Practical Veterinary Dental Radiography K22418_Book.indb 1 9/20/17 2:19 PM K22418_Book.indb 2 9/20/17 2:19 PM Practical Veterinary Dental Radiography BROOK A. NIEMIEC DVM, DipAVDC, DipEVDC, FAVD Veterinary Dental Specialties & Oral Surgery San Diego, California, USA JERZY GAWOR DVM, PhD, DipAVDC, DipEVDC, FAVD European Veterinary Specialist in Dentistry Klinika Weterynaryjna Arka Kraków, Poland VLADIMÍR JEKL MVDr, PhD, DipECZM (Small Mammal Medicine and Surgery) European Recognized Veterinary Specialist in Zoological Medicine (Small Mammal) Avian and Exotic Animal Clinic, Faculty of Veterinary Medicine University of Veterinary and Pharmaceutical Sciences Brno and Exotic Companion Mammal Care Jekl & Hauptman Brno, Czech Republic K22418_Book.indb 3 9/20/17 2:19 PM Top image on front cover kindly provided by iM3® CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2018 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper International Standard Book Number-13: 978-1-4822-2543-3 (Hardback) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liabil- ity for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is intended for use by medical, scientific or health-care profession- als and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified. 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Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging‑in‑Publication Data Names: Niemiec, Brook A., author. | Gawor, Jerzy, author. | Jekl, Vladimir, author. Title: Practical veterinary dental radiography / Brook A. Niemiec, Jerzy Gawor, and Vladimir Jekl. Description: Boca Raton : CRC Press, [2017] Identifiers: LCCN 2017001564| ISBN 9781482225433 (hardback : alk. paper) | ISBN 9781315177335 (master ebook) Subjects: LCSH: Veterinary dentistry. | Veterinary radiology. | MESH: Dentistry--veterinary | Radiography, Dental--veterinary | Veterinary Medicine. Classification: LCC SF867 .N538 2017 | NLM SF 867 | DDC 636.089/76--dc23 LC record available at https://lccn.loc.gov/2017001564 Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com K22418_Book.indb 4 9/20/17 2:19 PM CONTENTS v Preface xiii Abbreviations xv CHAPTER 1 MARKETING DENTAL RADIOGRAPHY 1 Brook A. Niemiec REFERENCES 3 CHAPTER 2 THE IMPORTANCE OF AND INDICATIONS FOR DENTAL RADIOGRAPHY 5 Brook A. Niemiec INTRODUCTION 5 PERIODONTAL DISEASE 5 Periodontal probing 5 FELINE TOOTH RESORPTION 8 CANINE TOOTH RESORPTION 11 ENDODONTIC DISEASE 12 PERSISTENT DECIDUOUS TEETH 16 ‘MISSING’ TEETH 18 MANDIBULAR FRACTURES 22 ORAL MASSES 24 EXTRACTIONS 26 CONCLUSIONS 28 REFERENCES 28 CHAPTER 3 DENTAL RADIOGRAPHY EQUIPMENT 31 Brook A. Niemiec DENTAL RADIOGRAPHY UNITS 31 DENTAL RADIOGRAPHIC FILM 32 DIGITAL DENTAL RADIOGRAPHY 33 The physics and technology of digital radiography 33 Creation of the digital image 35 Advantages of digital radiography 37 Disadvantages of digital radiography 37 Differences between standard and digital radiographic techniques 38 K22418_Book.indb 5 9/20/17 2:19 PM vi Contents RECOMMENDATIONS 38 CONCLUSION 39 REFERENCES 39 CHAPTER 4 DENTAL RADIOGRAPHIC POSITIONING 43 Brook A. Niemiec INTRODUCTION 43 STEP 1: PATIENT POSITIONING 43 STEP 2: FILM PLACEMENT WITHIN THE PATIENT’S MOUTH 44 STEP 3: POSITIONING THE TUBE HEAD 46 Parallel technique 46 Bisecting angle technique 46 Simplified technique 49 STEP 4: SETTING THE EXPOSURE 59 STEP 5: EXPOSING THE RADIOGRAPH 59 REFERENCES 59 CHAPTER 5 SKULL AND DENTAL RADIOGRAPHY USING MEDICAL X-RAY TECHNIQUES 61 Jerzy Gawor INTRODUCTION 61 PROJECTIONS AND VIEWS OF THE HEAD 68 Ventrodorsal and dorsoventral projections 68 Lateral projection 69 Left and right oblique lateral 70 Open-mouth extraoral projections: VD or DV 71 Open-mouth extraoral frontal projection 72 Open-mouth extraoral VD projection 72 Open-mouth extraoral DV projection 72 Frontal projection 72 Temporomandibular joint projections 72 FULL MOUTH RADIOGRAPHS 72 REFERENCES 84 CHAPTER 6 DEVELOPING/PROCESSING DENTAL RADIOGRAPHS 85 Brook A. Niemiec INTRODUCTION 85 STEP 1: CREATING A LIGHT SAFE ENVIRONMENT 85 STEP 2: REMOVAL OF FILM FROM THE PROTECTIVE PACKET 86 DEVELOPMENT AND FIXING 86 PROCESSING ERRORS 89 KEY POINTS 91 REFERENCES 91 K22418_Book.indb 6 9/20/17 2:19 PM Contents vii CHAPTER 7 COMMON ERRORS OF DENTAL RADIOGRAPHY PROJECTION 93 Brook A. Niemiec INTRODUCTION 93 PLACING THE FILM/SENSOR IN BACKWARDS 93 ERRORS OF VERTICAL ANGULATION 93 ERRORS OF HORIZONTAL ANGULATION 95 UNDEREXPOSURE AND OVEREXPOSURE 96 MISSING THE INTENDED STRUCTURE ON THE IMAGE 97 CONE CUT 97 KEY POINTS 98 FURTHER READING 98 CHAPTER 8 DENTAL RADIOGRAPHIC INTERPRETATION 99 PART A EVALUATION OF DENTAL RADIOGRAPHS AND DETERMINING THE TYPE, AGE, AND SIZE OF THE TEETH IMAGED 99 Jerzy Gawor INTRODUCTION 99 ORIENTATION 100 MANDIBULAR AND MAXILLARY IMAGES 102 Mandible 102 Maxillary 102 DETERMINING THE AGE AND SIZE OF THE PATIENT 104 Size of dentition 105 Age of patient 107 Size of the patient 108 REFERENCES 118 PART B NORMAL RADIOGRAPHIC ANATOMY 119 Brook A. Niemiec INTRODUCTION 119 BONE 119 TEETH 119 TOOTH/BONE INTERFACE 121 Maxilla 123 Mandible 125 REFERENCES 127 PART C PERIODONTAL RADIOGRAPHY 128 Jerzy Gawor INTRODUCTION 128 RADIOGRAPHY IN PERIODONTAL DISEASE 135 REFERENCES 142 K22418_Book.indb 7 9/20/17 2:19 PM viii Contents PART D RADIOGRAPHIC INTERPRETATION FOR ENDODONTIC DISEASE 143 Brook A. Niemiec INTRODUCTION 143 BONY CHANGES 143 TOOTH CHANGES 145 USING DENTAL RADIOGRAPHY TO MONITOR ENDODONTIC DIAGNOSIS AND THERAPY 149 Treated teeth 149 Questionable teeth 152 KEY POINTS 154 REFERENCES 154 PART E TOOTH HARD TISSUE DISEASES 156 Jerzy Gawor INTRODUCTION 156 TOOTH RESORPTION 156 Feline tooth resorption 157 Canine tooth resorption 161 CARIES 162 DEVELOPMENTAL DENTAL ABNORMALITIES OF HARD TISSUE 163 Dentinal dysplasia 163 Abnormalities of enamel formation 164 Intrinsically stained (discolored) teeth 166 ANATOMIC ANOMALIES OF THE DENTAL HARD TISSUE 167 REFERENCES 173 PART F TRAUMA 174 Jerzy Gawor INTRODUCTION 174 DENTAL TRAUMA 174 TOOTH LUXATION 177 FOREIGN BODIES 180 JAW FRACTURES 183 HIGH-RISE SYNDROME 186 TEMPOROMANDIBULAR JOINT AND SYMPHYSEAL INJURIES 188 OTHER TRAUMATIC ISSUES 188 HEALING, REMODELING OF THE FRACTURE LINE AND SCAR TISSUE 189 COMPLICATIONS AND CONSEQUENCES OF TRAUMATIC INJURIES 190 REFERENCES 192 PART G PROLIFERATIVE LESIONS 193 Jerzy Gawor INTRODUCTION 193 ODONTOGENIC CYSTS 199 K22418_Book.indb 8 9/20/17 2:19 PM Contents ix NONODONTOGENIC TUMORS 202 Feline tumors 202 Canine tumors 205 ODONTOGENIC TUMORS 209 COMPLICATIONS OF NEOPLASTIC DISEASE 212 OSSEOUS LESIONS 212 Secondary hyperparathyroidism 213 Osteonecrosis 214 Craniomandibular osteopathy 214 Osteomyelitis 215 Periostitis ossificans 215 Hyperostosis 216 Fibrous dysplasia 216 Osteosclerosis 217 Hypercementosis 217 3D RECONSTRUCTION 218 REFERENCES 219 CHAPTER 9 NASAL CAVITY PATHOLOGIES RELATED TO ORAL PROBLEMS 221 Jerzy Gawor INTRODUCTION 221 PROJECTIONS 222 NASAL PATHOLOGY 226 Infectious 228 Inflammatory 234 Proliferative lesions 237 Other 238 DIAGNOSIS 246 REFERENCES 246 FURTHER READING 247 CHAPTER 10 RADIOGRAPHY OF THE TEMPOROMANDIBULAR JOINT AND MANDIBULAR SYMPHYSIS 249 Jerzy Gawor INTRODUCTION 249 DIAGNOSIS 249 RADIOGRAPHY 250 Temporomandibular joint projections 250 Symphyseal projections 253 CLINICAL CONDITIONS AFFECTING THE TEMPOROMANDIBULAR JOINT 255 Trauma 255 Inflammatory and dysplastic conditions 258 Neoplasms 261 K22418_Book.indb 9 9/20/17 2:19 PM