the orderly
Special consideration formation of the dental lamina, failure of a
Pregnancy tooth germ to develop at the optimal time, lack
It is not desirable to obtain radiographs on a woman of necessary space imposed by a malformed
who is pregnant jaw, or disproposition between tooth mass and
Baseline Radiographs jaw size.
Monitoring of Wisdom Teeth CLINICAL FEATURES
Monitoring of mixed dentition  Maxillary incisor- missing primary teeth
 DENTAL ANOMALIES  Most common: Third molars, Second premolars
 DEVELOPMENTAL ABNORMALITIES and maxillary lateral and mandibular central
-occur during the formation of teeth incisors.
 CONGENITAL ABNORMALITIES DIFFERENTIAL DIAGNOSIS
-typically inherited anomalies  Anodontia and oligodontia may occur in
***teeth that form abnormally short roots patients with ectodermal dyplasia
 ACQUIRED ABNORMALITIES  When teeth are involved, the condition may
-result from changes of teeth after normal formation. present with multiple missing or malformed
***shortening of normal tooth roots by external teeth that often have conical or canine shape or
resorption a notable decrease in tooth size
 DEVELOMENTAL ABNORMALITIES MANAGEMENT
 NUMBER OF TEETH  Orthodontics,
 Supernumerary Teeth  For severe cases restorative, implant, and
 Missing Teeth prosthetic procedures
 Supernumerary Teeth  SIZE OF TEETH
(Hyperdontia, distodens, mesiodens, peridens,  Macrodontia
parateeth, and supplemental teeth)  Microdontia
 Develop in addition to the normal complement  MACRODONTIA
as a result of excess dental lamina in the jaws,  Teeth are larger than normal
and the tooth or teeth that develop may be  Often a single tooth, individual contralateral
morphologically normal or abnormal. teeth, or a group of teeth may involved
 Supplemental-when supernumerary teeth have  May occur sporadically, and is cause by
normal morphologic features unknown.
 Mesiodens-occur between the maxillary central CLINICAL FEATURES
incisors  appear large and may associated with crowding,
 Peridens-premolar area malocclusion, or impaction
 Distodens-molar area RADIOGRAPHIC FEATURES
 Mesiodens  Radiographs may reveal the increased size of
 Distodens both unerupted and erupted macrodont teeth
Peridens MANAGEMENT
Hyperdontia  In most cases does not require treatment.
CLINICAL FEATURES: Orthodontic treatment may be necessary if a
 Deciduous malocclusion is present.
 Permanent dentitions-most common  MACRODONTIA
 Single supernumerary teeth are most common  MICRODONTIA
in the anterior maxilla, referred as Mesiodens  The teeth are smaller than normal.
and in maxillary molar region  May involve all the teeth or be limited to a
single tooth or group of teeth
  Often the lateral incisors and third molars may CLINICAL FEATURES
be small  Results in a reduced number of teeth in the
  arch. Although more common bet deciduous
CLINICAL FEATURES teeth, fusion may occur in the permanent
 The involved teeth are noticeably small and dentition.
have altered morphology.  When deciduous canine and lateral incisor fuse,
 Microdont molars may have altered shape. the corresponding permanent lateral incisor
 *Reduction in both the size and number of may be absent.
cusps in microdontia  Fusion is more common in anterior teeth of
 *peg shape lateral incisor both the permanent and deciduous dentition
RADIOGRAPHIC FEATURES RADIOGRAPHIC FEATURES
 These small teeth are frequently malformed  Radiographs disclose the unusual shape or size
DIFFERENTIAL DIAGNOSIS of the fused teeth.
 The recognition of small teeth indicates the  May also show unusual configuration of the
diagnosis. The number and distribution of pulp chamber or root canal
microdonts may also suggest consideration of  FUSION
syndromes (congenital heart disease, progeria) MANAGEMENT
MANAGEMENT  Depends on which teeth are involved, degree of
 Restorative or prosthetic treatment fusion, and morphologic results. If deciduous
 MICRODONTIA are affected, they may retained as they are.
 ERUPTION OF TEETH  Endodontic therapy may be necessary and
 Transposition perhaps maybe difficult
 TRANSPOSITION  In some cases it is most prudent to leave the
  Condition in which two typically adjacent teeth teeth as they are.
have exchanged positions in the dental arch  
CLINICAL FEATURES  CONCRESCENCE
 Permanent canine and first premolar are the  Occurs when the roots of two or more primary
most frequent transposed teeth or permanent teeth are fused by
 Second premolar infrequently lie between the cementum.
first and second molars.  If the condition occurs during development, it is
 The transposition of central and lateral incisors sometimes referred to as true concresence
is rare.  If the condition occurs later, it is acquired
RADIOGRAPHIC FEATURES concresence.
 Radiographs reveal transposition when the CLINICAL FEATURES
teeth are not in their usual sequence in the  Maxillary molars are frequently involved
dental arch. especially the third molars and a
DIFFERENTIAL DIAGNOSIS supernumerary tooth.
 Transposed teeth are usually recognized RADIOGRAPHIC FEATURES
MANAGEMENT  May not always distinguish between
 Altered prosthetically for function and esthetic concrescence and teeth that are in close
 TRANSPOSITION contact or that are simply superimposed
 ALTERED MORPHOLOGY OF TEETH  CONCRESCENCE
 Fusion DIFFERENTIAL DIAGNOSIS
 Concresence  It is usually impossible to determine
 Gemination radiographically with certainty whether the
teeth whose root images are superimposed
 Taurodontism
are actually joined.
 Dilaceration
 If roots are joined, it may not be possible to tell
 Dens Invaginatus, Dens in Dente and Dilated
whether the union is by cementum or by
Odontome
dentin(fusion).
 Dens Evaginatus
 In this regard the absence of PDL space
 Amelogenesis Imperfecta
between the roots may be helpful
 Dentinogenesis Imperfecta
MANAGEMENT
 Osteogenesis Imperfecta
 Concresence affects treatment only when the
 Dentin Dysplasia
decision is made to remove on or both of
 Regional Odontodysplasia are involved teeth because this condition
 Enamel Pearl complicates the extraction.
 Talon Cusp  Removal of one might result unintended and
 Turners Hypoplasia simultaneously removal of the other.
 Congenital Syphilis  GEMINATION
 FUSION (SYNODONTIA)  Rare anomaly that arises when a single tooth
 Results from the union of adjacent tooth germs bud attempts to divide
of developing teeth
  Complete twinning results in normal tooth plus
a - If the roots dilacerate mesially or distally, the
supernumerary tooth in the arch
CLINICAL FEATURES
 More frequently affects the primary teeth,
usually in the incisor region.
 It can be detected clinically after the anomalous
tooth erupts.
RADIOGRAPHIC FEATURES
 Radiographs reveal the altered shape of the
hard tissues and pulp chamber of the
geminated tooth.
 Radiopaque enamel outlines the clefts in the
crowns and invaginations and thus accentuates
them.
 Pulp chamber is usually single and enlarged and
may be partially divided.
DIFFERENTIAL DIAGNOSIS
 Includes fusion
 If the malformed tooth is counted as one,
individuals with gemination have a normal
tooth count, whereas those with fusion are
seen to be missing a tooth.
 GEMINATION
 TAURODONTISM
 The body of taurodont teeth appears elongated
and the roots short.
 Pulp chamber extends from a normal position in
the crown throughout the length of the
elongated body, leading to a more apically
positioned pulpal floor.
 Occur in permanent or primary dentition
 Fully expressed in the molars and less often in
the premolars.
CLINICAL FEATURES
 Not recognizable clinically because the body
and roots or taurodont teeth lie below the
alveolar margin.
RADIOGRAPHIC FEATURES
 The peculiar features is the elongated pulp
chamber and more apically positioned
furcation.
 The shortened roots and root canals are a
function of the long body and normal length of
the tooth. Dimensions of crown
are normal.
 DIFFERENTIAL DIAGNOSIS
 Identification of the wide apical foramina and
incompletely formed roots aid in the differential
diagnosis.
 Greater frequency in trisomy 21 syndrome.
 
 TAURODONTISM
 Dilaceration
- is diturbance in tooth formation that produces a
sharp bend or curve in tooth anywhere in the
crown or the root.
Clinical features:
- If the dilaceration is so pronounced that the
tooth does not erupt, the only clinical indication
of the defect is a missing tooth. If the defect is
in the crown of an erupted tooth, it may be
readily recognized as an angular distortion.
Radiographic features:
condition is clearly apparent on a periapical
radiograph when the roots are dilacerated
buccally (labially) or lingually, the central x ray
passes approximately parallel with the
deflected portion of the root and the apical end
of the root may have the appearance of a
circular or oval radiopaque with a central
radiolucency (the apical foramen and root
canal), giving appearnce of a bull’s eye.
- Radiolucent halo encircling the radiopaque
area.
Differential diagnosis:
- Dilacerated roots may be difficult to differentiate from
fused root, sclerosing osteitis, or a dense bone island.
 Dens invaginatus, dense in dente, and dilated
odontome
Synonyms: Gestant odontome and “tooth within a
tooth”
- The least severe form of this infolding is dense
invaginatus, and the most severe form is dilated
odontome.
- The invangination can occur in either the
cingulum area (dense invaginatus) or incisal
edge (dense in dente) of the crown or in the
root during tooth development.
- It may also involves the pulp chamber or root
canal system.
Clinical features:
- Dens invaginatus may appear as nothing more
than a small pit between the cingulum and the
lingual surface of an incisor tooth.
- In dense in dente, the pit is located at the incisal
edge of the tooth and crown morphology may
appear abnormal, having appearnce of a
microdont
Radiographic features:
- The infolding of the enamel lining is more
radiopaque than the surrounding tooth
structure and can easily be identified as an
inverted teardrop-shaped radiolucency with a
radiopaque border.
- If the coronal invagination is extensive, the
crown is almost invariably malformed and the
apical foramen is usually wide
- In the most severe from (dilated odontome)
the tooth is severely deformed, having circular
or oval shape with a radioluscent interior.
 Dens Evaginatus
- is the result of an outpouching of the enamel
organ.
- Enamel-covered tubercle usually occurs in or
near the middle of the occlusal surface of a
premolar or occasionally a molar.
Clinical features:
- Appears as a tubercle of enamel on the occlusal
surface of the affected tooth. A hard, polyplike
protuberance . The tubercle often has a dentin
core and a very slender pulp horn frequently
extends into the evagination.
- After the tubercle is worn down by the
opposing teeth, it appears as a small circular
facer with a black pit in the center.
Synonyms: Leong’s premolar”
Radiographic features:
- The radiographic image show an extension of a
dentin tubercle on the occlusal surface unless
the tubercle already worn down. The dentin
core is usually covered with opaque enamel.
 Amelogenesis Imperfecta
- is a genetic anomaly arising from mutation that may
have occurred in one of four different genes that play
some role in enamel formation.
- The mutation may be inherited in an autosomal
dominant or recessive manner, or it may be
inherited in an x-linked pattern.
Clinical features:
 Hypoplastic type
- the color of the underlying dentin imparts a
yellowish-brown color to the tooth.
- the enamel may be abnormal: rough, pitted,
smooth, or glossy.
- crown of the teeth may appear undersized with
a roughly square shape.
 Hypomaturation
- Enamel has a mottled appearance but is of
normal thickness.
- Its color may range from clear to cloudy white,
yellow, or brown.
- The teeth may be capped with white, opaque
enamel.
- “snow-capped” teeth.
 Hypocalcification
- Crowns of the teeth are normal in size and
shape when they erupt because enamel is of
regular thickness, enamel is poorly mineralized
(it is less dense than dentin)
- Teeth dark brown from food stains.
 Hypomaturation/hypocalcification
- Combination of hypomaturation and
hypocalcification that involves both permanent
and deciduous dentition.
- Primary defect is enamel hypomaturation;
mottled and discolored to a yellow or brown
color.
Radiographic features:
- The hypoplastic amelogenesis imperfecta
include a square crown, a relatively thin
radiopque layer of enamel, low or absent cusps,
and multiple open contact between the teeth.
- “Picket fence” type of appearance
- The hypomaturation form demonstrates a
normal thickness of the enamel, but its density
is the same as that of dentin.
- Hypocalcified forms the enamel thickness is
normal but its density is even less (more
radioluscent)than that of dentin.
 Dentinogenesis imperfecta
Synonyms: Hereditary opalescent dentin
- Genetic anomaly involving primarily the dentin,
althought the enamel may be thinner than abnormal in
this condition
Three types of dentenogenesis imperfecta exist, and
each has been associated with a particular genetic
defect.
 Type I – associated with osteogenesis
imperfecta and is caused by mutations of one of
two genes involved in synthesis of collagen
typeI
 Type II- similar to type I but only affects the
dentin without any skeletal defects.
 Type III – “Brandywine isolated”, was described
in a population of fewer than 200 persons in the
brandywine region of maryland. Exhibit enlarge
pulp chambers, making them susceptibe to pulp
exposure.
Clinical features:
- They show a high degree of amber-like
translucency and a variety of colors from yellow
to blue-gray. The colors change according to
whether the teeth are observed by transmitted
light or reflected light.
- In adults the teeth may frequently wear down
to the gingiva. The exposed dentin becomes
stained.
- The color of the abraded teeth may change to
dark brown or even black.
Radiographic features:
- Cervical portion of the tooth that gives the
crown a bulbous apperance.
- The roots are usually short and slender. They
may be partial or complete obliteration of the
pulp chamber.
 Osteogenesis Imperfecta
- AKA: brittle Bone disease
- is a hereditary disorder of connective tissue
with the clinical feature of bone fragility, blue
sclera, wormian bones(bones in skull sutures),
skeletal deformities, and progressive
osteopenia
 Dentin Dysplasia
- Genetically inherited autosomal-dominant
abnormality that resembles dentinogenesis imperfecta.
Two types have been described:
 Type I (radicular)
 Type II (coronal)
Clinical features:
Type I
- normal color & shape in both dentition
- Exfoliate with little or no trauma
- Slight bluish-brown translucency is apparent
Type II
- The crowns of the primary teeth appear to be of
the same color, size, and contour as those in
dentinogenesis imperfecta.
Radiographic features:
- “W” shape in molar root
- 20% of type I are associated with rarefying
osteitis.
- Obliteration of the pulp chamber in deciduous
dentition.
- Abnormally large pulp chamber in permanent
dentition.
 Regional Odontodysplasia
Synonyms: Odontogenesis imperfecta and ghost teeth
- Relatively rare condition in which both enamel
and dentin are hypoplastic and hypocalcified.
The localized arrest in tooth development
typically affected only a few adjacent teeth in a
quadrant.
Clinical features:
- Teeth affected with regional odontodyplasia are
small and mottled brown as a result of staining
of hypocalcified and hypoplastic enamel.
- Susceptible to caries, are brittle, and are subject
to fractures and pulpal infection.
Radiographic features:
- Described as having a “ghostlike” appearance.
- The pulp chambers are large and the root canals
wide because the hypoplastic dentin is thin, just
serving to outline the image of the root.
 Enamel Pearl
Synonyms: Enamel drop, enamel nodule, & enameloma
- a small globule of enamel 1 to 3 mm in
diameter that occurs on the roots of molars
- enamel pearl are formed by Hertwig’s epithelial
root sheath
Clinical features:
- Most enamel pearls form below the crest of the
gingiva and are not detected during a clinical
examination.
- Enamel pearls that form on the maxillary molars
are usually in the mesial or distal furca, and
pearls that develop in mandibular molars are
more often in the buccal or lingual furca.
- Usually no clinical symptoms are associated
with their presence, althought they may
predispose to periodontal pocket formation and
subsequent periodontal disease.
Radiographic features:
- Enamel pearl appears smooth, round, and
comparable in degree of radiopacity to the
enamel covering the crown.
- Occsaionally the dentine casts a small, round,
radioluscent shadow in the center of the
radiopaque sphere of enamel
 Talon cusp
- Is an anomalous hyperplasia of the cingulum of
a maxillary or mandibular incisor.
Clinical features:
- It may be found in either sex and on both
primary and permanent incisors.
- When view from its incisal edge, an incisor
bearing the cusp is T-shape with the top of the T
representing the incisal edge.
Radiographic features:
- The radiopaque image of a talon cusp is
superimposed on that of the crown of the
involved incisor.
- The cusp is often apparent radiographically
before eruption and may simulate the presence
of a supernumerary tooth.
 Turner’s Hypoplasia
 Turner’s Hypoplasia
 Turner’s hypoplasia- a permanent tooth with a
local hypoplastic defect in its crown. This defect
may have been caused by the extension of a
periapical infection from its deciduous
predecessor or by mechanical trauma
transmitted through the deciduous tooth. If the
trauma* takes place while crown is forming, it
may Adversely effect the ameloblasts of the
developing tooth and result in some degree of
enamel hypoplasia or hypomineralization.
 Congenital Syphilis
 Congenital Syphilis
 30% of people with congenital syphilis have
dental hypoplasia that involves the permanent
incisors and first molars.
 Development of primary teeth is seldom
disturbed.
Characteristic:
Incisors
Screwdriver- shaped crown, with the mesial and distal
surfaces tapering from the middle of the crown of the
incisal edge.
First Molars
Usually smaller than normal and maybe even smaller
than second molar crowns. Cusps of these molars are
surface hypoplastic, unevenly formed irregular globules,
like the surface of a mulberry, a small berry having
appearance similar to a blackberry.
 Congenital Syphilis
 Attrition
 Attrition
- Is physiologic wearing of the dentition resulting
from occlusal contacts between the maxillary
and mandibular teeth. It occurs on incisal,
occlusal, and interproximal surfaces.
- It occurs in more than 90% of young adults and
is generally more severe in men than women.
- It extent depends on the abrasiveness of the
diet, salivary factors, mineralization of the
teeth, and emotional tension.
- Physiologic attrition is a component of the aging
process.
- When the loss of dental tissue becomes
excessive such as bruxism.
 Attrition
 Result in a change in the normal outline of the
tooth structure, altering the normal curved
surfaces into flat planes.
 The crown shortened and is bereft of the incisal
or occlusal surface enamel.
 Interproximal wear causes the contact points to
become broad and flatten.
 Reduction in the size of the pulp chambers and
canals may occur because attrition stimulates
the deposition of secondary dentin
 Abrasion
 nonphysiologic wearing of teeth in contact with
foreign substances as a result of friction
induced by factitious habits or occupational
hazard.
 Causes: improper brushing and that form of
dental floss; pipe smoke, opening hairpins with
teeth, improper use of toothpicks, denture
clasps, and cutting thread.
 Tooth brush Injury
 Improper “back –and-fort” movements of the
toothbrush with heavy pressure cause the
bristles to assume a wedge-shaped
arrangement between technique
 Dental Flossing
 Excessive and improper use of dental floss,
particularly in conjunction with toothpaste, may
result in abrasion of the dentition.
 Most frequent site is the cervical portion of the
proximal surfaces just above the gingiva
 * Dental floss abrasion is narrow semilunar
radiolucency in the interproximal surfaces of the
cervical area.
 most often the radiolucent grooves on the
Distal surfaces of the teeth are Deeper than
those on the mesial surfaces.
 Erosion
 Results from chemicals action not involving
bacteria. Although in many cases the cause is
not apparent, in others it is obviously the
contact of acid with teeth.
 The source of the acid chronic vomiting or acid
reflux from gastrointestinal disorders or from a
diet rich in acidic foods, citrus fruits, or
carbonated beverages.
 regurgitated acid attack lingual or palatal tooth
surfaces and dietary
 Resorption
 Resorption is the removal of tooth structure by
osteoclasts, referred to as odontoclasts when
they are resorbing tooth structure.
 Classified Resorption
 Internal Resorption
 Occurs within the pulp chamber or canal and
involves resorption of the surrounding dentin.
 Enlargement of the size of the pulp space at the
expense of tooth structure.
 Condition may be transient and self-limiting or
progressive.
 Etiology of the recruitment and activation of
odontoclasts is unknown but may be related to
inflammation of the pulp tissues.
 Initiated be acute trauma to the tooth, direct
and indirect pulp capping, pulpotomy, and
enamel.
 The lesions are localized, radiolucent, and
round, oval, or elongated within root or crown
and continuous with the image of the pulp
chamber or root canal.
 Sharply defined and smooth or slightly
scalloped. The result is an irregular widening of
the pulp chamber or canal.
 Classified Resorption
 External Resorption
 Odontoclasts resorb the outer surface of the
tooth.
 Commonly involves the root surface but may
also involve the crown of an unerupted root.
 Resorption may involve cementum and dentin
and in some cases gradually extends to the
pulp.
 Resorption may occur to a single tooth, multiple
teeth, or , in a rare cases, all of the dentition.
Etiology is unknown case
 Common sites for external root resorption are
the apical and cervical regions.
 The lesion begins at the apex, it generally
causes a smooth resorption of the tooth
structure, resulting in blunting of the root apex.
 Secondary Dentin
 Secondary dentin is that deposited in the pulp
chamber after the formation of primary dentin
has been completed.
 Deposition may be part of physiologic aging and
may result from such innocuous stimuli as
chewing or slight trauma.
 Pathologic condition as moderately progressive
caries, trauma, erosion, attrition, abrasion, or a
dental restorative procedure.
 Hypercementosis
 The excess deposition of cementum on root
surfaces. Hypercementosis results from
supraeruption, inflammation, or trauma;
sometimes there is no unknown cause.
 On dental radiograph is evident radiographically
as an excessive buildup of cementum around all
part of root.
 Hypercementosis does not cause any clinical
signs or symptoms.
 Teeth affected by hypercementosis are vital and
do not require treatment.
• Normal Anatomy
• MARIA ELENA TRINIDAD Z. ORTEGA, DMD,MSci
• DEFINITIONS OF GENERAL TERMS
TYPES OF BONE
• Cortical bone
• Cancellous none
CORTICAL BONE
Derived from Latin word cortex means outer layer. Also
reffered as compact bone, is the dense outer layer of
the bone (Fig. 25-1).
The inferior border of the mandible is composed of
cortical bone and appears radiopaque. (Fig 25-2)
• CANCELLOUS BONE
Derived from Latin and means “arranged like a lattice”.
Cancellous bone is the soft spongy bone located
between two layers of the dense cortical bone (Fig. 25-
3).
PROMINENCE OF BONE
Composed of dense cortical bone and appear
radiopaque on dental radiograph.
Five bony prominences seen in maxillary and
mandibular periapical radiograph:
• Process - a marked prominence or projection of
bone; an example is the coronoid process of
the mandible. (Fig 25-5)
• Ridge - a linear prominence or projection of
bone; example is the internal oblique ridge of
the mandible. (Fig 25-6)
• Spine - a sharp, thorn-like projection of bone;
example is the anterior nasal spine of the
maxilla. (Fig 25-7)
• Tubercle - a small bump or nodule of bone;
example is the genial tubercles of the mandible.
(Fig 25-8)
• Tuberosity - a rounded prominence of bone;
example is the maxillary tuberosity (Fig 25-9)
• SPACES AND DEPRESSIONS IN BONE
• Canal - a tube-like passageway through bone
that contains nerves and blood vessels; example
is the mandibular canal (Fig 25-10)
• Foramen - an opening or hole in bone that
permits the passage of nerves and blood
 vessels; example is the mental foramen of the
mandible (Fig 25-11).
• Fossa - a broad, shallow, scooped-out or
depressed area of the bone; example is the
submandibular fossa of the mandible (Fig 25-
12).
• Sinus - a hollow space, cavity, or recess in bone;
example is the maxillary sinus (Fig 25-13).
• MISCELLANEOUS TERMS
• SEPTUM - a bony wall or partition that divides
two spaces or cavities. An example is the nasal
septum (Fig 25-14).
• SUTURE - an immovable joint that represents a
line of union between adjoining bones of the
skull. An example is the median palatal suture
of the maxilla (Fig 25-15).
• NORMAL ANATOMIC LANDMARKS
BONY LANDMARKS OF THE MAXILLA
The upper jaw is composed of two paired bones, the
maxillae (Fig 25-16). The paired maxillae meet at the
midline of the face and are often reffered to as a single
bone, the maxilla.
The maxilla has been described as the architectural
cornerstone of the face.
• INCISIVE FORAMEN
Description: also known as the nasopalatine foramen;
an opening or hole in bone that is located at the midline
of the anterior portion of the hard palate directly
posterior to the maxillary central incisors. The
nasopalatine nerve exits the maxilla through the incisive
foramen. (Fig 25-17)
• Radiographic appearance: a small ovoid or
round radiolucent area located between the
roots of the maxillary central incisors (Fig. 25-
18)
• SUPERIOR FORAMINA OF THE INCISIVE CANAL
Description: are two tiny openings or holes in bone that
are located on the floor of the nasal cavity (Fig 25-19).
• Radiographic appearance: two small round
radiolucencies located superior to the apices of
the maxillary central incisors (Fig 25-20)
• MEDIAN PALATAL SUTURE
Description: the immovable joint between the two
palatine process of the maxilla. (Fig 25-21)
Radiographic appearance: a thin radiolucent line
between the maxillary central incisors (Fig 25-22)
• LATERAL FOSSA/CANINE FOSSA
Description: a smooth, depressed area of the maxilla
located just inferior and medial to the infraorbital
foramen between the canine and lateral incisors (Fig 25-
23)
Radiographic appearance: a radiolucent area between
the maxillary canine and lateral incisors (Fig 25-24)
• NASAL CAVITY/NASAL FOSSA
Description: a pear-shaped compartment of bone
located superior to the maxilla. (Fig 25-25)
Radiographic appearance: a large radiolucent area
above the maxillary incisors (Fig 25-26)
• NASAL SEPTUM
Description: a vertical bony wall or partition that divides
the nasal cavity into the right and left nasal fossae (Fig
25-27).
Radiographic appearance: a vertical radiopaque
partition that divides the nasal cavity (Fig 25-28)
• FLOOR OF THE NASAL CAVITY
Description: a bony wall formed by the palatal
processes of the maxilla and horizontal portion of the
palatine bones (Fig 25-29)
Radiographic appearance: a dense radiopaque band of
bone above the maxillary incisors (Fig 25-30)
• ANTERIOR NASAL SPINE
Description: a sharp projection of the maxilla located at
the anterior and inferior portion of the nasal cavity (Fig
25-31)
Radiographic appearance: a V-shaped radiopaque area
located at the intersection of the floor of the nasal
cavity and the nasal septum (Fig 25-32)
• INFERIOR NASAL CONCHAE
Description: wafer-thin, curved plates of bone that
extend from the lateral walls of the nasal cavity (Fig 25-
33)
Radiographic appearance: a diffuse radiopaque mass or
projection within the nasal cavity (Fig 25-34)
• MAXILLARY SINUS
Description: paired cavities or compartments of bone
located within the maxilla (Fig 25-35)
Radiographic appearance: a radiolucent area located
above the apices of the maxillary premolars and molars
(Fig 25-36)
• SEPTA WITHIN THE MAXILLARY SINUS
Description: are bony walls or partition that appears to
divide the maxillary sinus into compartment (Fig 25-37)
Radiographic appearance: radiopaque lines within the
maxillary sinus (Fig 25-38)
• NUTRIENT CANALS WITHIN THE MAXILLARY
SINUS
Description: tiny, tube-like passageways through bone
that contain blood vessels and nerves that supply the
maxillary teeth and interdental areas.
Radiographic appearance: a narrow radiolucent band
bounded by two thin radiopaque lines (Fig 25-39)
• INVERTED Y
Description: intersection of the maxillary sinus and the
nasal cavity
Radiographic appearance: a radiopaque upside-down Y
formed by the intersection of the lateral wall of the
nasal fossa and the anterior border of the maxillary
sinus (Fig 25-40)
• MAXILLARY TUBEROSITY
Description: a rounded prominence of bone that
extends posterior to the third molar region (Fig 25-41)
Radiographic appearance: a radiopaque bulge distal to
the third molar region (Fig 25-42)
• HAMULUS
Description: a small hook-like projection of the bone
extending from the medial pterygoid plate of the
sphenoid bone (Fig 25-43)
Radiographic appearance: a radiopaque hook-like
projection posterior to the maxillary tuberosity area (Fig
25-44)
• ZYGOMATIC PROCESS OF THE MAXILLA
Description: a bony projection of the maxilla that
articulates with the zygoma or malar (cheek) bone (Fig
25-45)
Radiographic appearance: a J or U-shaped radiopacity
located superior to the maxillary first molar region (Fig
25-46)
• ZYGOMA
Description: articulates with the zygomatic process of
the maxilla (Fig 25-47)
Radiographic appearance: a diffuse, radiopaque band
extending posteriorly from the zygomatic process of the
maxilla (Fig 25-48)
• BONY LANDMARKS OF THE MANDIBLE
• Ramus - the vertical portion of the mandible
that is found posterior to the third molar.
• Body - the horizontal U-shaped portion that
extends from ramus to ramus.
• alveolar process - the portion of the mandible
that encases and supports the teeth.
• GENIAL TUBERCLE
Description: tiny bumps of bone that serve as
attachment sites for the genioglossus and geniohyoid
muscles (Fig 25-50)
Radiographic appearance: a ring-shaped radiopacity
below the apices of the mandibular incisors. (Fig 25-51)
• LINGUAL FORAMEN
Description: a tiny opening or a hole in bone located on
the internal surface of the mandible (Fig 25-52)
Radiographic appearance: a small radiolucent dot
located inferior to the apices of the mandibular incisors
(Fig 25-53)
• NUTRIENT CANALS
Description: are tubelike passageways through bone
that contain nerves and blood vessels that supply the
teeth.
Radiographic appearance: a vertical radiolucent lines
(Fig 25-54)
• MENTAL RIDGE
Description: a linear prominence of cortical bone
located on the external surface of the anterior portion
of the mandible (Fig 25-55).
Radiographic appearance: a thick radiopaque band that
extends from the premolar region to the incisor region
(Fig 25-56)
• MENTAL FOSSA
Description: a scooped-out, depressed area of bone
located on the external surface of the anterior mandible
(Fig 25-57)
Radiographic appearance: a radiolucent area above the
mental ridge (Fig 25-58)
• MENTAL FORAMEN
Description: an opening or a hole in bone located on
the external surface of the mandible region of the
mandibular premolars. (Fig 25-59)
Radiographic appearance: a small ovoid or round
radiolucent area located in the apical region of the
mandibular premolars (Fig 25-60)
• MYLOHYOID RIDGE
Description: a linear prominence of bone located on the
external surface of the mandible (Fig 25-61)
Radiographic appearance: a dense radiopaque band
that extends downward and forward from the molar
region (Fig 25-62)
• MANDIBULAR CANAL
Description: a tube-like passageway through bone that
travels the length of the mandible
Radiographic appearance: a radiolucent band (Fig 25-
63)
• INTERNAL OBLIQUE RIDGE
Description: a linear prominence of bone located on the
internal surface of the mandible that extends
downward and forward from the ramus (Fig 25-64)
Radiographic appearance: a radiopaque band that
extends downward and forward from the ramus (Fig 25-
65)
• EXTERNAL OBLIQUE RIDGE
Description: linear prominence of bone located on the
external surface of the body of the mandible (Fig 25-66)
Radiographic appearance: a radiopaque band
extending downward and forward from the anterior
border of the ramus of the mandible (Fig 25-67)
• SUBMANDIBULAR FOSSA
Description: scooped-out, depressed area of bone
located on the internal surface of the mandible inferior
to the mylohyoid ridge (Fig 25-68)
Radiographic appearance: a radiolucent area in the
molar region below the mylohoid ridge (Fig 25-69)
• CORONOID PROCESS
Description: a marked prominence of bone on the
anterior ramus of the mandible (Fig 25-70)
Radiographic appearance: cannot be seen on a
mandibular periapical radiograph but does appear on a
maxillary molar periapical fil; a triangular radiopacity
superimposed over, or inferior to, the maxillary
tuberosity region (Fig 25-71)
• NORMAL TOOTH ANATOMY
Tooth structure
• Enamel - the densest structure found in the
human body; outermost radiopaque layer of
the crown of the tooth (Fig 25-73)
• Dentin - found beneath the enamel layer of a
tooth and surrounds the pulp cavity (Fig 25-73)
• Dentinoenamel junction - DEJ; junction
between the dentin and enamel of a tooth (Fig
25-73)
• Pulp cavity - consist of pulp chambers and pulp
canals (Fig 25-74)
• SUPPORTING STRUCTURES
ALVEOLAR BONE - bone of the maxilla and mandible
that supports and encases the roots of teeth (Fig 25-75)
• ANATOMY OF ALVEOLAR BONE
LAMINA DURA
Description: the wall of the tooth socket that surrounds
the root of a tooth.
Radiographic appearance: a dense radiopaque line that
surrounds the root of a tooth (Fig 25-77)
• ALVEOLAR CREST
Description: the most coronal portion of the alveolar
bone found between the teeth.
Radiographic appearance: radiopaque and is typically
located 1.5 to 2.0 mm below the junction of the crown
and the root surfaces. (Fig 25-78)
• PERIODONTAL LIGAMENT SPACE
Description: the space between the root of the tooth
and the lamina dura.
Radiographic appearance: a thin radiolucent line
around the root of a tooth. (Fig 25-79)
• SHAPE AND DENSITY OF ALVEOLAR BONE
ANTERIOR REGIONS - appears pointed and sharp
between the teeth (Fig 25-80)
POSTERIOR REGIONS - appears flat and smooth
between the teeth (Fig 25-81)
• SUMMARY
 • The dental radiographer must have a thorough to give the film greater sensitivity to xradiation
knowledge of the anatomy of the maxilla and Protective layer - thin transparent coating
mandible; each normal anatomic landmark seen placed over the emulsion; protects the
on a periapical radiograph corresponds to that emulsion surface from manipulation as well
seen on the human skull. Knowledge of the as mechanical and processing damage
anatomy of the maxilla and mandiblenas Emulsion
viewed on the human skull enables the dental homogeneous mixture of gelatinand silver
radiographer to identify the normal anatomy halide crystals
seen on a radiograph. GELATIN
• Recognition of normal anatomic landmarks used to suspend and evenly disperse
enables the dental radiographer to distinguish millions of microscopic silver halide crystals
between maxilla and mandibular radiographs over the film base
and accurately mount dental films. absorbs the processing solutions and allows
• Recognition of normal anatomic landmark is the chemicals to react with the silver halide
also necessary for interpretation of dental crystals
radiographs. A knowledge of the normal SILVER HALIDE
anatomy seen on periapical radiograph is a chemical compound that is sensitive to
essential before the dental radiographer can radiation or light
begin to recognize abnormalities (e.g, diseases made up of the element silver plus a
and lesions). halogen, either bromine or iodine
• Each normal anatomic landmark as viewed on a Latent Image
periapical radiograph is described in this Formation
chapter. Latent Image - a pattern of stored energy on the
exposed film (cannot be seen)
Dental X-Ray Film Intraoral film - one that is
Dr. Maria Elena Trinidad Zapanta-Ortega placed inside the mouth
Dr. Virginia Theresa Facto-Tampus Extraoral film - one that is
Radiograph place outside the mouth
"Father of Modern Oral Duplicating film - one
Radiology" that is identical to the
Importance or use of original
radiographs 3 Types of X-ray Film
"Remove radiology from medical science, and a Used in Dental
vast majority of medical cases can become Radiography
unreasonably difficult to be solved." Intraoral Film
-Haider Imam- Intraoral Film
Quick Review "Father of Radiography" Packaging
Getting to know X-ray Film Film packets - the film and its surrounding packaging
X-ray Film Packet X-ray Film - intraoral x-ray film is a double-emulsion
Contents type of film
Black Paper: surrounds film; Paper film wrapper - a black paper protective sheet that
protects emulsion covers the film and shields the
Film: raised dot in one corner film from light.
used for film orientation Lead foil sheet - a single piece of lead foil that is found
Lead Foil: protects film from within the film packet and is
backscatter; reduces patient located behind the film wrapped in a black protective
exposure; strengthens packet; paper
pattern on foil identifies when Outer package wrapping - a soft vinyl or paper wrapper
film is placed backwards (back that hermetically seals the film
of film faces teeth) packet, protective black paper, and lead foil sheet.
Composition and Latent Image Two sides of outer
Image - a picture or likeness of an image wrapper of the film
Receptor - refers to something that responds to a packets
stimulus Tube side - is solid, white and has a raised bump in one
Four Basic Components corner that
of X-ray Film corresponds to the identification dot on the x-ray film
Film base - flexible piece of polyester * when placed in the mouth, the white side (tube side)
plastic; 0.2mm thick; constructed to of the film
withstand heat, moisture, and chemical packet must face the teeth and the tubehead.
exposure Label side - a flap that is used to open the film packet to
Adhesive layer - thin layer of adhesive remove the
material covering both sides of film base film prior to processing.
Film emulsion - a coating attached to both * when placed in the mouth, the color-coded side (label
sides of the film base by the adhesive layer side) of the
packet must face the tongue. Intensifying Screens - a device that transfers x-ray
Intraoral Film energy into visible light; the visible light, in turn,
Types exposes the screen film
Periapical Film - used to examine the entire tooth and Cassette Holder - a special device that is used to
supporting bone hold the extraoral film and the intensifying screens
Bite-wing Film - used to examine the crowns of both the Film Types
maxillary and mandibular teeth on one film Direct Exposure / Non-screen films
Occlusal Film - used for examination of large areas of Intensifying Screen Films
the Special Application Films
maxilla or mandible Mammography
Intraoral Film Sizes Detail Extremity Radiography
Periapical Film Contact Surgical Radiography
Size 0 - the smallest intraoral film available and is used Cathode Ray Tube (CRT) Imaging
for very Laser Films
small children Duplication Films
Size 1 - used primarily to examine the anterior teeth in Fluoroscopic Spot Filming
adults Duplicating Film
Size 2 - the “standard film”, used to examine the Duplicating Film
anterior and Packaging
posterior teeth in adults Available in periapical sizes as well as in 5 X 12-
Bite-wing Film inch and 8 X 10-inch sheets
Size 0 - used to examine the posterior teeth in very Boxed in quantities of 50, 100, or 150 sheets
small children Film Storage and
Size 1 - used to examine the posterior teeth in children. Protection
when positioned Film must be stored in areas that are adequately
vertically, it can be used to examine the anterior teeth shielded from sources of radiation and should not
in adults be stored in areas where patients are exposed to
Size 2- used to examine the posterior teeth in adults. x-radiation.
The most frequently Summary
used bite-wing film Dental X-ray Film
Size 3 - longer and narrower than the standard Size 2 -an image receptor that
film and is used has four basic components
only for bite-wings film base
Occlusal Film - the largest intraoral film and is almost adhesive layer
four times as large as film emulsion
a standard Size 2 periapical film protective layer
Size 4 - used to show large areas of the upper and lower Images are recorded on dental x-ray film when the
jaw. film is exposed to x-radiation.
Types of Film The silver halide crystals in the film emulsion absorb
Bitewing the x-radiation during x-ray exposure and store the
Intraoral Film energy from the radiation; the stored energy forms an
Speed invisible pattern on the emulsion known as the latent
the size of the silver halide crystals image.
the thickness of the emulsion When the exposed film with the latent
the presence of special radiosensitive dyes image undergoes chemical processing
Film Speed procedures, a visible image results.
-refers to the amount of radiation required to produce a Three types of film are
radiograph used in dental
of standard density, film speed, or sensitivity, is radiography:
determined by the intraoral film
following: extraoral film
*A speed (the slowest) to F speed (the fastest) duplicating film
*Only D-speed film (Kodak Ultra-Speed) and Intraoral Film - placed inside the mouth and exposed
*E-speed film (Kodak Ektaspeed) - used for intraoral Four components:
radiography x-ray film
paper film
Extraoral Film lead foil sheet
Extraoral Film outer package wrapping
Types Screen Film - a film that requires the use of a Manufactured in 5 sizes (0, 1, 2, 3, 4)
screen for exposure Available in D speed and E speed (requires
Nonscreen Film - an extraoral film that does not one-half the exposure time of D-speed film and
require the use of screens for exposure exhibits comparable image contrast and
Extraoral Film resolution)
Equipment - large number = large size
Extraoral Film - placed outside the mouth and exposed
Typically screen films and require the use of
intensifying screens and a cassette holder for
exposure
Intensifying screens transform x-ray energy into
visible light, which in turn exposes the screen
film.
Use of intensifying screens requires less
radiation to expose a screen film and results in
less radiation exposure for the patient.
Duplicating Film - used to copy dental radiographs
Special type of photographic film used to make
an identical copy of an intraoral or extraoral
radiograph.
Used in a darkroom setting and is not exposed
to x-radiation
Film - adversely affected by heat, humidity, and
radiation and must be stored away from sources
of radiation in temperatures of 50 to 70 degrees
Fahrenheit and with a relative humidity level of
30 to 50%.
Dental film should always be used before the
expiration date on the label.
Dental X-ray Image
Characteristics
Radiopaque
Radiolucent
provides a great deal of information
images exhibit proper density and
contrast, have sharp outlines, and are of
the same shape and size as the
radiographed.
Diagnostic radiograph
Two terms are used to
describe the black and
white areas viewed on a
dental radiograph:
-portion of a processed radiograph
that is dark or black
- lacks density and permits passage
of the x-ray beam with little or no
resistance
-portion of a processed radiograph
that appears light or white
- dense and absorb or resist the
passage of the x-ray beam
High object density results in low film
density (e.g., amalgam, tooth structure,
bone)
Visual Characteristics
Density and Contrast
Density
overall blackness or darkness of a
dental radiograph
milliamperage (mA)
operating kilovoltage peak (kVp)
exposure time
3 exposure factors control the density of
a dental radiograph:
Contrast
difference in the degrees of blackness
between adjacent areas on a dental
radiograph
High contrast - dental radiograph that
has very dark areas and very light areas
Low contrast - dental radiograph that
does not have very dark and very light
areas but instead has many shades of
gray
Scales of Contrast
Short scale contrast - dental radiograph
that shows only two densities, areas of
black and white, has a short contrast scale
Long-scale contrast - dental radiograph
that exhibits many densities, or many
shades of gray, has a long contrast scale
- range of useful densities on a
dental radiograph
Geometric Characteristics
Sharpness, Magnification, and Distortion
Sharpness
capability of the x-ray film to reproduce
the distinct outlines of an object
fuzzy, unclear area that surrounds a
radiographic image
from two Latin words, "pene" meaning almost
and "umbra" meaning shadow
Penumbra
Three influencing
factors of sharpness
of the film
Focal spot size
Film composition
Movement
Area on the anode of an x-ray tube or the target
of an accelerator that is struck by electrons and
from which the esulting x-rays are emitted
Shape and size of a focal spot influence the
resolution of a radiographic image
An increase in focal spot size, which may
accompany deterioration of the x-ray tube,
reduces the ability to define small structures (also
called actual focal spot)
Focal Spot
Penumbra
Partial shadow
Zone of unsharpness along the edge
of the images in a radiograph
The larger the penumbra, the less
sharp the image will be
In projection geometry, the sharpness of a shadow is
determined by three factors dealing with the size of
the PENUMBRA and UMBRA
Small source of radiation
Maximum object film distance
Minimum object film distance
The smaller the focal spot the sharper the image
appears
The larger the focal spot area, the greater the amount
of the penumbra and
loss of image sharpness
Region of very low illumination on a dark
background.
Zone in which the brightness varies from some
illumination to zero (umbra) in the shadow cast by
an opaque object intercepting light from an
extensive light source.
Penumbra
The part of a shadow in which there is no light from
any light source.
A sharp appearance to the edges of a structure on a
radiograph.
An image with sharply defined margins.
Umbra
Focal spot size - the smaller the focal
spot, the sharper the image appears
Film composition - the larger the crystals
the less image sharpness
Movement - film or patient movement
result to less sharpness
Influencing factors
Magnification
radiographic image that appears larger than
the actual size of the object it represents.
Two influencing
factors of
magnification
Target-film distance - the distance
between the source of x-rays and the
film.
Object-film distance - the distance
between the object being radiographed
and the dental x-ray film.
Distortion
a variation in the true size and shape of
the object being radiographed
Two influencing
factors of distortion
Object-film alignment
to minimize dimensional distortion, the object
and film must be parallel to each other
X-ray beam angulation
to minimize dimensional distortion, the x-ray
beam must be directed perpendicular to the
tooth and the film
Techniques
Paralleling, Bisecting
Paralleling Technique
Accomplished by placing the
receptor parallel to the long axis of
the tooth
After this parallel relationship has
been established, the central ray
must be directed perpendicular to
both the tooth and receptor.
Bisecting Technique
Accomplished by placing the receptor as
close to the tooth as possible
Central ray of the x-ray beam should be
directed perpendicular to an imaginary line
that bisects or divides the angle formed by
the long axis of the tooth and the plane of
the receptor.
Foreshorthened and Elongated
Images
Foreshortening
Ray is perpendicular to the film but not
the object
Elongation
Ray is perpendicular to the object but not
the film
Summary
A number of influencing factors affect the visual image
characteristics of film density and contrast as well as the
geometric characteristics of sharpness, magnification,
and distortion.
The milliamperage, operating kilovoltage peak, and
exposure time can be used to adjust the density of a
dental radiograph. Subject thickness also influences the
density of a film.
Only the operating kilovoltage peak has a direct
influence on film contrast.
A radiograph that exhibits areas of black and
white is termed high contrast and is said to have
a short contrast scale; a radiograph that exhibits
many shades of gray is termed low contrast and
is said to have a long contrast scale.
To create a sharp image, the dental radiographer uses
the smallest focal
spot possible, chooses a film with small crystals in the
emulsion, and limits
patient and film movement.
To limit image magnification, the longest target-film
distance and the
shortest object-film distance are used.
To limit image distortion, the film and the tooth are
positioned parallel to
each other, and the x-ray beam is directed
perpendicular to the tooth and
film.
Dental X-ray Film Processing
to convert the latent (invisible) image on
the film into a visible image
to preserve the visible image so that it is
permanent and does not disappear
from the dental radiograph
Film Processing
refers to a series of steps that collectively produces
a visible permanent image on a dental radiograph
Purpose of film processing
is two fold
DEVELOPMENT - a chemical solution known as
developer is used in the development 1. process.
*the purpose of the developer is to chemically reduce
the exposed, energized silver halide crystals
into black metallic silver.
2. RINSING - a water bath is used to wash or rinse the
film. Rinsing is necessary to remove the
developer from the film and stop the development
process.
3. FIXATION - a chemical solution known as the fixer is
used in the fixing process.
* the purpose of the fixer is to remove the unexposed,
unenergized silver halide crystals from the film
emulsion.
4. WASHING - washing step is necessary to thoroughly
remove all excess chemicals from the
emulsion.
5. DRYING - the final step; films may be air-dried at
room temperature in a dust-free area or
placed in a heated drying cabinet.
Film Processing
Steps
 storage
temperature and humidity controlled
Film Processing Ideal darkroom requirements:
Solutions Darkroom
powder -to provide a completely
ready-to-use liquids darkened environment where
liquid concentrate x-ray film can be handled
It may be obtained in the and processed to produce
following forms: diagnostic radiographs
* fresh chemicals produce the best radiographs. To -must be properly designed
maintain and well equipped
freshness, film processing solutions must be replenished Must be convenient, ideally, it should be located
daily and near the area where x-ray units are installed
changed every 3 to 4 weeks. Must be large enough to accommodate film
developer processing equipment and to allow ample working
fixer space
Two special chemicals solutions are Should measure at least 16 to 20 square feet and
necessary for film processing: provide enough space for one person to work
Developer Solutions comfortably
Four Basic Ingredients Location
Developing agent - also known as the reducing agent the volume of radiographs processed
contains two chemicals, hydroquinone the number of persons using the room
(paradihydroxybenzene) and Elon (monomethy-para- the type of processing equipment used (processing
aminophenol sulfate) tanks versus automatic processor)
Hydroquinone generates the black tones and the sharp the space required for duplication of films and
contrast of the radiographic image storage.
Elon aka metol acts quickly to produce a visible Size of darkroom is determined by
radiographic image, generates the many some factors:
shades of gray seen on a dental radiograph Room lighting - Incandescent is required for
Preservative - the antioxidant sodium sulfite is the procedures not associated with the act of
preservative used in the developer solution processing films
the purpose of the preservative is to prevent the Safelighting - the special kind of lighting that is used
developer solution from oxidizing in the to provide illumination in the darkroom.
presence of air Two essential types of lighting:
Acceleration - the alkali sodium carbonate is used in the Lighting
developer solution as an accelerator AUTOMATIC PROCESSOR
(activator) is to activate the developing agents - is another simple way of
Restrainer - the restrainer used in the developing processing dental x-ray films
solution is potassium bromide - automates all film processing
the purpose of the restrainer is to control the developer steps
and to prevent it from developing Insert tanks
the exposed and unexposed silver halide crystals Master tanks
Fixer Solution PROCESSING TANK OR
Four Basic Ingredients MANUAL PROCESSING
Fixing agent - the clearing agent; is made up of sodium - is a simple method that is
thiosulfate or ammonium thiosulfate used to develop, rinse, fix, and
and is commonly called hypo. wash dental x-ray films.
Purpose: to remove or clear all unexposed and Two processing tanks:
undeveloped silver halide crystals from the less processing time is required
film emulsion time and temperatures are automatically controlled
Preservative - sodium sulfite, is also used in the fixer less equipment is used
solution less space is required
Purpose: to prevent the chemical deterioration of the Automatic processing is often preferred over manual
fixing agent film processing for four reasons:
Hardening agent - potassium alum, to harden and shrink THERMOMETER
the gelatin in the film emulsion after it necessary for manual processing and is used to
has been softened by the accelerator in the developer determine
solution the temperature of the developer solution
Acidifier - acetic acid or sulfuric acid, to neutralize the TIMER
alkaline developer used to indicate such time intervals; used to signal the
The Darkroom radiographer that the films must be removed from the
conveniently located current processing solution
of adequate size equipped with correct lighting FILM HANGER or FILM RACKS or PROCESSING HANGERS
arranged with ample work space with adequate a device equipped with clips used to hold films during
processing developer as needed
Equipment Accessories - replace faulty and inaccurate thermometers
STIRRING ROD OR STIRRING PADDLE and timers
used to agitate the developer and fixer solutions prior - if developer is depleted or contaminated ,
to replace it with fresh developer solution
processing Appearance:
PLASTIC APRON the film appears light
used to protect clothing during the processing of films Time and Temperature
and OVERDEVELOPED FILM
the mixing of chemicals Problems:
Miscellaneous Equipment - excess development time
Component and Parts of - inaccurate timer
Automatic Processor - high developer temperature
PROCESSOR HOUSING - encases all of the component - inaccurate thermometer
parts of the automatic - concentrated ( overactive ) developer
processor solution
FILM FEED SLOT - is an opening on the outside of the Solution:
processor housing that is used - check the temperature of the developer and
to insert unwrapped films into the automatic processor the time the film should remain in the developer
ROLLER FILM TRANSPORTER - is a system of rollers used solution
to move the film rapidly - decrease the time the film remains in the
through the developer, fixer, water, and drying developer as needed
compartments - replace faulty and inaccurate thermometers
DEVELOPER COMPARTMENT - holds the developer and timers
solution - if developer is overactive, replace it with fresh
FIXER COMPARTMENT - holds the fixer solution developer solution
Component and Parts of Appearance:
Automatic Processor the film appears dark
WATER COMPARTMENT - holds circulating water RETICULATION OF
DRYING CHAMBER - holds heated air and is used to EMULSION
dry the wet film Problem:
REPLENISHER PUMP AND REPLENISHER SOLUTION - when a film is subjected to a sudden
used to maintain proper solution concentration and temperature change between the
levels automatically in some automatic processor developer solution and the water bath
FILM RECOVERY SLOT - is an opening on the outside Solution:
of the processor housing where the dry, processed - check the temperature of the processing
radiograph emerges from the automatic processor solutions and water bath
Film Duplication - avoid drastic temperature differences
FILM DUPLICATOR between the developer and the water bath
- provides a diffused light source that evenly Appearance:
exposes the special duplicating film. the film appears cracked
- An identical copy of an intraoral or an Chemical Contamination
extraoral radiograph Developer Spots
PROCESSING PROBLEMS AND Problem:
SOLUTIONS when the developer solution comes in
Reasons: contact with the film before processing
time and temperature errors Solution:
chemical contamination errors - use a clean work area in the darkroom
film handling errors - to ensure a clean working surface, place a
lighting errors paper towel on the work area before
Time and Temperature unwrapping films
UNDERDEVELOPED FILM Appearance:
Problems: dark spots appear on the film
- inadequate development time Chemical Contamination
- inaccurate timer Fixer Spots
- low developer temperature Problem:
- inaccurate thermometer fixer solution are coming in contact with
- depleted or contaminated developer the film before processing
solution Solution:
Solution: - use a clean work area in the darkroom
- check temperature of the developer as well as - to ensure a clean working surface, place a
the time the film must remain in the developer paper towel on the work area before
solution unwrapping films
- increase the time the film remains in the Appearance:
white spots appear on the film to avoid air bubbles, gently agitate and stir film
YELLOW-BROWN racks after placing them in the processing
STAINS solution
Problem: Appearance:
- use of exhausted developer or fixer white spots appear on the
- insufficient fixation time film
- insufficient rinsing Fingernail Artifact
Solution: Problem:
- replace depleted developer and fixer solutions when the film emulsion is damaged by the
with fresh chemicals operator's fingernail during rough handling
- make certain that films have adequate fixation of the film
time and adequate rinse time Solution:
- rinse processed films for a minimum of 20 to prevent a fingernail artifact, gently handle
minutes in circulating cool water the film by the edges
Appearance: Appearance:
film appears black crescent-shaped
yellowish brown marks appear on the film
Problem: Fingerprint Artifact
results from a low level of developer Problem:
solution and represents an undeveloped when the film is touched by fingers
portion of the film Solution: contaminated developer
- check the developer level before processing Solution:
films - wash and dry hands thoroughly before
- add proper replenisher solution if necessary processing films
- make certain that all films on the film rack are - work in a clean area to avoid contaminating
completely immersed in the developer solution the hands
Appearance: - handle the films by the edges only
a straight white Appearance:
border a black fingerprint appears
Film Handling on the film
DEVELOPER CUT-OFF Static Electricity
Problem: Problem:
results from a low level of fixer solution and - opening a film packet quickly
represents an unfixed portion of the film - opening a film packet before touching
Solution: another object, such as the film processor
- check the fixer level before processing films or countertop in a carpeted office
- add proper replenisher solution if necessary - occurs most frequently
- make certain that all films on the film rack are Solution:
completely immersed in the fixer solution - always open film packets slowly
Appearance: - in a carpeted office, touch a conductive
straight black object before unwrapping films
border Appearance:
Film Handling thin, black branching lines
FIXER CUT-OFF Scratched Film
Overlapped Film Problem:
Problem: when the soft film emulsion is
when two films come into contact with removed from the film base by a sharp
each other during manual or automatic object, such as a film clip or film hanger
processing techniques. Solution:
Solution: - use care when placing a film rack in the
to avoid overlapped films, care should processing solutions
be taken to ensure that no film is permitted to - avoid contact with other film hanger
come into contact with another film during Appearance:
processing white lines appears on the
Appearance: film
white or dark areas appear Light Leak
on the films where overlap Problem:
has occurred - accidental exposure of the film to white
Air Bubbles light
Problem: - torn or defective film packets that
when air is trapped on the film surface expose a portion of the film to light
after the film is placed in the processing Solution:
solution - examine film packets for minute tears or
Solution: defects before use
- do not use film packets that are torn or
defective
- never unwrap films in the presence of white
light
Appearance:
area appears black
Fogged Film
Problem:
- improper safelighting and light leaks in
the darkroom
- improper film storage
- outdated films
- contaminated processing solutions
- high developer temperature
Solution:
- check the filter and bulb wattage of the safelight
- minimize film exposure to the safelight and check
the darkroom for light leaks
- check the expiration date on film packages and
store films in a cool, dry, and protected area
- avoid contamination of processing solutions by
replacing tank covers after each use
- always check developer temperature before
processing films
Appearance:
appears gray and lacks
image detail and contrast