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Veterinary Oral Diagnostic Imaging. Edition No. 1

  • Book

  • 448 Pages
  • November 2023
  • John Wiley and Sons Ltd
  • ID: 5838825
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.

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


Brenda L. Mulherin Iowa State University College of Veterinary Medicine in Ames, IA, USA.