Zheen Panoramic X-ray

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تیشکی ددان ، Dental X-ray , اشعة اسنان

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2D Imaging

Digital Panoramic (OPG)

An OPG is a panoramic or wide view x-ray of the lower face, which displays all the teeth of the upper and lower jaw on a single film. It demonstrates the number, position and growth of all the teeth including those that have not yet surfaced or erupted. It is different from the small close up x-rays dentists take of individual teeth. An OPG may also reveal problems with the jawbone and the joint which connects the jawbone to the head, called the Temporomandibular joint or TMJ. An OPG may be requested for the planning of orthodontic treatment, for assessment of wisdom teeth or for a general overview of the teeth and the bone which supports the teeth.

TABLE 7.1 Radiology for treatment planning in implant industry

SINGLE IMPLANT

Anterior maxilla

Periapical radiograph. If cross-sectional information is needed possibly use limited-volume CBCT.



Premolar maxilla

Periapical and/or panoramic radiograph. If cross-sectional information is needed, possibly use limited-volume CBCT.



Molar maxilla

Periapical and/or panoramic radiograph. If cross-sectional information is needed, possibly use limited-volume CBCT especially to visualise the antral floor.



Anterior mandible

Periapical radiograph. If cross-sectional information is needed possibly use limited-volume CBCT to show lingual fossae.



Post-foraminal mandible

Periapical and/or panoramic radiograph. To show three dimensional position of the inferior dental canal and to investigate concavities of lingual/submandibular fossae, possibly use limited-volume CBCT.



MULTIPLE IMPLANTS



Multiple exposures using the above guidance can become unwieldy and carry significant radiation exposure. A good panoramic radiograph with magnification markers can often give excellent information. Where cross-sectional information is needed, CT, limited or full-volume CBCT should be used, if the exposure is likely to improve the outcome for patient and surgeon.

MRI could be considered as it entails no exposure to ionising radiation.



IF REQUIRED DURING SURGERY



Periapical radiographs should be used, with radiographic measurement markers. For ease of use during surgery, the use of a digital system should be considered.



POST-OPERATIVE



Periapical and/or panoramic radiographs may be used.



GENERAL GUIDANCE AND POST-TREATMENT REVIEW



Periapical and panoramic radiographs give good two-dimensional information, but the surgeon must be aware of potential magnification and patient positioning errors. The use of sectional imaging is appropriate in complex and anatomically challenging cases, but the surgeon should be aware of the need to reduce the dose by using CBCT and MRI rather than conventional CT. In all cases, the technique employed should justify the radiation dose. Post-operative review protocols appear to be the subjective opinion of authors. A radiograph at completion of the restoration and 12 months later may be considered essential in

gaining baseline data and assessment of any changes in bone levels due to factors such as remodelling, function or inflammation. An ongoing review interval of one, three, or up to five years is suggested, to verify stability of bone levels or to detect progressive bone loss. A careful clinical examination should be able to indicate a stable situation, but it is advisable to obtain radiographic evidence of bone levels if signs are present that may suggest deterioration, eg. increased probing depth, bleeding, exudate, mobility.

Dental Radiography and Pregnancy

Concern exists for the safety of dental X-rays in pregnant patients and operators. The ADA recommends the use of aprons and thyroid shields for pregnant patients, and dosimeters and work practice controls for pregnant operators.2 Studies of pregnant patients receiving dental care have affirmed the safety of dental treatment.11, 12 The American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women reaffirmed its committee opinion in 2015: “Patients often need reassurance that prevention, diagnosis, and treatment of oral conditions, including dental X-rays (with shielding of the abdomen and thyroid) … [is] safe during pregnancy.”13

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