Dental radiology

A dental surgeon takes an average of 2,000 X-ray images per year, which means that dental radiology represents a major part of the practitioner's clinical activity. Radiology is therefore a daily concern, and every patient, whether at the start, during or after treatment, requires appropriate imaging modalities. Many radiologists and oral surgery specialists also practice dento-maxillofacial radiology. The stock of equipment, estimated at over 33,000 generators, is constantly growing. Today, the equipment required for digitized intra-oral techniques is the minimum, and the need to complement these facilities with equipment for panoramic radiology, or even digitized volume imaging (Cone Beam CT – CBCT), now concerns a good number of practitioners associated in group practices of various odontological specialties.

The intra- and extra-oral dental radiological examinations described here are considered to be first-line when they are minimally invasive and easy to perform in the office. If necessary, volumetric imaging can be used as a second line of defence, as it is less energy-efficient in terms of radiation but provides a wealth of three-dimensional information, and is becoming increasingly important for complex treatment plans. The recent arrival, spectacularly rapid spread and technical evolution of CBCT have had a major impact on dental practice, to the extent that new indications (HAS), new codes (CCAM) and appropriate training have become essential. What's more, indications that used to involve CT scans are now being redirected towards CBCT, thereby limiting patient dose.

It should be remembered that dental X-ray imaging is just another tool used by practitioners in their day-to-day practice, and that it is clinical necessity that dictates the radiological act, in line with the concepts of radiation protection: optimization, limitation and justification. An exposure is justified if it is of sufficient direct medical interest to offset the risk it may present, and if no other technique of comparable efficacy involving less risk is available. This is the process of establishing the net benefit of an examination in relation to the potential harm associated with exposure to ionizing radiation. The relevance of the expected diagnostic or therapeutic information must therefore guide the correct indication of radiological procedures.

Based on the initial and ongoing training provided by the Dental Radiology Department at the Paris Descartes Faculty of Dental Surgery, this article aims to provide the key elements needed to understand the practice of radiological imaging in dental and maxillofacial surgery, from 2D intra-oral radiology to recent volume imaging. It is on the basis of the necessary dialogue between the world of engineering sciences...