X-ray investigations in the child patient

Lecturer Porumb Anca, Ph.D.

Department of Dental Medicine, School of Medicine and Pharmacy, University of Oradea

Abstract

The use of dental x-rays is nowadays indispensable for the clinician. The x-ray examination should be based on the clinical examination of the patient. The most commonly used x-rays in pediatric dental medicine are retroalveolar x-ray, bite-wing x-ray and orthopantomography. The indication of CBCT in the child patient should be well-justified from a professional point of view and the benefits and risks of exposure to radiation carefully balanced.

Key-words: child, dental x-rays, X radiation

Introduction

Our paper is meant to be a review of all types of dental x-rays used for child patients. The types of x-rays recommended for children are not similar to those prescribed for adult patients. Moreover, the dosage is also different: the dose for the adult patient is a certain one and the dose for child patients is completely different.

Material and method

We have reviewed below several types of x-rays:

  • Retroalveolar x-ray
  • Bite-wing x-ray
  • Orthopantomography
  • Occlusal radiography
  • Profile cephalometry
  • CBCT and which are its recommendations in case of child patients

Results and discussions

Retroalveolar x-ray is the oldest radiological dental x-ray, but is still commonly used today. It is made on ¾ cm films, it is considered to be capable of providing the most complete and numerous data on teeth, alveolar ridges and neighboring anatomical formations.

Based on the principle of isometrics and orthoradiology, it offers an image of the same size as the real one.

The particularity of retroalveolar x-ray in pedodontics, considering that it is performed in smaller oral cavities, in younger patients, is that it can be done on 2/3 cm films, more easily accepted by the child patient.

The main deficiency is that it is fragmentary, and it is sometimes necessary to complete it with other x-rays.

Fig.1 – Retroalveolar x-ray

Bite-wing x-ray is an intraoral film x-ray, where the packaging has a paper fin out of fabrication. Other names: winged x-ray, interproximal x-ray.

Working technique: the film is applied retroalveolar and finned between the antagonist teeth in the occlusion plane. The exposure time is as for a standard retroalveolar film.

The fin is not covered with a radiosensitive emulsion, it only performs a mechanical role of intraoral support of the tooth!

The bite-wing x-ray shows the antagonist teeth and part of the gums, more precisely the crowns, the parcel, the coronal half of the root, the occlusal halves of the alveolar septum belonging to both arches, on the same film, within the same exposure.

Bite-wing x-ray is recommended to reveal proximal cavities, cavities clinically masked by gums or crowns, to show early pathological changes of the marginal periodontium.

This type of x-ray is not recommended when highlighting the apex, also in advanced chronic marginal periodontitis, with significant bone resorption, because the alveolar ridge does not appear on the film.

The disadvantage of the bite-wing film x-ray comes from the incomplete information supply of the image!

Fig.2 – Bite-wing x-ray

Orthopantomography offers satisfactory information on the following:

  • Temporary teeth;
  • Permanent teeth; presence or absence of dental buds;
  • Evolution of eruption;
  • Presence or absence of the eruption space;
  • Formation of root;
  • Presence of extra teeth.

Orthopantomography is sometimes difficult to perform in small children given the lengthy exposure. However, orthopantomographies are recommended for children and have a high value of diagnosis in child patients.

Fig. 3 – Orthopantomography

Occlusal x-ray uses 5/8 cm film. The X-ray beam may be cranio-caudal or caudo-cranial. The direction of caudal-cranial X-ray is recommended in the case of salivary gland lithiasis.

The direction of the cranio-caudal x-ray is used in case of superior canines included, unilaterally or bilaterally. It is also used after the breaker treatment when we want to radiographically check the opening of the medio-sagittal suture for a child patient.

Fig. 4 – Occlusal x-ray

Profile cephalometry is used, with the orthopantomography, as a first measure of x-ray investigation, essential before the beginning of an orthodontic treatment with fixed polyaggregate equipment.

Fig. 5 – Profile cephalometry

Con beam computer tomography (CBCT) in the child patient is rarely used and the recommendation should be well-justified and the benefits and the risks of exposure to radiation should be carefully balanced.

CBCT has the following recommendations in the child patient:

  • To diagnose extra teeth
  • Inclusion of canines
  • In anomalies in the development of maxillaries
  • To evaluate aerial space
  • To evaluate ATM
Fig. 6 – CBCT

Conclusions

X-ray examination should be based on careful and detailed clinical examination of the patient.

The most commonly used x-rays in pediatric dental medicine are retroalveolar x-ray, bite-wing x-ray and orthopantomography. Occlusal radiography, profile cephalometry and CBCT can also be used.

The recommendation of x-ray examination in a child patient must be well-justified from a professional point of view and the benefits and risks of radiation exposure should be carefully balanced, irradiation that accumulates over the course of their lives and we cannot forget for a moment that we deal with beings in full of growth and development, and so dear to all of us, the children!

References

  1. Anca Porumb. Diagnosticul clinic-radiologic in anomaliile dentare isolate.Editura Universitatii din Oradea, 2014
  2. Anca Porumb, Liana Todor, Ruxandra Matei, Gabriela Ciavoi, Camelia Dalai, Ioan Tig, Ramona Amina Popovici. The assessment of imagistic explorations in ortodontics. Medicine in Evolution 2015; XXI(3): 551-555.
  3. Anca Porumb, Ligia Vaida, Ioana Ignat Romanul, Anda Muntean, Bogdan Sink, Sergiu Tofan, Silviu Brad, Ovidiu Motoc, Ramona Amina Popovic.Clinical and radiological considerations in transpositions. Medicine in Evolution 2015; XXI(1): 164-168.
  4. Porumb Anca,Porumb C., Ratiu C. Importanţa examenului radiologic în stabilirea diagnosticului de anomalie dentară izolată. Clujul Medical 2006; LXXIX: 61-64.
  5. Floarea Fildan, Ioan Mihai Covalcic. Radiologie stomatologica-Notiuni de fizica si tehnica radiologica.Editura Medicala Universitara Iuliu Hatieganu Cluj Napoca 1999: 131-179.
  6. Ademir Horia Stana, Otilia Lavinia Stana (Gag), Gheorghe Ciobanu, Anca Porumb, Calin Gheorghe Cioban, Ramona Amina Popovici, Alexandra Moga. Appications of imaging Technologies in maxillary cyst assessment. Revista de Chimie Bucuresti 2017; 5: 1130-1136.

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