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.
Table of Contents
List of Contributors xv
Preface xvii
Acknowledgements xix
1 History, Physiology, Modality Options, and Safety for Diagnostic Imaging of the Oral Cavity 1
Brenda L. Mulherin
History of Diagnostic Imaging 1
Discovery of X-rays 1
Developing of Safety Measures 1
Shortening of Exposure Time 1
Glass Plates to Film 2
Progression to Digital 2
Philosophy of Diagnostic Imaging 2
Choosing the Appropriate Modality 2
Ability to Interpret Findings 3
Radiographic Indications 3
Documentation of Disease 3
Value of Full-Mouth Radiography 3
American Animal Hospital Association Guidelines Regarding Dental Radiography 3
Intraoral Dental Radiographic Equipment 3
Generators 3
Wall-Mounted Units 4
Handheld Units 4
Mobile Units/Castor-Mounted Units 4
Film 4
Standard Film 5
Digital Image Acquisition 6
Radiographic Imaging 7
Basic Unit of an X-ray 7
Milliamperes (mA), Kilovoltage Peak (kVp), and Exposure Time 8
Radiographic Densities 9
Radiopaque 9
Radiolucent 10
Digital Image Creation 10
Creation of a Digital Image 10
Digital Imaging and Communications in Medicine Format (DICOM) 10
Pixels 10
Advanced Imaging Modalities 10
Computed Tomography 10
Cone Beam Computed Tomography (CBCT) 12
Magnetic Resonance Imaging 13
Definitions Relating to Imaging Modalities 13
Sagittal Plane 13
Transverse Plane 13
Dorsal Plane 14
Computed Tomography Window Width and Window Level 14
Window Width 15
Window Level 15
Other Common Viewing Windows 16
Bone Window 16
Soft Tissue Window 16
Radiation Safety 16
Radiation Safety Apparel 16
Collimation 16
As Low As Reasonably Achievable (ALARA) 17
Time, Distance, and Shielding 17
Time 17
Distance 17
Shielding 17
Radiation Safety Equipment Inspection 17
Protective Apparel 17
Care of Radiation Safety Equipment 18
Radiation Safety Inspection Protocol 19
References 20
2 Digital Dental Radiographic Positioning and Image Labeling 23
Brenda L. Mulherin and Chad Lothamer
Benefits to Proper Positioning 23
Practicing Techniques 23
Use of Position Indicating Device (PID) 23
Positioning Techniques 24
Patient Positioning 24
Sternal Recumbency 25
Dorsal Recumbency 25
Lateral Recumbency 25
Sensor/Phosphor Plate/Film Placement 26
Basic Positioning of Sensor 27
Eliminating Unused Film Space 29
Visualization of the Crown and Space Apical to Root 29
Intraoral Parallel Technique 30
Ideal Radiographic Technique 30
Placement of Sensor for Parallel Technique 31
Size Matters 31
Alternative Positioning 32
Parallel Technique for Cats 32
Intraoral Bisecting Angle Technique 32
Plane of the Tooth, Plane of the Film, and the Angle that Bisects 32
Shadow Game: Elongation, Foreshortening, and the Bisecting Angle 32
Axis of the Sensor, the Tooth, and the PID 33
Positioning of the Patient Matters 35
Anatomical Variations 36
Uses of the Bisecting Angle Technique 36
Occlusal Radiographic Technique 37
Feline Maxillary Premolar and Molar Teeth 37
Extraoral Technique 37
“Almost Parallel” or “Near Parallel” Technique 39
Localization of the Palatal Roots 39
Techniques for Imaging Caudal Teeth in Small Patients 43
Technique Errors 44
Foreshortening and Elongation 44
Cone Cutting 46
Missing the Apex 47
Overexposed or Underexposed 49
Artifacts 50
Repeat Radiographs 51
Conclusion 52
References 53
3 Interpretation of Normal Radiographic Anatomy 55
Brenda L. Mulherin
Value of Intraoral Radiographic Imaging 55
Quality of Images 56
Exposure Artifacts 56
Positioning Techniques 56
Parallel Technique 56
Bisecting Angle Technique 56
Positioning Artifacts 56
Elongation 56
Foreshortening 56
Cone Cutting 56
Missing the Apex 57
Mounting of Standard Dental Radiographs 57
Types of Mounting 57
Labial Mounting 57
Lingual Mounting 57
Labial Mounting of Standard Dental Radiographic Film 57
Lingual Mounting of Standard Radiographic Film 57
Digital Radiographic Mounting 58
Labial Mounting-Positioning of Teeth 59
Determining Maxilla from Mandible 59
Determining Right from Left 59
Modified Triadan Numbering System 62
Deciduous versus Permanent Teeth 65
Eruption Patterns 65
Mixed Dentition 66
Interpretation of Images 70
Tooth Root Numbers 75
Maxillary Teeth 75
Mandibular Teeth 77
Evaluation of the Structures 82
Crown 84
Root 90
Bone 105
Interpretation of Radiographic Shadows 105
Nomenclature 107
Where to Begin? 109
Conclusion 110
References 117
4 Interpretation of Common Oral Pathology in the Canine Patient 119
Brenda L. Mulherin and Chanda Miles
Periodontal Disease 119
Stages of PD 120
Types of Bone Loss 123
Horizontal Bone Loss 123
Vertical Bone Loss 123
Furcation Bone Loss 124
Supernumerary Roots and Teeth 129
Canine Tooth Resorption 131
Types of Tooth Resorption 132
External Tooth Resorption 132
External Surface Resorption 132
Internal Tooth Resorption 134
Treatment of Tooth Resorption 134
Odontogenic Cysts 135
Dentigerous Cysts 135
Periapical Cysts 137
Treatment for Odontogenic Cysts 138
Tooth Fractures 138
Root Fractures 142
Retained Tooth Roots 142
Endodontic Disease 143
Etiology 143
Radiographic Signs of Endodontic Disease 148
Widened PDL Space 148
Loss of Lamina Dura 148
Periapical Lucency 148
External and Internal Root Resorption 149
Widened Pulp Canal 150
Pulp Canal Calcification 150
Apical Periodontitis 151
Acute Apical Abscess 151
Chronic Apical Abscess 152
Endodontic Therapy 154
Root Canal Therapy 154
Vital Pulp Therapy 156
Attrition and Abrasion 157
Eruption Abnormalities 159
Persistent Deciduous Teeth 159
Unerupted Teeth 162
Abnormal Eruption 163
Conclusion 165
References 165
5 Interpretation of Common Pathology in the Feline Patient 167
Brenda L. Mulherin and Chanda Miles
Periodontal Disease 167
Types of Bone Loss 168
Buccal Alveolar Expansile Osteitis (BAEO) 168
Tooth Resorption 168
Stages and Types of Feline Tooth Resorption 177
Stages of Tooth Resorption 177
Types of Tooth Resorption 180
Criteria for Performing Crown Amputation/Intentional Root Retention 180
Supraeruption/Extrusion 185
Osteomyelitis and Osteitis 185
Retained Tooth Roots 187
Endodontic Disease 187
Conclusion 190
References 198
6 Oral Surgery: Neoplasia and Cystic Conditions 199
Megan Mickelson
Radiographic Indications of Neoplasia (Benign and Malignant) 199
Benign Oral Tumors 200
Canine Acanthomatous Ameloblastoma (CAA) 200
Peripheral Odontogenic Fibroma (POF) 200
Feline Inductive Odontogenic Tumor (FIOT) 201
Malignant Oral Tumors 201
Nontonsillar Squamous Cell Carcinoma (SCC) 201
Papillary Squamous Cell Carcinoma (PSCC) 203
Oral Malignant Melanoma (MM) 204
Fibrosarcoma (FSA) 206
Osteosarcoma (OSA) 206
Multilobular Osteochondrosarcoma (MLO) 208
Radiographic Indications of Cystic Conditions 209
Dentigerous Cyst 209
Radicular Cyst 212
Canine Furcation Cyst 213
Surgical Ciliated Cyst 213
Lateral Periodontal Cyst 213
Odontogenic Keratocyst (OKC)/Canine Odontogenic Parakeratinized Cyst (COPC) 216
Compound and Complex Odontomas 216
Limitations of Dental Radiography for Neoplasia 216
Conclusion 230
References 230
7 Interpretation of Uncommon Pathology in the Canine and Feline Patient 235
Brenda Mulherin, Chanda Miles, and Michael Congiusta
Introduction 235
Uncommon Conditions with Predilection for Canine Patients 235
Craniomandibular Osteopathy (CMO) 235
Idiopathic Calvarial Hyperostosis 237
Periostitis Ossificans (PO) 237
Malformed Roots/Root Hypoplasia 238
Dens Invaginatus/Dens in Dente 240
Uncommon Conditions Observed in both Canine and Feline Patients 245
Masticatory Myositis 245
Pulp Stones and Denticles 246
Osteosclerosis 247
Renal Secondary Hyperparathyroidism 248
Enamel Pearls 253
Uncommon Conditions with Predilection for Feline Patients 253
Dentition Abnormalities 253
Fused Roots 254
Supernumerary Roots 256
Supernumerary Teeth 257
Abnormal Eruption 257
Unerupted Teeth 258
Patellar Fracture and Dental Anomaly Syndrome (PADS) or Knees and Teeth Syndrome 258
Conclusion 262
Acknowledgment 262
References 262
8 Diagnostic Imaging of Exotic Pet Mammals and Zoo Animals 265
June Olds
Dental Diagnostic Imaging for Nontraditional (Exotic) Animals 265
General Considerations for Exotic Companion Mammals 266
Restraint 266
Knowledge of Normal Anatomy 266
General Positioning and Projection Recommendations 267
Standard Radiography 267
Standard Radiographic Positions 267
Intraoral Radiographs 272
Intraoral Films Used Extraorally 275
Magnification Techniques 275
Anatomical Variations 275
Rabbits 275
Guinea Pigs and Chinchillas 276
Rats, Mice, Hamsters, Gerbils, and Other Commonly Kept Rodent Pets 283
Ferrets 287
African Pygmy Hedgehogs 287
Sugar Gliders 289
Prairie Dogs (Cyomys ludovicianus) 293
Captive Nondomestic or “Wild” Mammals 293
Nonhuman Primates 293
Carnivores 297
Radiographic Positioning and Techniques in Captive Animals 297
Animal Training 300
Other Dental Conditions in Zoologic Animals 304
Trauma 304
Attrition 304
Macropod Progressive Periodontal Disease (MPPD) 304
Molar Progression 308
Advanced Diagnostic Imaging in Exotic Pet Mammals and Zoo Animals 308
Standard Computed Tomography 308
Cone Beam Computed Tomography 312
Micro-computed Tomography 316
Considerations for Computed Tomography 321
Conclusion 326
Acknowledgment 327
References 327
9 Diagnostic Imaging and Interpretation of the Equine Patient 331
Joan Howard, Molly Rice, Kara Frerichs, and Beatrice Sponseller
Introduction to Equine Dental Radiographs 331
Radiation Safety 332
Radiographic Systems 332
Direct Digital Radiographic System (DR) 332
Computed Tomography 332
Standard Radiographic System 332
Radiographic Technique 332
Guidelines for Radiographic Views 332
Concepts to Understand 332
Directing the Primary Beam Through the Interproximal Spaces 333
Open Mouth Oblique Cheek Teeth Projections 334
Radiographic Views 334
Lateral View 334
Dorsoventral View 336
Dorsal Ventral Oblique Projection of the Maxillary Cheek Teeth 338
Ventral Dorsal Oblique Projection of the Maxillary Cheek Teeth 340
Ventral Dorsal Oblique Projection of the Mandibular Cheek Teeth 340
Dorsal Ventral Oblique Projection of the Mandibular Cheek Teeth 340
Occlusal Intraoral View of the Maxillary Incisors and Canines 340
Occlusal Intraoral View of the Mandibular Incisors and Canines 343
Evaluation of an Image 346
Labial Mounting 346
Radiographic Anatomy 347
Radiographic Changes in Dental Disease 350
Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) 352
Apical Infections 353
Periodontal Disease 354
Sinusitis 356
Neoplasia 357
Other Suggested Abnormalities to be Radiographed 358
Conclusion 360
Acknowledgment 372
References 372
10 Advanced Imaging of the Oral Cavity 373
Stephanie Goldschmidt
Introduction to the Use of Advanced Imaging Techniques in the Maxillofacial Region 373
Magnetic Resonance Imaging (MRI) 373
Technical Principles of MRI 373
T1- and T2-Weighted Sequences 374
Other MRI Sequences 375
Indications for Use of MRI over CT in the Maxillofacial Region 376
Temporomandibular Joint Disease (TMD) 376
Salivary Gland Disease 376
Abnormalities in the Muscles of Mastication and Inability to Open/Close the Mouth 376
Conclusions on the Clinical Indication for Use of MRI 377
Computed Tomography (CT) 379
Technical Principles of Multidetector CT (MDCT) Scanners 380
Technical Principles of Cone Beam CT (CBCT) Scanners 382
Viewing CT Images 383
Differences in Image Characteristics Between CBCT and MDCT 387
Spatial Resolution 387
Soft Tissue Imaging 387
Artifacts 389
Other Impactful Differences in Practical Use Between MDCT and CBCT 389
Indications for Use of Either MDCT or CBCT in the Maxillofacial Region 389
Maxillofacial Trauma 389
Bony Pathology 390
Osteomyelitis/Osteonecrosis 390
Fibro-Osseous Disease 390
Osseous Neoplasia 391
Clefts 392
Indications for Multidetector CT only (not CBCT) in the Maxillofacial Region 395
Oral Neoplasia with a Soft Tissue Component 395
Soft Tissue Pathology 395
Indications for CBCT only (not MDCT) in the Maxillofacial Region 395
Dentoalveolar Trauma 396
Periodontal Disease 396
Endodontic Disease 396
Tooth Resorption 399
Diagnosis and Treatment of Missing Teeth 401
Conclusions on the Clinical Indication for Use of CBCT Versus MDCT 402
References 402
Index 407
