Why Are the Intraoral Radiographic Techniques Used in Dentistry?
Intraoral radiographic techniques are mainly used for the diagnosis and screening of dental carious lesions and deep-rooted infections or lesions with dental associated pathologies.
Intraoral radiographic views are vital for detecting and understanding the nature of dental caries, the associated oral pathology, and deep-rooted dental, oral, or bony infections of the jaw. The dental radiographic view is, in fact, a two-dimensional view of a three-dimensional object like our tooth structure that comprises the enamel, dentin, pulp, the periodontal apparatus, and the surrounding alveolar bone. Any associated changes or pathologies in these parts of the tooth or the oral cavity can hence be clearly distinguished by the bitewing, periapical and occlusal radiographs (all being two-dimensional imaging radiographic technology commonly used in the dental clinic or hospital setting). Currently, advanced imaging techniques like CBCT (cone beam computed tomography) and CT (computed tomography) scans are used for maxillofacial surgeries and dental implant procedure planning as compared to two-dimensional techniques because of the enhanced view and the dimensional advantage it offers.
Let us have a detailed look into the advantages and purpose of the most commonly used two-dimensional intraoral radiographic localization techniques and the benefits of these views.
What Are Bitewing Radiographs?
These radiographs are typical or routinely used screening two-dimensional radiographs taken on patients for checking interdental caries and as an alternative to the conventional two-dimensional intraoral periapical radiographs (IOPA). One bitewing is usually taken for assessment of each side or segment of the posterior teeth. These radiographs are usually aimed or taken in a horizontal manner, or they can also be done vertically to gain detail into the carious lesions upon biting the upper and lower teeth together.
What Are the Benefits of Bitewing Radiographs?
Bitewings are useful for the following two reasons:
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Caries Assessment- These radiographs not only help identify caries which is not clinically detectable, but they can also be useful in assessing other carious lesions in between the tooth surfaces that may otherwise remain elusive on routine two-dimensional IOPA or panoramic imaging or orthopantomogram such as interproximal caries or recurrent caries.
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Bone Assessment- Bitewing radiographic modality allows the operator to analyze or assess the bone levels of patients, and it also gives a contrast between typically healthy levels of bone to those lesions accompanied by early bone loss as a result of dental carious lesions leading to periapical infection and inflammation of the tooth in question.
What Are Periapical Radiographs?
The periapical region is basically the apex of the tooth root, and these periapical radiographs are usually used to assess certain specific teeth for diagnostic confirmation. They provide the operator with anatomic details of the individual tooth structure and the structures around particular teeth.
What Are the Indications of Periapical Radiographs?
Periapical radiographs may be used for these below-enlisted reasons by your dental surgeon:
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Assessment of Periapical Pathology- This is the main advantage of periapical radiographs as they help assess the presence of periapical infections that are associated with the tooth in question or suspected or carious lesion. The periapical infection usually manifests as a radiolucent area around the tooth root.
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Endodontic Treatment- Periapical radiographs are a main adjuvant modality useful for endodontic purposes. They can be used during endodontic or root canal treatment to assess the progression of disease stages and determine the working length or obturation in the radiographs.
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Periodontal Disease- Periapical radiography, in fact, is considered the gold standard diagnostic radiograph for patients suffering from the periodontal disease because the degree of bone loss, be it mild, moderate, or severe, can be visualized clearly by the dentist or periodontist. The bone dimensions related to a specific tooth can be clearly observed because, in periodontal disease, the alveolar bone gets easily resorbed, and the bone height is eventually lost, deteriorating the periodontal apparatus that acts as a cushion and protective support system for the tooth structure.
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Ectopic Teeth- In periapical radiography, any potential ectopic teeth location can be identified as well as localized using the traditional parallax technique. In the parallax technique of detecting ectopic teeth, two periapical radiographs are taken in seemingly different positions to assess the correct location of this suspect tooth.
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Root Morphology Analysis and Assessment- This is a particularly important preoperative protocol or planning phase before dental extractions, particularly for impacted teeth like wisdom or supernumerary teeth.
What Are Occlusal Radiographs?
The occlusal radiographs would be either for the maxillary or upper occlusal segment of the upper teeth or the mandibular or lower occlusal teeth segment.
Occlusal radiography may be defined as the intraoral radiographic views or technique employed for using the dental X-ray set wherein the image receptor which is the film packet or the digital phosphor plates is placed in accordance with the patient occlusal plane for occlusal surface analysis of anterior and posterior teeth. Occlusal radiographs are also indicated mainly when the results of the analysis are insufficient or not a confirmative diagnosis through panoramic radiography like OPG (orthopantomogram). These might be either due to abnormal incisor relationships between the maxillary and mandibular anterior (such as orthodontic deep bite, crossbite), localized tooth positions, in assessing supernumerary teeth positions, for detecting deep pathological lesions, and traumatic injury to the bone. Occlusal radiographs are also taken in the primary dentition, detecting carious extensions into the maxillary and mandibular anterior teeth.
The different kinds of maxillary projections through the occlusal view or occlusal radiographs (maxillary occlusal projections) commonly used by the dentist are:
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Upper Standard or Upper Maxillary Anterior Occlusal Radiographs- These are also called standard occlusal radiographs.
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Upper Oblique Occlusal- These are called oblique occlusal radiographs.
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Vertex Occlusal- These are vertex occlusal views but are not commonly used.
The most common occlusal radiographic view in the maxillary segment is the standard occlusal view which is the upper maxillary anterior radiograph.
The different kinds of mandibular (lower jaw) occlusal projections are as below :
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Lower 90° Occlusal View Radiographs- They are also known as true occlusal radiographs.
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Lower 45° or Anterior Occlusal View- It is also known as standard occlusal radiographs.
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Lower Oblique Occlusal- They are also known as the oblique occlusal radiographs and are also a common mandibular occlusal projection view.
What Are the Benefits of Occlusal Radiographs?
These maxillary or mandibular views are helpful for these below-enlisted reasons:
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Localization of ectopic or even impacted teeth.
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Identifying any potential salivary calculi that may result from obstruction commonly in many patients, specifically of the submandibular salivary gland.
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Helps in the easy identification of localized oral pathologies, including dental cysts associated with buccolingual bone plate expansion.
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Foreign body identification.
Due to the fact that the occlusal films are placed in between the teeth, occlusal views are recommended most in patients suffering from lockjaw or limited mouth opening (trismus).
Conclusion
Intraoral radiographic views through bitewing, periapical and occlusal radiographs are hence not only commonly used techniques in daily dental practice for diagnosis and screening of dental lesions, but they also have several advantages aiding in the dental practice for easy detection and planning comprehensive treatment by your dental surgeon.
