2014 self-study course three course The Ohio State University College of Dentistry is a recognized provider for ADA, CERP, and AGD Fellowship, Mastership and Maintenance credit. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada.org/goto/cerp. The Ohio State University College of Dentistry is approved by the Ohio State Dental Board as a permanent sponsor of continuing dental education ABOUT this FREQUENTLY asked COURSE… QUESTIONS… Q: Who can earn FREE CE credits? . READ the MATERIALS. Read and review the course materials. A: EVERYONE - All dental professionals in your office may earn free CE contact . COMPLETE the TEST. Answer the credits. Each person must read the eight question test. A total of 6/8 course materials and submit an questions must be answered correctly online answer form independently. for credit. us . SUBMIT the ANSWER FORM Q: What if I did not receive a ONLINE. You MUST submit your confirmation ID? answers ONLINE at: A: Once you have fully completed your p h o n e http://dent.osu.edu/sterilization/ce answer form and click “submit” you will be directed to a page with a . RECORD or PRINT THE 614-292-6737 unique confirmation ID. CONFIRMATION ID This unique ID is displayed upon successful submission Q: Where can I find my SMS number? of your answer form. A: Your SMS number can be found in t o l l f r e e the upper right hand corner of your 1-888-476-7678 monthly reports, or, imprinted on the back of your test envelopes. The SMS number is the account number for ABOUT your your office only, and is the same for f a x FREE CE… everyone in the office. 614-292-8752 Q: How often are these courses available? . TWO CREDIT HOURS are issued for successful completion of this self- A: FOUR TIMES PER YEAR (8 CE credits). e - m a i l study course for the OSDB 2014-2015 biennium totals. [email protected] . CERTIFICATE of COMPLETION is used to document your CE credit and is mailed to your office. w e b . ALLOW 2 WEEKS for processing and www.dent.osu.edu/ mailing of your certificate. sterilization Page 1 PANORAMIC RADIOGRAPHY AND 2014 RADIOLUCENCIES OF THE JAWS course The purpose of this study is to introduce health care professionals with some of the more common entities that are seen in the jaws. This study will focus three on preparing readers to formulate a reasonable differential diagnosis for radiolucencies of the jaws. INTRODUCTION Panoramic radiography is an imaging technique that produces tomographic views for facial bones. The resulting images provide a broad overview of the teeth, jaw bones, and sinuses. The technique was first introduced in the armed forces to expedite oral exams for soldiers. While panoramic radiographs are limited in their able to differentiate between ability to determine dental caries, anatomy and pathology. they are beneficial in locating the site of third molar impaction, To effectively interpret an image, temporomandibular joint problems, it is important to have good fractures, odontogenic cysts and images and an appropriate setting tumors, and osseous pathology. The for evaluation. The sections below intensity of radiation exposure to will highlight ways in which such the patient during image an image can be achieved. determination is low and the images can be obtained in a relatively short QUALITY amount of time. The quality of the panoramic film Besides being limited in their ability is dependent on the appropriate to exhibit anatomic details required positioning of the patient, for assessing dental caries, minimal movement during the panoramic radiographs show a procedure, and the contrast written by significant degree of overlapping settings of the imaging machine. amber kiyani, dds structures in the incisor region. The An image of good quality will be superimposition of the cervical spine devoid of distortions and will in this region makes interpretation present a sharp image with a of any pathology in the anterior jaws good contrast. edited by difficult and creates a need for rachel a. flad, bs additional images. LIGHTING CONDITIONS karen k. daw, mba, cecm Panoramic radiographs are routinely evan miller Appropriate lighting conditions performed in dental practices. The are also important for assessing current recommendations advocate panoramic radiographs. Films and reimaging every five years. It is digital images can be best viewed important for us, as oral health care when the ambient lighting is professionals, to be able to read reduced. For panoramic films, these images effectively and to be Page 2 most dental offices have a view box that provides STEP 2 – MARGINS AND SHAPE the necessary lighting intensity. It is pertinent to ensure that the film is uniformly approximated to The margins can either be described as well- the light source. defined or ill-defined. Well-defined margins usually represent benign processes. They may STEPS TO ANALYZE PANORAMIC have corticated margins, a thin radio-opaque line around the periphery of the defect (sclerotic IMAGES margins), and a wider, non-uniform radio-opaque periphery. Ill-defined margins frequently There are two ways of coming up with a represent malignant processes. differential diagnosis when a radiographic anomaly is identified. The first one is called the The shape of the lesion can provide pertinent “Aunt Minnie” method and involves comparison of clues for diagnosis. A unilocular, well-demarcated the anomaly to the characteristic image database defect would be most consistent with a benign that you have in your memory. While this method cystic process. A multi-locular radiolucent process is frequently employed, it relies on human would be highly suggestive of either an memory and may fail to include numerous odontogenic keratocyst or an ameloblastoma. possibilities in the list of differential diagnoses, which can be found on Page 11 of this study. STEP 3 – INTERNAL STRUCTURE Therefore, we advocate the use of the step-by- step technique outlined below. Radiographic defects are classified into three categories: radiolucent, mixed radiolucent, and STEP 1 - LOCATION radio-opaque. Radiolucent defects usually represent soft tissue growths within the jaws. Location of the radiographic defect is very Radio-opaque lesions would be most consistent important while formulating a differential with calcified masses, such as odontomas diagnosis. The initial step would include defining (collection of tooth-forming tissues) and whether the anomaly is localized, limited to a osteomas (benign bone tumors). Mixed defects specific area in the jaws, or exhibits a more diffuse represent bone forming processes that are involvement. A single periapical radiolucency of frequently referred to as fibro-osseous lesions. an anterior mandibular tooth would suggest a diagnosis of periapical inflammatory disease, STEP 4 – EFFECT ON SURROUNDING while multiple periapical radiolucencies would be STRUCTURES more consistent with cemento-osseous dysplasia. Similarly, unilateral defects are more suggestive of The effect of the lesion on surrounding structures a disease process while bilateral symmetrical is a good measure of the clinical behavior of the defects would most likely represent normal (or disease process. variations of normal) structures. Slow growing benign processes frequently result The relative position of the lesion can also be in tooth displacement, while odontomas would extremely helpful. Something in close association usually cause apical displacement of the tooth, with the tooth would most likely represent an thus impeding tooth eruption. Chronic odontogenic process, while those close to the inflammatory processes would result in tooth inferior alveolar canal would be suggestive of a resorption rather than displacement; uniform neural origin. widening of the periodontal ligament space is witnessed during tooth movement. Malignant Size is also critical for diagnostic purposes. A well- processes would result in a more irregular defined radiolucency in the anterior maxilla, widening of the membrane space. between the central incisors, would represent a nasopalatine duct cyst when it is larger than 6 Corticated and sclerotic margins are seen in mm. Anything smaller would be put into the association with lesions that are benign and slow category of an enlarged incisive canal. growing. Page 3 Dislocation of the inferior alveolar canal would may be barely perceptible, while others can span indicate a fibro-osseous process. Uniform an entire quadrant. The lamina dura along the widening of the canal would suggest a benign apex of the tooth is lost, and local or generalized neural process while a more irregular widening widening of the periodontal ligament space may would be indicative of a malignancy extending be identified. down the canal. In rare instances, periapical cysts may be located Periosteal bone growth is seen in association with more laterally due to an infected accessory canal. both benign and malignant intra-osseous Except for location, the radiographic presentation processes, including osteomyelitis and Ewing’s of lateral radicular cysts is similar to their sarcoma. counterparts at the apex. A persistent radiolucent defect following extraction of the tooth is called a STEP 5 – FORMING AN INTERPRETATION residual cyst. These present as round to oval radiolucencies that may undergo calcifications Once the lesion has been assessed according to over a period of time. the above parameters, you begin by placing it in the category of either normal or abnormal. If the Periapical abscesses have a more alarming lesion is abnormal, then it is either developmental presentation radiographically; however, or acquired. This step is followed by adding a symptoms and vitality testing can help in descriptor to the disease process, such as benign, establishing a diagnosis.