Dental radiology is a crucial diagnostic area within dentistry. It allows for a deep look into the structures of the oral cavity and face that cannot be seen with the naked eye. This non-invasive and painless imaging test plays a crucial role in diagnosing and planning treatment. In this article, we will take a closer look at the topic of dental radiology. We will discuss various types of images taken in the clinic, indications for their use, radiological protection, and the safety of their execution.
History of Radiology
The beginnings of dental radiology are associated with the groundbreaking discovery of X-rays by Wilhelm Roentgen in 1895. The initial applications of this radiation in dentistry allowed for imaging of tooth and jawbone structures, revolutionizing the diagnosis of oral diseases.
Today, various imaging techniques can be found in dental clinics. The most popular among them are cephalometry, panoramic radiography, CBCT (cone beam computed tomography), and periapical radiography. Each of these techniques has its own applications and areas where it plays a crucial diagnostic role.
Role of Radiation in Dentistry
Radiological Diagnosis
Dental radiography provides invaluable diagnostic information. Radiographic images allow for a precise assessment of tooth structure and surrounding tissues, enabling dentists to detect various health issues in patients, including decay, inflammatory changes around tooth roots, bone defects, resorptions, cysts, or neoplastic changes. Through regular diagnostics, early detection and appropriate treatment can be initiated.
Dental Treatment Planning
Radiographic examinations allow for precise treatment planning. They enable the dentist to assess aspects such as the number of tooth roots and canals, the effectiveness of root canal treatment, the extent of fillings, bone loss around teeth, root positions relative to other anatomical structures, among others. This information is significant for planning various dental procedures across all dental disciplines, from conservative dentistry with endodontics to orthodontics, periodontics, prosthodontics, surgery, and implantology.
Monitoring Dental Treatment
X-ray images are essential for monitoring the progress of dental treatment. Through regular imaging, dentists can evaluate the effectiveness of treatment and tissue regeneration.
Types of Radiological Examinations in Dentistry
- Cephalometry is an imaging technique of skull structures, allowing for measurement and analysis of various parameters. It is particularly useful in orthodontic treatment planning.
- Panoramic radiography provides a wide-angle X-ray projection showing the jaw and mandible with teeth, temporomandibular joints, and maxillary sinuses. It is particularly useful in general oral diagnostics and the diagnosis of impacted teeth, bone disorders, and maxillary sinus pathologies, among others.
- Cone Beam Computed Tomography (CBCT) is an advanced imaging technique enabling three-dimensional analysis of structures within the jaw and mandible. It is useful in dental surgery, implantology, or endodontics, allowing for a much more precise analysis of hard oral tissues, their spatial arrangement, and dimensions.
- Periapical radiography is a radiographic examination focusing on one area, usually one tooth. Due to its magnification and accuracy, it allows for a precise assessment of relevant structures and their pathologies, such as the presence of decay, periodontal diseases, or root fractures.
Each of these techniques has its indications for use in various dental fields. From orthodontics through surgery to endodontics, specific radiological examinations are utilized to better understand the patient’s problem, formulate the appropriate diagnosis, and plan treatment effectively.
Radiation in Dentistry: Dosage and Safety
It is crucial to emphasize that despite concerns about X-ray radiation, performing X-ray examinations in dental clinics is safe with appropriate radiological protection. The radiation dose in dental radiographic examinations is minimal, carefully controlled, and adjusted to diagnostic needs. The radiation dose emitted during an X-ray is comparable to daily activities such as flying or sun exposure, which occur more frequently than getting an X-ray. For comparison, a panoramic X-ray involves a dose of approximately 9-26 μSv, whereas in Poland, each of us receives around 6.8 μSv of natural radiation daily, and an intercontinental flight exposes passengers to about 138 μSv.
The side effects are minimal compared to the immense diagnostic value these examinations carry.
One of the main arguments for performing regular radiographic examinations is that many oral diseases and conditions, such as infections, tumors, or inflammatory changes, may be invisible during a routine dental examination. Radiological diagnosis allows for the identification of these conditions at an early stage, enabling faster and more effective treatment.
Panoramic Radiography vs. CBCT
Panoramic radiography and cone beam computed tomography (CBCT) are two different medical imaging techniques used in oral cavity diagnostics. Here are the main differences between them:
Panoramic Radiography:
- Two-dimensional imaging: Panoramic radiography is a layered image allowing for simultaneous visualization of all teeth, maxillary sinuses, mandibular bones, and temporomandibular joints.
- Application: It is used for general diagnostics, allowing evaluation of visible structures.
- Radiation dose: It is relatively low compared to other X-ray imaging methods and ranges from 9-26 μSv.
CBCT:
- Three-dimensional imaging: CBCT is a volumetric examination that provides a three-dimensional image of anatomical structures, offering a more detailed view of individual areas of the oral cavity.
- Application: It is used for more precise diagnostics, planning of implant treatments, determining the number of root canals, evaluating root canal treatment, analyzing bone structures, assessing maxillary sinuses, inflammatory states, oncological changes, etc.
- Radiation dose: CBCT requires a slightly higher radiation dose than panoramic radiography but provides more detailed and accurate images, significantly enhancing the diagnostic potential in a wide range of clinical applications. The radiation dose received by the patient during this examination, depending on the device, ranges from 5-38.3 μSv for slice tomography and 68-599 μSv for full jaw-jaw tomography.
In summary, panoramic radiography emits a lower radiation dose and provides a general overview of oral cavity structures. CBCT provides three-dimensional, more detailed images useful for precise diagnosis and treatment planning.
Computed Tomography (CT) vs. CBCT in Dental Practice
In recent years, there have been concerns about the radiation dose emitted during computed tomography. Unfortunately, these reports have led to misunderstandings regarding dental radiology, especially CBCT.
Cone beam computed tomography used in dental clinics allows for a significant reduction in the emitted radiation dose compared to computed tomography used in medicine. This is due, among other factors, to the difference in the size of the scanned area. CBCT in dentistry is focused only on a small area comprising the jaw and mandible. For example, head computed tomography covers a much larger area than CBCT. This requires taking a greater number of images that compose the final 3D image. These pieces of information significantly affect the emitted radiation dose – Head computed tomography involves a dose of about 2000 μSv, while CBCT of the jaw and mandible ranges from 58-699 μSv, depending on the machine performing the examination.
Main Differences Between Computed Tomography (CT) and CBCT
Radiation in Dentistry – Radiodiagnostics at Warsaw Dental Academy
At Warsaw Dental Academy, we prioritize not only precise and effective diagnostics but also ensuring the complete safety of our patients. Therefore, we use state-of-the-art equipment from VATECH – PAX-I 3D Smart Plus. It sets the standards for dental radiodiagnostics, being one of the best diagnostic devices currently available on the market. These devices are equipped with advanced technologies that generate a 50% lower radiation dose compared to conventional dental tomographs. In the case of CBCT examinations, the radiation doses in Vatech devices range from 50-70 μSv, which constitutes a significant reduction in potential side effects for patient health.
Vatech devices are also characterized by high precision and detail in radiological examinations, significantly influencing the treatment process and its effectiveness. In combination with optimized image resolution, the device allows our doctors to precisely identify even the smallest anatomical details. This, in turn, is a crucial aspect in surgical, implantological, and endodontic procedures.
The Importance of Radiological Examination in Diagnosis and Treatment Planning
Technological advancements in digital imaging systems have greatly expanded diagnostic accuracy for doctors. They have also helped reduce the risk of patient exposure to increased radiation. Although panoramic radiography is the gold standard in radiological diagnostics, this technology is not perfect. It may require multiple exposures to make an accurate diagnosis, resulting in multiple doses of radiation. Currently, thanks to properly conducted CBCT conforming to patient radiological protection standards, doctors can collect much more detailed data with just one examination. The radiation dose is lower than when multiple radiographic images of another type are required for an accurate diagnosis.
Through CBCT, our specialists can make diagnoses that would be impossible to formulate based solely on visual examination, palpation, and patient history data. An example of this is inflammatory changes developing around improperly treated root canals. Only radiological examination allows for detailed diagnosis of such cases and implementation of appropriate treatment. Early detection of such changes through radiological examinations significantly increases the chance of saving such teeth in the patient’s oral cavity. Long before any painful symptoms develop, which could suggest the development of inflammation.
It is always the dentist who decides on the type of radiological examination to be performed, based on subjective and objective examination. Based on the data collected during the examination and their experience, the doctor decides on the type of radiological examination to be performed. So that it is most beneficial for the patient in terms of the amount of detailed information it will provide. At the same time, our specialists operate in accordance with the ALARA principle (As Low As Reasonably Achievable) in medicine. It advocates for using the lowest radiation dose to achieve a diagnostic image, thereby minimizing the amount of radiation to which the patient may be exposed.
Contraindications
Of course, there are certain contraindications to taking X-rays. These may include the patient’s age, ongoing radiotherapy in the maxillofacial area, or certain periods of pregnancy. However, with appropriate protection, radiological examinations can be performed on pregnant women. Especially in situations where the potential diagnostic benefits outweigh the minimal radiation risk to the fetus.
Validity of the Examination
It is also worth noting that the diagnostic value of oral cavity X-rays lasts for about 2 years. Therefore, it is essential to have them regularly performed. This allows for monitoring changes in oral cavity structures and quick responses to any health problems. Of course, it should be remembered that any invasive dental treatment involves changes in tooth structures visible on X-rays, changing their diagnostic value.
Summary
Radiological diagnosis in dentistry is an irreplaceable tool that allows for precise diagnosis and treatment planning. These examinations are safe and are an essential step in ensuring effective and safe dental treatment. Thanks to them, doctors have a full picture of the patient’s oral health, enabling appropriate intervention and treatment. Their regular performance while maintaining proper protections is the key to maintaining health and a beautiful smile for many years.
At Warsaw Dental Academy, we prioritize the safety and comfort of our patients. Therefore, we use the latest diagnostic methods, while minimizing the radiation dose to which the patient is exposed.
