Veterinary Oral Diagnostic Imaging

Complete reference on using diagnostic imaging in veterinary dentistry and interpreting diagnostic images in dogs, cats, exotic pets, zoological animals, and horses

Veterinary Oral Diagnostic Imaging offers veterinary clinicians a complete guide to using diagnostic imaging for common dentistry and oral surgery procedures in a veterinary practice. It provides guidance on positioning, techniques, and interpreting diagnostic images in the oral cavity, with more than 600 high-quality dental diagnostic images showing both normal anatomy and pathology for comparison. Focusing on dental radiography in dogs, cats, exotic pets, zoological animals, and horses, the book also includes advanced modalities such as MRI, CT, and cone beam CT.

Veterinary Oral Diagnostic Imaging covers:

• History, physiology, and indications for diagnostic imaging of the oral cavity, with information on the history of diagnostic imaging and radiographic image creation
• Digital dental radiographic positioning and image labeling, covering the parallel technique, bisecting angle, radiographic positioning errors, and labial mounting
• Interpretation of anatomy, covering normal radiographic anatomy, dentition and tooth numbers, deciduous and permanent teeth of canine and feline patients, eruption patterns and common and uncommon radiographic pathology observed in these animals
• Standard imaging, radiographic anatomy, and interpretation of equine patients, as well as exotic pocket pets and zoological animals

Focusing on the fundamentals of dental radiographic imaging, interpretation, and applications to the oral cavity, Veterinary Oral Diagnostic Imaging is an essential resource for any veterinarian providing dental services as part of their practice, along with veterinary students and interns.

The editor

Brenda L. Mulherin, DVM, Diplomate AVDC, is a Clinical Professor with the Lloyd Veterinary Medical Center at Iowa State University College of Veterinary Medicine in Ames, Iowa, USA.

List of Contributors

Preface

Acknowledgments

Chapter 1 History, Physiology, Modality Options, and Safety for Diagnostic Imaging of the Oral Cavity

History of Diagnostic Imaging

Discovery of X-rays

                Developing of Safety Measures

                Shortening of Exposure Time

                Glass Plates to Film

                Progression to Digital

Philosophy of Diagnostic Imaging

                                Choosing the Appropriate Modality

                                Ability to Interpret Findings

Radiographic Indications

                                Documentation of Disease

                                Value of Full Mouth Radiography

                                American Animal Hospital Association Guidelines Regarding Dental Radiography

Intraoral Dental Radiographic Equipment

                                Generators

                                                Wall Mount units

                                                Handheld Units

                                                Mobile Units/Castor Mounted Units

                                Film

                                                Standard Film

                                                Digital Image Acquisition

Computed Radiography (CR) Photostimulable Phosphor (PSP) Plates (Indirect Plates)

                                                                Digital Radiography Image Sensors (Direct Plates)

                                                                Similarities of Indirect and Direct Plates

Radiographic Imaging

                                Basic Unit of an X-ray

                                Milliamperes (mA), Kilovoltage peak (kVp), and Exposure Time

Radiographic Densities

                                Radiopaque

                                Radiolucent

Digital Image Creation

                                Creation of a Digital Image

                                Digital Imaging and Communications in Medicine Format (DICOM)

                                Pixels

Advanced Imaging Modalities

                                Computed Tomography

                                Cone Beam Tomography (CBCT)

                                Magnetic Resonance Imaging

Definitions Related to Imaging Modalities

                                Sagittal Plane

                                Transverse Plane

                                Dorsal Plane

Computed Tomography Window Width and Window Level

                                Window Width

                                Window Level

Other Common Viewing Windows

                                Bone Window

                                Soft Tissue Window

Radiation Safety

                                Radiation Safety Apparel

                                Collimation

                                As Low As Reasonably Achievable (ALARA)

                                Time, Distance, and Shielding

                                                Time

Distance

Shielding

Radiation Safety Equipment Inspection

                                Protective apparel

                                Care of Radiation Safety Equipment

                                Radiation Safety Inspection Protocol

Chapter 2 Digital Dental Radiographic Positioning and Image Labeling

Benefits of Proper Positioning

                                Practicing Techniques

Use of Position Indicating Device (PID)

Positioning Techniques

Patient Positioning

                Sternal Recumbency

                Lateral Recumbency

                Dorsal Recumbency

Sensor/Plate/Film Placement

                Basic Positioning of Sensor

Eliminating Unused Film Space

                Visualization of the Crown and Space Apical to the Root

Intra Oral Parallel Technique

                Ideal Radiographic Technique

                Placement of Sensor for Parallel Technique

Size Matters

                Alternative Positioning

                Parallel Technique for Cats

Intra Oral Bisecting Angle Technique

                Plane of the Tooth, Film, and the Angel that Bisects

                Shadow Game: Elongation, Foreshortening, and the Bisecting Angle

                Axis of the Sensor, the Tooth and the PID

                Positioning of the Patient Matters

Anatomical Variations

Uses of the Bisecting Angle Technique

Occlusal Technique

                Localize Tooth Roots

                PID Perpendicular to the Target Area and Sensor

Extra Oral Technique

                Maxillary Premolars and Molar in Felines

                Eliminate Superimposition of Zygomatic Arch

                Extraoral Labeling

“Almost Parallel” or “Near Parallel”

                Maxillary Premolars and Molar in Cats

                Decrease Superimposition of Zygomatic Arch

Localization of Palatal Roots

                Clark’s Rule or “SLOB” Same Lingual Opposite Buccal

                Separation of Mesiobuccal and Mesiopalatal Roots

Techniques for Small Patients and Caudal Teeth

                Combination of Techniques

                Radiographing from a Mesial or Distal Projection

Technique Errors

Foreshortening

                Underrepresentation of Disease

Elongation

                Overrepresentation of Disease

Correction of Error

                Position Bean Perpendicular to Bisecting Angle

Cone Cutting

                Circular artifact

                Reposition the PID

                Reposition the Sensor

                Increase the distance of the PID from the Sensor

Missing the Apex

                2-4 mm of Hard or Soft Tissue Apical to Root

                Reposition the Sensor

                Reposition the PID

                Flip Orientation of Sensor

Over and Under Exposed

                Control of kVp, mA, or mAs

                Underexposure

                                Increase kVp or mAs

                Overexposure

                                Decrease kVp or mAs

Radiographic Artifacts

                Direct Artifacts

                                Chemically Developed Radiographs

                                Contamination of Sensor

                                Damage to Sensor

                                Age of Equipment

                Indirect Artifacts

                                Endotracheal Tubes

                                Pumice/Prophy Paste

                                Positioning Devices

Repeated Radiographs

                Improper Positioning of PID

                                Elongation

                                Foreshortening

                Improper Generator Settings

                                Overexposed

                                Underexposed

                Improper Film Placement

                                Too Far out of the Oral Cavity

                                Too Far into the Oral Cavity

                                Sensor Placed Backwards

Chapter 3 Interpretation of Normal Radiographic Anatomy

                Value of Intraoral Radiographic Imaging

                                Value of Radiographs in dogs

                                Value of Radiographs in Cats

                Quality of images

                                Exposure Artifacts

                                Positioning Techniques

                                Positioning Artifacts

                Mounting of Standard Dental Radiographs

                                Types of Mounting

                                                Labial Mounting

                                                Lingual Mounting

                                                Labial Mounting of Standard Dental Radiographic Film

                                                Lingual Mounting of Standard Film

                                                Digital Radiographic Mounting

                                Labial Mounting- Positioning of Teeth

                                                Determining Maxilla from Mandible

                                                Determining Right from Left

                                                Viewing of Maxillary and Mandibular Canines, Premolars and Molars

                                                Viewing of Maxillary and Mandibular Incisors

                Modified Triadan Numbering System

                Deciduous vs Permanent Teeth

                Eruption Patterns

                Mixed Dentition

                Interpretation of Images

                                Tooth Root Numbers

                                                Maxillary Teeth

                                                Mandibular Teeth

                                Evaluation of the Structures

                                                Crown

                                                                Enamel

                                                                Pulp

                                                                Dentin

                                                Root

                                                                Root Formation

                                                                Cementum

                                                                                Abnormalities associated with Cementum

                                                                Periodontal Ligament

                                                                Chevron

                                                                Missing or Supernumerary Teeth

                                                                Supernumerary Roots   

                                                                Reduced Number of Roots and Root Malformations

                                                                                Developmental Root Abnormalities

                                                                                                Fusion

Concrescence

                                                                                                Gemination

                                                                                                Dilacerated Tooth Roots

                                                Bone

                                                                Bone Loss

                                                                                Horizontal Bone Loss

                                                                                Vertical Bone Loss

                                                                                Furcation Bone Loss

                Interpretation of Radiographic Shadows

                Nomenclature

                                Mesial

                                Distal

                                Lingual

                                Palatal

                                Coronal

                                Apical

                                Facial

                                Buccal

                                Vestibular

                                Labial

                                Occlusal

                Diagrams of Normal Radiographic Anatomy of the Dog and Cat

Chapter 4 Interpretation of Common Oral Pathology in the Canine Patient

                Periodontal Disease

Stages of Periodontal Disease

Types of Bone Loss

                Horizontal Bone Loss

                Vertical Bone Loss

                Furcation Bone Loss

Supernumerary Roots and Teeth

Canine Tooth Resorption

Types of Tooth Resorption

                External Surface Resorption

                External Replacement Resorption

                External Inflammatory Resorption

                External Cervical Root Surface Resorption

Treatment of Tooth Resorption

Odontogenic Cysts

                Dentigerous Cysts

Tooth Fractures

                Root fractures

Retained Tooth Roots

Endodontic Disease

                Etiology

                Radiographic Signs of Endodontic Disease

                                Widened Periodontal Ligament Space

                                Loss of Lamina Dura

                                Periapical Lucency

                                External and Internal Root Resorption

                                Widened Pulp Canal

                                Pulp Canal Calcification

                Apical Periodontitis

                                Acute Apical Abscess

                Endodontic Therapy

Attrition and Abrasion

Eruption Abnormalities

                Persistent Deciduous Teeth

                Abnormal Eruption

Chapter 5 Interpretation of Common Oral Pathology in the Feline Patient

Periodontal Disease

Stages of Periodontal Disease

Types of Bone Loss

Horizontal Bone Loss

Vertical Bone Loss

Furcation Bone Loss

Buccal Alveolar Expansile Osteitis

Tooth Resorption

                Stages of Tooth Resorption

                Types of Tooth Resorption

                Criteria for Performing Crown Amputation/Intentional Root Retention

Supraeruption/Extrusion

Osteomyelitis and Osteitis

Retained Tooth Roots

Endodontic Disease

Chapter 6 Oral Surgery: Neoplasia and Cystic Conditions

            Radiographic indications of neoplasia (benign and malignant)

                                    Benign oral tumors

                                    Canine Acanthomatous Ameloblastoma (CAA)

                                    Peripheral Odontogenic Fibroma (POF)

                                    Feline Inductive Odontogenic Tumor (FIOT)

                        Malignant oral tumors

                                    Nontonsillar Squamous Cell Carcinoma (SCC)

                                    Papillary Squamous Cell Carcinoma (PSCC)

                                    Oral Malignant Melanoma (MM)

                                    Fibrosarcoma (FSA)

                                    Osteosarcoma (OSA)

                                    Multilobular Osteochondrosarcoma (MLO)

            Radiographic indications of cystic conditions

                        Dentigerous Cyst

                        Radicular Cyst

                        Canine Furcation Cyst

                        Surgical Ciliated Cyst

                        Lateral Periodontal Cyst

                        Odontogenic Keratocyst/Canine Odontogenic Parakeratinized Cyst

            Compound and complex odontomas

            Limitations of dental radiography for neoplasia

Chapter 7 Interpretation of Unique Pathology in the Canine and Feline Patient

Unique conditions with predilection for canine patients

Craniomandibular Osteopathy (CMO)

Idiopathic Calvarial Hyperostosis

Periostitis Ossificans (PO)

Malformed Roots/Root Hypoplasia

Dens invaginatus/Dens in Dente

Unique conditions observed in both canine and feline patients

Masticatory Myositis

Pulp Stones and Denticles

Osteosclerosis

Renal Secondary Hyperparathyroidism

                                Enamel Pearls

Unique conditions with predilection for feline patients

                                Dentition Abnormalities

Fused Roots

Supernumerary Roots

Supernumerary Teeth

Abnormal Eruption

Unerupted Teeth

Patellar Fracture and Dental Anomaly Syndrome (PADS) or Knees and Teeth Syndrome

Chapter 8 Diagnostic Imaging of Exotic Pet Mammals and Zoo Animals

Dental Diagnostic Imaging for Non-Traditional (Exotic) Animals

General considerations for Exotic Companion Mammals

                Restraint

                Knowledge of normal anatomy

General Positioning and Projection Recommendations

                Standard Radiography

                                Standard Radiographic Positions

                                                Lateral and dorsoventral

                                                Oblique Views

Rostrocaudal

                                Intraoral radiographs

                                Intraoral films used extraorally

                                Magnification techniques

                Anatomical variations

                                Rabbits

Guinea Pigs and Chinchillas

Rats, Mice, Hamsters, Gerbils and other commonly kept rodent pets

Ferrets

African Pygmy Hedgehogs

Sugar Gliders

Prairie dogs

Captive Non-domestic or “Wild” Mammals

                Small Zoologic species

Non-human Primates

Carnivores

                Radiographic Positioning and Techniques in Captive Animals

                                Animal Training

                Dental Conditions in Zoologic Animals

                                Trauma

                                Attrition

                                Macropod Progressive Periodontal Disease (MPPD)

                                Molar Progression

                Advanced Diagnostic Imaging in Exotic Pet Mammals and Zoo Animals

                                Standard Computed Tomography

                                Cone Beam Computed Tomography

                                Micro-Computed Tomography

                                Considerations for Computed Tomography

Chapter 9 Diagnostic Imaging and Interpretation of the Equine Patient

Introduction to Equine Dental Radiographs

Radiation Safety

Radiographic Systems

                        Direct Digital Radiographic System

                        Computed Tomography

                        Standard Radiographic System

Radiographic Technique

Guidelines for Radiographic Views 

Concepts to Understand

            Directing the Primary Beam Through the Interproximal Spaces

            Open Mouth Oblique Cheek Teeth Projections

Radiographic Views

                        Lateral View

                        Dorsoventral View

                        Dorsal Ventral Oblique Projection of the axillary cheek teeth

                        Ventral Dorsal Oblique Projection of maxillary cheek teeth

                        Ventral Dorsal Oblique Projection of the mandibular cheek teeth

                        Dorsal Ventral Oblique Projection of the mandibular cheek teeth

                        Occlusal Intraoral View of the maxillary incisors and canines

Occlusal Intraoral View of the mandibular incisors and canines

Evaluation of an Image

Labial mounting

Radiographic anatomy

Radiographic changes in dental disease

Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH)

Apical infections

Periodontal disease

Sinusitis

Neoplasia

   Other Common abnormalities

Chapter 10 Advanced Imaging of the Veterinary Patient

Introduction to the use of advanced imaging techniques in the maxillofacial region

                Choosing Advanced Imaging

                Determining Between MRI or CT

Magnetic Resonance Imaging (MRI)

                                Technical principles of MRI

                                T1 and T2 Weighted Sequences

                                Other MRI Sequences

                Indications for use of MRI over CT in the maxillofacial region

                                Temporomandibular joint disease

                                Salivary gland disease

Abnormalities in the muscles of mastication and inability to open/close mouth

                Conclusions on the clinical indication for use of MRI

                Computed Tomography (CT)

                                Technical principles of Multi-Detector CT (MDCT)

Technical principles of Cone Beam CT (CBCT)

Viewing CT images

Differences in imaging characteristics between CBCT and MDCT

                Spatial resolution

                Soft tissue imaging

                Artifacts

Other impactful differences in practical use between MDCT and CBCT

Indications for use of either MDCT or CBCT in the maxillofacial region

                Maxillofacial trauma 

                Bony pathology

                                Osteomyelitis/osteonecrosis

                                Fibro-osseous disease

                                Osseous neoplasia

                Clefts

Indications for MDCT only (not CBCT) in the maxillofacial region

                Oral neoplasia with a soft tissue component

                Soft tissue pathology

Indications for CBCT only (not MDCT) in the maxillofacial region

                Dentoalveolar trauma

                Periodontal disease

                Endodontic disease

                Tooth resorption

                Diagnosis and treatment of missing teeth 

Conclusions on the clinical indication for use of CBCT versus MDCT

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