Professional Documents
Culture Documents
SIXTH EDITION
Cover image
Title page
Dedication
Copyright
Preface
Acknowledgements
Part I. Introduction
Introduction
Introduction
Atomic Structure
X-Ray Production
Introduction
Ideal Requirements
4. Image Receptors
Introduction
Digital Receptors
Radiographic Film
Cassettes
5. Image Processing
Chemical Processing
Dose Units
Dose Limits
Dose Rate
Dose Limitation
Footnote
Control of Infection
Footnote
9. Periapical Radiography
Main Indications
Radiographic Techniques
Anatomy
Conclusion
Main Indications
Positioning Techniques
Resultant Radiographs
Introduction
Introduction
Terminology
Main Indications
Bimolar Technique
Introduction
Main Indications
Equipment
Introduction
Tomographic Theory
Panoramic Tomography
Selection Criteria
Equipment
Technique and Positioning
Normal Anatomy
Footnote
Main Indications
Normal Anatomy
Radiation Dose
Quality Assurance
Footnote
Introduction
Quality Assurance (QA)
Working Procedures
Audits
Footnote
Introduction
Contrast Studies
Radioisotope Imaging
Ultrasound Examinations
Conclusion
Introduction
Classification of Caries
Introduction
Introduction
Selection Criteria
Introduction
Main Indications
Main Contraindications
Radiographic Examination
Peri-operative Imaging
Footnote
Introduction
Introduction
Footnote
Introduction
Step-By-Step Guide
Footnote
STEP I
STEP II
STEP III
STEP IV
STEP V
Summary
Introduction
Hormone-Related Diseases
Blood Dyscrasias
Introduction
Skeletal Fractures
Introduction
Normal Anatomy
Investigations
Footnote
Introduction
Normal Anatomy
Normal Appearance of the Antra on Conventional Radiographs
Antral Disease
Investigations
Index
Dedication
To our families
Copyright
© 2021, Elsevier Limited. All rights reserved.
ISBN: 978-0-7020-7688-6
Printed in China
2 1
Preface
It is now nearly 30 years since the first edition of Essentials was
published and nearly 6 years since the first co-authored fifth edition.
This sixth edition is again co-authored with my friend and colleague
Nicholas Drage and marks the last edition that I will be directly
involved with, given that I am in the twilight of my career. It is
reassuring to know that Essentials will be in Nicholas’ safe hands.
I am delighted that we have been given this final opportunity to
update and refresh Essentials together and to be able to introduce
colour images throughout – we hope this has given the book a
completely new and modern feel. In addition to the new photographic
material, we have revised and updated nearly every chapter. We have
tried to align the content and terminology more closely with the new
international classifications in relation to cysts, tumours, bone lesions
and diseases, caries and periodontal diseases. Many new radiographs
have been added and we have placed greater emphasis on examples
showing normal radiographic anatomy, working on the principle that
the main reason for radiographic imaging is to be able to distinguish
the difference in appearance between normal and abnormal, to
determine the presence or absence of (hard tissue) disease. Another
major change has been to reorder the contents of several chapters so
that digital imaging is described first, recognising the switch from
film-based imaging to digital imaging.
The website created with, and linked to, the previous edition
proved popular with students, particularly the online self-assessment
questions relating to each chapter, so these have also been reviewed
and new questions added as appropriate.
Despite the various updates and revisions, the aims and objectives
of this book remain the same, namely to provide a basic, but
comprehensive, practical account of what we consider to be the
essential subject matter of both dental radiography and radiology as
required by undergraduate and postgraduate dental students. As in
previous editions, some things have had to be omitted, or sometimes,
over-simplified. However, the book remains first and foremost a
teaching manual (albeit more colourful) rather than a comprehensive
reference. We believe that the content remains sufficiently broad,
detailed and up-to-date to satisfy the requirements of most
undergraduate and postgraduate examinations and the needs of most
general dental practitioners. Students are encouraged to build on the
information included here by using the excellent and more
comprehensive textbooks available.
We hope that once again the result is a clear, logical and easily
understandable textbook that continues to make a positive
contribution to the challenging tasks of teaching and learning dental
radiology.
EW
Acknowledgements
As with previous editions, this edition has only been possible thanks
to the enormous amount of help and encouragement that we have
received from our various friends and colleagues in both London and
Cardiff.
In particular, we would like to thank Nigel Pearson, Head of the
Medical Photography Department at Guy’s and St Thomas’, and Sam
Evans from the Dental Photography Unit, Cardiff University, who
together are responsible for all the new photographic images. Special
thanks to Beatrice Cicchetti for volunteering to be our adult patient
model – her patience and ever-present smile made hours of
photography bearable for all of us! Our thanks also to Clive and
Charlene Bathurst for allowing their daughter Hayley to be our child
patient model. Our thanks also to Richard Beal (Clarke Dental
Limited), Paul Keeley (Henry Schein Dental) and Jay McKay (Sirona-
Dentsply) for supplying some of the equipment for photography
purposes.
We are very grateful to several colleagues for their help and advice
with specific chapters. They include Melanie Wilson, Senior Lecturer
in Oral Microbiology in Cardiff for Chapter 8 ; Dirk Bister, Consultant
in Orthodontics at Guy’s for Chapter 14 ; Simon Harvey, Consultant in
Dental & Maxillofacial Radiology at Guy’s for Chapter 18 ; Avi
Banerjee, Professor of Cariology at King’s College London for Chapter
21 ; Francis Hughes, Professor of Periodontology at King’s College
London for Chapter 22 , George Paolinelis, Consultant in Oral Surgery
at Guy’s for Chapter 23 and Eddy Odell, Professor of Oral Pathology,
King’s College London for Chapters 26 and 27 . In addition, Dental
Radiology Departmental colleagues at Guy’s willingly offered their
help and advice – in particular we would like to thank Jackie Brown,
Bethan Thomas, John Rout, Niall O’Neill, Amanda Loughlin, Beatrice
Cicchetti and Stephen Goss. We are also very grateful to Andrew
Gulson, from Public Health England for his permission to allow us to
reproduce parts of the 2020 Guidance Notes. Special thanks to
Allisson Summerfield for co-ordinating the IT and imagery, the hours
she spent photocopying and electronically correcting the proofs, and
for always being on hand to ensure the job got done! Many thanks
also to Elsevier’s Alison Taylor, our now retired Content Strategist,
Fiona Conn for masterminding the manuscript to get it ready for
production, and Karthikeyan Murthy and his team for their huge
effort in getting the book to final publication.
Last, but by no means least, we would once again like to thank our
wives Catriona and Anji and our children Stuart, Felicity and Claudia,
and Karisma and Jaimini for their love, understanding and
encouragement throughout the production of this edition and for
accepting the sacrifice of family time that it has involved.
EW
ND
PA R T I
Introduction
OUTLINE
Introduction
The use of X-rays is an integral part of clinical dentistry, with some
form of radiographic examination necessary on the majority of
patients. Radiographs are primarily taken to determine the presence
or absence of underlying hard tissue disease affecting the teeth and/or
bones. As a result, radiographs are often referred to as the clinician’s
main diagnostic aid . Traditional radiography enables the creation of
conventional two-dimensional radiographic images, but technological
advances in computer generated images – so-called cone beam
computed tomography (CBCT) - has resulted in imaging in three
dimensions and improved diagnostic capability (see Figs. 1.1 and 1.2 ).
FIG. 1.1 A traditional two-dimensional dental radiograph
showing the hard tissues of the teeth, containing metallic
amalgam restorations, and the supporting alveolar bone.
FIG. 1.4 (i) Front view and (ii) plan view of various
cylinders of similar shape but made of different
materials: (A) plaster of Paris, (B) hollow plastic, (C)
metal, and (D) wood. (iii) Radiographs of the cylinders
show how objects of the same shape, but of different
materials, produce different radiographic images.
• The grey shadows represent areas where the X-ray beam has
been stopped to a varying degree.
CHAPTER VI.
Journey to Mount Ætna.—Mule travelling.—Neglected state of the
country.—Melilla, the town of honey.—Narrow escape of the
author.—Prospect of Ætna.—A Sicilian village and country-
house described.—Comparison of Sicily with New England.
CHAPTER VII.
Perilous adventure in crossing a river.—A Sicilian ferry-boat.—
Enormous size of Ætna.—Inhabitants of the mountain.—
Another accident with the mules.—Arrival at Catania.
Having rested our mules and munched a bit of dinner, we set out
again, meaning to arrive at Catania before night. We passed by
some beautiful green fields and groves of olives, but a short time
afterward the track led us toward the sea, and we came to a bare,
sandy plain. Here was a river in our way, with a wretched straw hut
on the bank, inhabited by a man who kept a ferry-boat. We
dismounted and crossed in the boat, but the mules were led up the
stream to go over a ford at some distance. After passing this stream,
we found the country wilder than ever: it consisted of sand-hills,
overgrown here and there with low bushes and coarse grass, like the
land at Cape Cod. Presently we came to another river, where there
was no boat, nor house, nor human being, to be seen. One of the
muleteers approached the stream with a long pole, to sound the
depth of the water. It was not very deep, but the bottom was a
quicksand, and the sounding-pole sunk into it till he found there was
no firm bottom. He went up and down the bank, trying other places,
but could not find a spot that was passable.
We were now in a great perplexity. I could not imagine any
possible means of getting across; the muleteers held a noisy talk
together about what was to be done, and at last led the way along
the bank down stream. I asked where we were going, and was told
that at the mouth of the river was a sand-bar, firm enough to allow us
to cross upon it. In about a quarter of an hour, we came to the sea-
shore. There was a smooth, sandy beach all along the coast, and
the tide ran out of the river with a pretty rapid current. The bar was
several feet under water, and the heaving of the sea, with the rapidity
of the tide, made a great surf. I thought it a very dangerous thing to
ride out into the ocean through the surf of a sand-bar, for the
purpose of crossing a river, but there was no other way, and we
pushed on. The head mule was frightened as he entered the sea,
and seemed unwilling to proceed. One of the muleteers dismounted,
and led him by the bridle into the surf, wading up to his middle in the
water. By a good deal of coaxing and pulling, he made him advance.
The mules are so accustomed to follow one another in a string, that
the head one is sure to lead all the rest wherever he goes, so the
whole file of them plunged in after him. When I had got a
considerable distance out on the bar, my animal became frightened
at the waves that were tumbling about his legs, and he sidled off into
deep water. I expected hardly anything less than to be drowned, for,
on finding the water rising up to his back, he grew so bewildered that
he was unable to tell which way he was going, and would have
carried me directly out to sea if I had not pulled in the reins with all
my might, and brought him to a full stop. After allowing him to
recover his breath a little, I drew his head round in the proper
direction, and forced him onward; by repeated trials, I regained a
shallower spot, where he grew more quiet, and finally got to land. All
the others crossed the bar in safety.
The country after we passed the river was sandy and wild,
abounding in marshes and lagoons, where we saw a great many
wild ducks. Late in the afternoon we came to another stream, much
broader and deeper than any of the others. There was a large
ferryboat like a mud-scow, which carried us over, mules and all. The
animals made a terrible uproar on board, kicking, pushing and biting
each other at a furious rate. The boat had neither oars nor sail, but
was moved by a rope stretched across the stream from shore to
shore. The banks of the river were soft and clayey, and there was a
clumsy sort of wharf for a landing-place, made of sticks and bushes
tied together.
This river was anciently named Syn[oe]thus; at present it is called
Giarretta. It is remarkable for containing amber, which is carried
down to the sea in its waters, and afterwards thrown up on the beach
by the waves, for many miles along the coast. A great many persons
are constantly searching along the beach for this precious material.
After my arrival at Catania, I saw a fisherman who had just picked up
four or five highly valuable lumps. They were of a beautiful yellow
color, and of the most transparent clearness I ever saw. It is well
known that this article is made into beads and other ornamental
work, but the nature of its origin has never been satisfactorily shown.
From the masses being often found in the shape of tears or globules,
like bulbs of turpentine or gum, it was formerly supposed to be some
hardened vegetable matter; but no tree has ever been discovered
exuding amber. Sometimes insects are imbedded in the lumps, and
this has led many persons to imagine that the insects manufacture it,
as the bees make wax. It is remarkable that it is never found
originally on land, and nowhere except on the sea-beach. This part
of the Sicilian coast, and the Prussian shore of the Baltic, produce
the most of it. It is also found on the shores of the Adriatic and the
coast of Maryland.
It was some time before we got ready to start from the ferry after
crossing. The mules had become so antic from their squabble in the
boat, that they continued to bite and kick and jostle one another,
squealing and whirrying most terribly. Several of them threw off their
loads in the hurly-burly, and we were forced to bang them lustily with
sticks before they would be quiet. At last we mounted and set off
again, and I was glad to hear that there were no more rivers to cross
on the way to Catania. A little boy, who sat on one of the mules
between two great packs, kept singing all the way. Some of the flat
marshy spots were all overgrown with canes, such as we use for
fishing rods: they were fifteen or twenty feet high. The country
people make use of them to prop their vines, as we set up poles for
beans. I saw many laborers in the vineyards along the road, setting
the vine-props; these are taken down when the grapes are gathered,
and the tops of the vine-stalks are cut and dried for fuel. During the
winter, the vine looks like a dead and worthless stump, but it sprouts
anew in the spring, and by midsummer shoots up to the top of the
pole.
Every step of our journey brought us nearer to the great volcano,
which more and more excited my wonder as I approached it. I could
now plainly distinguish the numerous hills which stud its whole lower
surface like warts. Many villages appeared scattered about in
various parts of the mountain. I never before had any idea of its
enormous magnitude. There are thousands of people who live at a
great height upon this mountain, and have never been off it during
their lives. Yet it is always smoking at the summit, and often bursts
out in fiery eruptions, that lay waste whole towns and destroy many
of the inhabitants.
Long after the sun had set to us, I continued to see the snowy top
of Ætna brightened with his declining rays. As it grew dark, our road
led us down to the sea-shore again, and we travelled many miles
along the sandy beach. The mules were sadly tired with their long
journey; every five minutes one of them fell from utter weariness and
inability to sustain his load. The muleteers set them on their legs
again, gave them a sound beating, and drove them onward. In the
dark, I rode against the mule who was trotting before me: the beast,
either being more vicious than the others, or rendered cross by
fatigue, gave a kick, which was intended for my animal, but missed
him, and struck me on the left leg. The pain of the blow was so great
that I fell instantly from the saddle upon the ground, and should have
been left there in the dark, if I had not bawled out loudly. The whole
train was stopped when the accident was known. My first belief was
that my leg was broken; upon feeling the bone, however, no fracture
could be perceived; and, after a good deal of chafing, the pain
somewhat abated, and I was helped again into the saddle. I jogged
on slowly, keeping a sharp look-out for fear of another accident,
having had adventures enough to satisfy me for one day. This affair
delayed our progress so that we did not reach Catania till late in the
evening, when it was much too dark to see anything of the city. I
must therefore reserve my description of the place for the next
chapter.
Balboa discovering the Pacific.