Radiographic examination in oral surgery

Abstract

The maxillofacial area presents exceptional difficulties as far as the radiographic examination is concerned. Even so, this examination is the most valuable and important diagnostic tool for oral surgeons, who have to chose the most appropriate radiographic technique among many, so that the information they gather will help them significantly in diagnosis and therapy. It is obvious, of course, that radiographs are taken only if necessary for diagnostic purposes and after meticulously scrutinizing the patient's history and the clinical examination of the patient. Conventional radiographs are two-dimensional images, which depict three-dimensional anatomical areas. Therefore, correct interpretation of the radiographs is very important in diagnosing problems of the oral and maxillofacial area, and is achieved when: The radiographs are of good quality. The technique used for the various radiographs is known. The entire area that interests us is depicted. We are aware of the anatomy of the area and how various anatomical structures are depicted on radiographs. We are well aware of the various pathologic lesions that may present in the area and how they are depicted radiographically. The diagnostic information obtained from a radiograph depends on the quality of the radiograph; the higher the quality of the image, the greater the probability of an accurate diagnosis. Some pathologic conditions may require an increase or decrease of the technique factors involved in developing a radiograph. This is due to the pathologic lesion itself. When the lesion enhances bone density, the technique factors must increase. In contrast, when the lesion causes a decrease in bone density, then the technique factors decrease. Generally, the main indications for radiographic examination are: Discovering a correlation between pathologic lesions and normal anatomical structures, e.g., the maxillary sinus, mandibular canal, nasal fossa, mental foramen, etc. Discovering impacted and supernumerary teeth, root remnants, etc. Evaluation of the degree of radiopenetration of a lesion. Identification of a lesion and its size, shape, and boundaries. The development of a lesion. The effect of a lesion on the bone cortex and the adjacent teeth. The main radiographic techniques used in oral surgery are the following: Periapical projection. Occlusal projection. Panoramic radiograph. Lateral oblique projection of mandible. More rarely, other extraoral projections of the face and jaw may be used, depending on the situation. Periapical projections are advantageous in that they provide detailed information about the bone structure and aid us in the study of teeth that remain in the maxilla and mandible. Occlusal projections have the same advantages as periapical radiographs, but they also depict larger areas. These projections provide the third dimension, used in conjunction with periapical or panoramic radiographs. They are also used for evaluating the arch of the jaw, bone quality and for examination of the greatest buccolingual dimension of the mandible. A panoramic radiograph provides us with valuable information concerning the bone and its correlation to the mandibular canal, the maxillary sinus, and the nasal fossa. It also gives us an overall assessment of the dentoalveolar system and allows us to study the existing teeth, as well as the presence of bony lesions, root remnants, impacted teeth, etc. Chapter 2. © Springer-Verlag Berlin Heidelberg 2007.