Identification of Restorations, Dental Materials, and Foreign Objects Chapter 32 Identification of Restorations, Dental Materials, and Foreign Objects

Dental Radiography Questions What is the appearance of the different restorations used in dentistry? What is the appearance of materials used in dentistry? What is the appearance of other miscellaneous objects that may be viewed on dental images?

Dental Radiography Chapter 32 Reading Iannucci & Howerton (pp. 383-401)

Dental Radiography Chapter 32 Outline Identification of Restorations, Dental Materials, and Foreign Objects Identification of restorations Identification of materials used in dentistry Identification of miscellaneous objects

Introduction Purpose Iannucci & Howerton (pp. 383) To review common dental restorations, dental materials, and foreign objects that may be seen on dental images The patient must be present to record important clinical information.

Identification of Restorations Amalgam restorations Gold restorations Stainless steel and chrome crowns Post and core restorations Porcelain restorations Composite restorations Acrylic restorations These are all common restorative materials.

Identification of Restorations Iannucci & Howerton (p. 384) (Fig. 32-1) Metallic restorations Metallic restorations absorb x-rays. Very little radiation comes in contact with the receptor That area of receptor remains unexposed, and the metallic restorations appear completely radiopaque on a dental image. Amalgam, gold Will appear light or white on a dental image.

Identification of Restorations Iannucci & Howerton (p. 384) Nonmetallic restorations may vary in appearance from radiolucent to slightly radiopaque, depending on the density of the material. Porcelain is the most dense and least radiolucent, and acrylic the least dense and most radiolucent. Porcelain, composite, and acrylic. On what type of restoration might you find these materials?

Amalgam Restorations One-surface amalgam restorations Iannucci & Howerton (pp. 384-385) One-surface amalgam restorations Amalgam overhangs Amalgam fragments

One-Surface Amalgam Restorations Iannucci & Howerton (pp. 384-385) (Figs. 32-2 through 32-5) These appear as distinct, small, round or void radiopacities. They may be seen on buccal, lingual, or occlusal surfaces. Larger two-surface and multisurface amalgam restorations also appear radiopaque and are characterized by irregular outlines or borders.

Amalgam Overhangs Iannucci & Howerton (pp. 384-385) (Figs. 32-6, 32-7) Extensions of amalgam seen beyond the crown portion of a tooth in the interproximal region Disrupts natural cleansing contours of the tooth, traps food and plaque, and contributes to bone loss What can happen if an amalgam overhang is not fixed? What causes an amalgam overhang?

Amalgam Fragments Iannucci & Howerton (pp. 385-386) (Figs. 32-8, 32-9) Fragments of amalgam may be inadvertently embedded in adjacent soft tissue during restoration of a tooth. They appear as dense radiopacities with irregular borders. May be seen in any location where soft tissue if present.

Gold Restorations Iannucci & Howerton (pp. 385-387) (Figs. 32-10 through 32-15) Gold restorations appear completely radiopaque and, unlike amalgam restorations, exhibit a smooth marginal outline. Gold crowns and bridges Gold crowns and bridges appear as large radiopaque restorations with smooth contours and regular borders. Gold foil restorations These appear as small round radiopacities. If the dental radiographer is unsure as to whether the restoration is gold or amalgam, just simply do an examination of the patient to verify what is seen radiographically.

Stainless Steel and Chrome Crowns Iannucci & Howerton (pp. 386-387) (Figs. 32-16 through 32-18) Appear radiopaque, but not as densely radiopaque as amalgam or gold. Outlines and margins appear smooth and regular. Some areas may appear “see-through” on a radiograph. Prefabricated restorations that are usually used as interim or temporary restorations. Thin and do not absorb dental x-rays to the extent that amalgam, gold, and other cast metals do.

Post and Core Restorations Iannucci & Howerton (pp. 387-388) (Fig. 32-19) These can be seen in endodontically treated teeth. Appears radiopaque on a dental image The core portion resembles the prepared portion of a tooth crown, and the post portion extends into the pulp canal. Cast metal and appears as radiodense as amalgam or gold.

Porcelain Restorations Iannucci & Howerton (pp. 388-390) (Figs. 32-20 through 32-25) Appearance of porcelain restorations is slightly radiopaque and resembles the radiopacity of dentin. All-porcelain crowns A thin radiopaque line outlining the prepared tooth that represents cement may be evident through the slightly radiopaque porcelain crown. Porcelain-fused-to-metal crown The metal component appears completely radiopaque, and the porcelain component appear slightly radiopaque.

Composite Restorations Iannucci & Howerton (pp. 389-390) (Figs. 32-26, 32-27) Composite restorations may vary in appearance from radiolucent to slightly radiopaque depending on the composition of the composite material. Some manufacturers of composite materials add radiopaque particles to their products to help the viewer differentiate a composite restoration from dental caries on a dental image. If questions arise regarding a composite restoration versus dental caries, a visual and digital exam can be done to distinguish between the two.

Acrylic Restorations Iannucci & Howerton (p. 390) These are often used as an interim or temporary crown or filling. Acrylic is the least dense of all nonmetallic restorations and appears radiolucent or barely visible on a dental image.

Identification of Materials Used in Dentistry Materials used in restorative dentistry Materials used in endodontics Materials used in prosthodontics Materials used in orthodontics Materials used in oral surgery

Materials Used in Restorative Dentistry Iannucci & Howerton (pp. 390-391) (Figs. 32-28, 32-29, 32-30) Base materials Are used as cavity liners placed on the floor of a cavity preparation to protect the pulp. They appear radiopaque, less radiodense than amalgam. Metallic pins Metallic pins are used to enhance retention of amalgam or composite. They appear as cylindrical or screw-shaped radiopacities. Include zinc phosphate and zinc oxide-eugenol paste. The restorative material is placed over the base material.

Materials Used in Endodontics Iannucci & Howerton (p. 391) (Figs. 32-31, 32-32) Gutta percha Gutta percha is a claylike material used to fill pulp canals. Appears radiopaque, similar to base materials, is less radiodense than metallic restorations. Silver points These are used to fill pulp canals. They are very radiopaque, similar to other metallic materials, appear more radiodense than gutta percha. Placed as a filling material in the pulp canal after root canal therapy Appears as a radiopaque material in the roots of a tooth

Materials Used in Prosthodontics Iannucci & Howerton (pp. 391-393) (Figs. 32-33, 32-34, 32-35) Patients should be instructed to remove all complete and partial dentures before dental images are taken. Complete dentures A complete denture that is not removed gives the illusion of rootless, or “floating” teeth. Removable partial dentures An RPD with a metal base with acrylic saddles appears densely radiopaque where metal is present and slightly radiopaque in the areas of acrylic. If these are not removed before images are taken, it may obscure important information concerning adjacent teeth and underlying bone.

Materials Used in Orthodontics Iannucci & Howerton (pp. 393-394) (Figs. 32-36 through 32-39) Orthodontic bands, brackets, and wires may be observed on dental images. They have a characteristic appearance.

Materials Used in Oral Surgery Iannucci & Howerton (pp. 393, 395-396) (Figs. 32-40 through 32-44) Implants are being used with increased frequency. The appearance varies based on the shape and design of the implant used. Suture wires, metallic splints and plates, bone screws, and stabilizing arches are used in oral surgery to stabilize fractures of the maxilla and mandible. The endosteal implant is made of a metallic material and appears radiopaque on a dental image.

Identification of Miscellaneous Objects Jewelry Eyeglasses and napkin chain These objects can obscure important diagnostic information.

Jewelry Metal earrings appear as dense radiopacities. Iannucci & Howerton (pp. 395-398) (Figs. 32-45 through 32-49) Metal earrings appear as dense radiopacities. A radiodense object causes an artifact known as a ghost image. These images can obscure important information and render the image nondiagnostic. Necklaces and nose jewelry may also be seen. Have the patient remove metal earrings if an extraoral image is being taken.

Eyeglasses and Napkin Chain Iannucci & Howerton (pp. 397-398) (Fig. 32-50) The metal portion of eyeglass frames appears as a radiopacity on dental image. The patient napkin chain may be seen on an extraoral image. Have the patient remove eyeglasses for intraoral and extraoral image capture. The patient will only need to remove the napkin chain if an extraoral image is being taken.