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Dental Radiography of the Horse

Article in Journal of Veterinary Dentistry · March 2018

DOI: 10.1177/0898756417736882

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Robert Baratt
Salem Valley Veterinary Clinic
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Step-by-Step
Journal of Veterinary Dentistry
2018, Vol. 35(1) 37-41
Dental Radiography of the Horse ª The Author(s) 2017
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DOI: 10.1177/0898756417736882
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Leah E. Limone, DVM1 and

Robert M. Baratt, DVM, MS, DAVDC, DAVDC/Equine2

Abstract
This step-by-step article describes radiographic imaging of the horse’s teeth and paranasal sinuses with standard radiographic
equipment. Obtaining radiographs of the horse’s skull that are of diagnostic quality can be challenging. The descriptions offered in
this article can help practitioners become more comfortable with obtaining diagnostic images, which will improve recognition of
radiographic signs of dental and paradental pathology.

Keywords
horse, dental, radiography, radiographs, equine

Introduction
There are several excellent publications describing radiography
techniques in horses.1-3 This step-by-step article provides an
additional resource for learning the art of dental radiography in
the horse. Since most equine practitioners do not have access to
intraoral phosphor plates, extraoral techniques for evaluating
the horse’s teeth with direct digital radiographic (DR) systems
are discussed.

Equipment Considerations
Commonly used portable X-ray generators with variable
exposure time and kVp and a fixed mA are sufficient for
radiography of the horse’s head. A speculum or bite block is
needed for open-mouth views. Open-mouth views allow for
optimal image quality since superimposition of contralateral
arcades is reduced or eliminated. Bilateral images (of
affected and unaffected arcades) are necessary for reliable
radiographic interpretation. The AVDC convention of pre-
senting the radiographs with “labial mounting” is used in
conjunction with the ACVR terminology.4 Labial mounting
allows radiographs to be presented as if the viewer is look-
ing into the patient’s mouth. The right cheek teeth would be
presented with the horse’s nose on the viewer’s right. The
maxillary incisor crowns are facing down, and the mandib-
ular incisor crowns are facing up; the horse’s left incisors
would be to the viewer’s right. The dorsoventral views of
the skull are presented with the nose down and the horse’s
left side on the viewer’s right. As the sensor and generator
are handheld, adequate protective gowns, gloves, and a thyr-
oid shield are necessary. The clinician should ensure that
the assistant is never in the primary X-ray beam. Adequate
sedation is necessary to obtain diagnostic dental radiographs
to reduce motion artifact. The primary author’s preferred
Figure 1. Laterolateral view (6-year-old, thoroughbred gelding). In
the right latero–left lateral (right–left lateral) view, the sensor is placed
on the left side of the horse’s head and the X-ray beam is directed at
the rostral end of the facial crest, perpendicular to the long axis of the
head (and the sensor). This view is primarily used to evaluate the
paranasal sinuses. In this young horse, the apices of the maxillary first
molar fill the RMS. CFS indicates conchofrontal sinus; CMS, caudal
maxillary sinus; RMS, rostral maxillary sinus; VCB, common dorsal
compartment (bulla) of the ventral conchal sinus and the RMS, located
dorsal to the infraorbital canal (IFC).
1
Northeast Equine Veterinary Dental Services, LLC, Topsfield, MA, USA
2
Salem Valley Veterinary Clinic, Salem, CT, USA
Corresponding Author:
Leah E. Limone, Northeast Equine Veterinary Dental Services, LLC. PO Box
264, Topsfield, MA 01983, USA.
Email: leahlimonedvm@gmail.com
38 Journal of Veterinary Dentistry 35(1)

Figure 2. Dorsoventral (DV) view. If the horse is adequately sedated (with the head resting on a low stool), the clinician can look over the
X-ray generator to direct the X-ray beam perpendicular to the dorsal plane, which is parallel to the hard palate, centering at the level of
the rostral end of the facial crest. In most cases, this will require significantly higher kVp and mAs than the lateral views. Slight caudorostral or
rostrocaudal angulation of the primary beam is needed to obtain long-axis direction of the caudal and rostral maxillary cheek teeth, respectively.
This view also is used to evaluate paradental sinuses. CMS indicates caudal maxillary sinus; RMS, rostral maxillary sinus; VCS, ventral conchal
sinus.

Figure 3. The left (A) and right (B) offset mandible dorsoventral (DV) views are used to reduce the overlapping images of the maxillary and
mandibular cheek teeth. Assistants can offset the mandibles with gauze bandage, or a commercially available speculumc can be used (C). Since the
caudal molars are angled rostrally and the rostral premolars are angled caudally, they will not be clearly imaged when the central beam is
centered on the rostral end of the facial crest and directed perpendicular to the palate.
Limone and Baratt 39

Figure 4. Open-mouth right dorsal to left ventral lateral oblique view of the maxillary cheek teeth (Rt30D-LeVO; A). The sensor is on the left side
of the horse’s head, and the generator is raised 30 from the straight lateral position (B). Opening the mouth for this view decreases the
superimposition of the mandibular cheek teeth. The buccal roots of the left maxillary cheek teeth may be separated from the palatal root, allowing
clearer assessment of the mesial and distal buccal roots.

Figure 5. Open-mouth right dorsal to left ventral lateral oblique view of the left mandibular cheek teeth (Rt10D-LeVO). This positioning is
similar to that used for Figure 4 but with less angle (10 ) and with the central beam directed at a more ventral location but still at the level of the
rostral end of the facial crest. This view isolates the crowns of the left mandibular cheek teeth.

sedation protocol is intravenous administration of detomi-

dinea (0.01-0.02 mg/kg) used in combination with butorpha-
nolb (0.005-0.01 mg/kg). Appropriate sedation lowers the
horse’s head, and the head can be rested on a low support,
such as a stool. Resting the DR sensor on the same object
greatly diminishes motion artifact.
Standard Views
The following radiographic views are used to obtain diagnostic
images of the equine dentition. Additional tooth-specific views
may be required when “survey” views do not properly isolate the
target tooth. The actual oblique angles that give the best image
will vary between horses and by patient age (Figures 4–10).
40 Journal of Veterinary Dentistry 35(1)

Figure 6. Open-mouth right ventral to left dorsal lateral oblique view (Rt45V-LeDO; B). This positioning isolates the apices of the left maxillary
cheek teeth, projecting the palatal root dorsal to the buccal roots (A). A steeper angle (60 ) is needed in the young horse (with longer reserve
crowns). With proper positioning of the sensor, the apices of the left mandibular cheek teeth may also be imaged in this view or may be imaged
in a separate view (see Figure 7).

Figure 7. Open-mouth right ventral to left dorsal lateral oblique view (Rt45V-LeDO) of the left mandibular cheek teeth (A). The apices of the
left mandibular cheek teeth are imaged in this view. The central beam directed at the center of the left mandibular arcade will image the left
mandibular apices (B).

Figure 8. Intraoral bisecting angle technique of the maxillary incisors (A-C). The central beam (yellow line) is directed perpendicular to the
plane (black line) that bisects the angle between the incisor reserve crown root (white line) and the sensor (red line, D). The patient must be
sedated adequately to prevent chewing and tongue motion. Radiolucent bite plates that fit most McPherson-type speculums are now com-
mercially available.d Alternatively, an aluminum speculume may be used. Left (B) and right (C) oblique occlusal views (15 -30 left and right of
midline) are used to isolate the second and third incisors on each side.
Limone and Baratt 41

Figure 9. Extraoral open-mouth orthogonal oblique views of the maxillary canine teeth. The central beam is perpendicular to the long axis of
the head, centered on the commissure of the lips, and lowered 15 to 30 from the straight lateral for the ventrodorsal projection; the maxillary
canine tooth closest to the sensor will be the lower of the 2 maxillary canine teeth.

Figure 10. Intraoral occlusal views of the mandibular incisors and canine teeth (A-C). The bisecting angle technique is used. Turning the horse’s
head to the right or left facilitates appropriate positioning of the generator for the straight occlusal and oblique occlusal views. The mandibular
canine teeth can generally be imaged with this technique.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
Notes
a. Dormosedan, Zoetis, Kalamazoo, Missouri.
b. Butorphanol Tartrate Injection, Bayer Animal Health, Shawnee
Mission, Kansas.
c. Juliuster, MXR Podoblock BV, Midlaren, the Netherlands.
d. XtandR bite plates Podoblock USA LLC, Hobe Sound, Florida.
e. Alumispec, Equine Dental Instruments, Elmwood, Wisconsin.
References
1. Baratt RM. Advances in equine dental radiology. Vet Clin North
Am Equine Pract. 2013;29(2):367-395.
2. Baratt RM. How to improve the diagnostic quality of your dental
radiographs. AAEP Proc 2016;62:63-68.
3. Tremaine H. A modern approach to equine dentistry 3. Imaging. In
Pract. 2012;34(3):114-127.
4. Smallwood JE, Shively MJ, Rendano VT, Habel RE. A standar-
dized nomenclature for radiographic projections used in veterinary
medicine. Vet Radiol. 1985;26(1):2-9.

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