Brenda L. Mulherin, DVM, Diplomate AVDC, is a Clinical Professor with the Lloyd Veterinary Medical Center at Iowa State University College of Veterinary Medicine in Ames, Iowa, USA.

• List of Contributors xvPreface xviiAcknowledgements xix1 History, Physiology, Modality Options, and Safety for Diagnostic Imaging of the Oral Cavity 1Brenda L. MulherinHistory of Diagnostic Imaging 1Discovery of X-rays 1Developing of Safety Measures 1Shortening of Exposure Time 1Glass Plates to Film 2Progression to Digital 2Philosophy of Diagnostic Imaging 2Choosing the Appropriate Modality 2Ability to Interpret Findings 3Radiographic Indications 3Documentation of Disease 3Value of Full-Mouth Radiography 3American Animal Hospital Association Guidelines Regarding Dental Radiography 3Intraoral Dental Radiographic Equipment 3Generators 3Wall-Mounted Units 4Handheld Units 4Mobile Units/Castor-Mounted Units 4Film 4Standard Film 5Digital Image Acquisition 6Radiographic Imaging 7Basic Unit of an X-ray 7Milliamperes (mA), Kilovoltage Peak (kVp), and Exposure Time 8Radiographic Densities 9Radiopaque 9Radiolucent 10Digital Image Creation 10Creation of a Digital Image 10Digital Imaging and Communications in Medicine Format (DICOM) 10Pixels 10Advanced Imaging Modalities 10Computed Tomography 10Cone Beam Computed Tomography (CBCT) 12Magnetic Resonance Imaging 13Definitions Relating to Imaging Modalities 13Sagittal Plane 13Transverse Plane 13Dorsal Plane 14Computed Tomography Window Width and Window Level 14Window Width 15Window Level 15Other Common Viewing Windows 16Bone Window 16Soft Tissue Window 16Radiation Safety 16Radiation Safety Apparel 16Collimation 16As Low As Reasonably Achievable (ALARA) 17Time, Distance, and Shielding 17Time 17Distance 17Shielding 17Radiation Safety Equipment Inspection 17Protective Apparel 17Care of Radiation Safety Equipment 18Radiation Safety Inspection Protocol 19References 202 Digital Dental Radiographic Positioning and Image Labeling 23Brenda L. Mulherin and Chad LothamerBenefits to Proper Positioning 23Practicing Techniques 23Use of Position Indicating Device (PID) 23Positioning Techniques 24Patient Positioning 24Sternal Recumbency 25Dorsal Recumbency 25Lateral Recumbency 25Sensor/Phosphor Plate/Film Placement 26Basic Positioning of Sensor 27Eliminating Unused Film Space 29Visualization of the Crown and Space Apical to Root 29Intraoral Parallel Technique 30Ideal Radiographic Technique 30Placement of Sensor for Parallel Technique 31Size Matters 31Alternative Positioning 32Parallel Technique for Cats 32Intraoral Bisecting Angle Technique 32Plane of the Tooth, Plane of the Film, and the Angle that Bisects 32Shadow Game: Elongation, Foreshortening, and the Bisecting Angle 32Axis of the Sensor, the Tooth, and the PID 33Positioning of the Patient Matters 35Anatomical Variations 36Uses of the Bisecting Angle Technique 36Occlusal Radiographic Technique 37Feline Maxillary Premolar and Molar Teeth 37Extraoral Technique 37“Almost Parallel” or “Near Parallel” Technique 39Localization of the Palatal Roots 39Techniques for Imaging Caudal Teeth in Small Patients 43Technique Errors 44Foreshortening and Elongation 44Cone Cutting 46Missing the Apex 47Overexposed or Underexposed 49Artifacts 50Repeat Radiographs 51Conclusion 52References 533 Interpretation of Normal Radiographic Anatomy 55Brenda L. MulherinValue of Intraoral Radiographic Imaging 55Quality of Images 56Exposure Artifacts 56Positioning Techniques 56Parallel Technique 56Bisecting Angle Technique 56Positioning Artifacts 56Elongation 56Foreshortening 56Cone Cutting 56Missing the Apex 57Mounting of Standard Dental Radiographs 57Types of Mounting 57Labial Mounting 57Lingual Mounting 57Labial Mounting of Standard Dental Radiographic Film 57Lingual Mounting of Standard Radiographic Film 57Digital Radiographic Mounting 58Labial Mounting-Positioning of Teeth 59Determining Maxilla from Mandible 59Determining Right from Left 59Modified Triadan Numbering System 62Deciduous versus Permanent Teeth 65Eruption Patterns 65Mixed Dentition 66Interpretation of Images 70Tooth Root Numbers 75Maxillary Teeth 75Mandibular Teeth 77Evaluation of the Structures 82Crown 84Root 90Bone 105Interpretation of Radiographic Shadows 105Nomenclature 107Where to Begin? 109Conclusion 110References 1174 Interpretation of Common Oral Pathology in the Canine Patient 119Brenda L. Mulherin and Chanda MilesPeriodontal Disease 119Stages of PD 120Types of Bone Loss 123Horizontal Bone Loss 123Vertical Bone Loss 123Furcation Bone Loss 124Supernumerary Roots and Teeth 129Canine Tooth Resorption 131Types of Tooth Resorption 132External Tooth Resorption 132External Surface Resorption 132Internal Tooth Resorption 134Treatment of Tooth Resorption 134Odontogenic Cysts 135Dentigerous Cysts 135Periapical Cysts 137Treatment for Odontogenic Cysts 138Tooth Fractures 138Root Fractures 142Retained Tooth Roots 142Endodontic Disease 143Etiology 143Radiographic Signs of Endodontic Disease 148Widened PDL Space 148Loss of Lamina Dura 148Periapical Lucency 148External and Internal Root Resorption 149Widened Pulp Canal 150Pulp Canal Calcification 150Apical Periodontitis 151Acute Apical Abscess 151Chronic Apical Abscess 152Endodontic Therapy 154Root Canal Therapy 154Vital Pulp Therapy 156Attrition and Abrasion 157Eruption Abnormalities 159Persistent Deciduous Teeth 159Unerupted Teeth 162Abnormal Eruption 163Conclusion 165References 1655 Interpretation of Common Pathology in the Feline Patient 167Brenda L. Mulherin and Chanda MilesPeriodontal Disease 167Types of Bone Loss 168Buccal Alveolar Expansile Osteitis (BAEO) 168Tooth Resorption 168Stages and Types of Feline Tooth Resorption 177Stages of Tooth Resorption 177Types of Tooth Resorption 180Criteria for Performing Crown Amputation/Intentional Root Retention 180Supraeruption/Extrusion 185Osteomyelitis and Osteitis 185Retained Tooth Roots 187Endodontic Disease 187Conclusion 190References 1986 Oral Surgery: Neoplasia and Cystic Conditions 199Megan MickelsonRadiographic Indications of Neoplasia (Benign and Malignant) 199Benign Oral Tumors 200Canine Acanthomatous Ameloblastoma (CAA) 200Peripheral Odontogenic Fibroma (POF) 200Feline Inductive Odontogenic Tumor (FIOT) 201Malignant Oral Tumors 201Nontonsillar Squamous Cell Carcinoma (SCC) 201Papillary Squamous Cell Carcinoma (PSCC) 203Oral Malignant Melanoma (MM) 204Fibrosarcoma (FSA) 206Osteosarcoma (OSA) 206Multilobular Osteochondrosarcoma (MLO) 208Radiographic Indications of Cystic Conditions 209Dentigerous Cyst 209Radicular Cyst 212Canine Furcation Cyst 213Surgical Ciliated Cyst 213Lateral Periodontal Cyst 213Odontogenic Keratocyst (OKC)/Canine Odontogenic Parakeratinized Cyst (COPC) 216Compound and Complex Odontomas 216Limitations of Dental Radiography for Neoplasia 216Conclusion 230References 2307 Interpretation of Uncommon Pathology in the Canine and Feline Patient 235Brenda Mulherin, Chanda Miles, and Michael CongiustaIntroduction 235Uncommon Conditions with Predilection for Canine Patients 235Craniomandibular Osteopathy (CMO) 235Idiopathic Calvarial Hyperostosis 237Periostitis Ossificans (PO) 237Malformed Roots/Root Hypoplasia 238Dens Invaginatus/Dens in Dente 240Uncommon Conditions Observed in both Canine and Feline Patients 245Masticatory Myositis 245Pulp Stones and Denticles 246Osteosclerosis 247Renal Secondary Hyperparathyroidism 248Enamel Pearls 253Uncommon Conditions with Predilection for Feline Patients 253Dentition Abnormalities 253Fused Roots 254Supernumerary Roots 256Supernumerary Teeth 257Abnormal Eruption 257Unerupted Teeth 258Patellar Fracture and Dental Anomaly Syndrome (PADS) or Knees and Teeth Syndrome 258Conclusion 262Acknowledgment 262References 2628 Diagnostic Imaging of Exotic Pet Mammals and Zoo Animals 265June OldsDental Diagnostic Imaging for Nontraditional (Exotic) Animals 265General Considerations for Exotic Companion Mammals 266Restraint 266Knowledge of Normal Anatomy 266General Positioning and Projection Recommendations 267Standard Radiography 267Standard Radiographic Positions 267Intraoral Radiographs 272Intraoral Films Used Extraorally 275Magnification Techniques 275Anatomical Variations 275Rabbits 275Guinea Pigs and Chinchillas 276Rats, Mice, Hamsters, Gerbils, and Other Commonly Kept Rodent Pets 283Ferrets 287African Pygmy Hedgehogs 287Sugar Gliders 289Prairie Dogs (Cyomys ludovicianus) 293Captive Nondomestic or “Wild” Mammals 293Nonhuman Primates 293Carnivores 297Radiographic Positioning and Techniques in Captive Animals 297Animal Training 300Other Dental Conditions in Zoologic Animals 304Trauma 304Attrition 304Macropod Progressive Periodontal Disease (MPPD) 304Molar Progression 308Advanced Diagnostic Imaging in Exotic Pet Mammals and Zoo Animals 308Standard Computed Tomography 308Cone Beam Computed Tomography 312Micro-computed Tomography 316Considerations for Computed Tomography 321Conclusion 326Acknowledgment 327References 3279 Diagnostic Imaging and Interpretation of the Equine Patient 331Joan Howard, Molly Rice, Kara Frerichs, and Beatrice SponsellerIntroduction to Equine Dental Radiographs 331Radiation Safety 332Radiographic Systems 332Direct Digital Radiographic System (DR) 332Computed Tomography 332Standard Radiographic System 332Radiographic Technique 332Guidelines for Radiographic Views 332Concepts to Understand 332Directing the Primary Beam Through the Interproximal Spaces 333Open Mouth Oblique Cheek Teeth Projections 334Radiographic Views 334Lateral View 334Dorsoventral View 336Dorsal Ventral Oblique Projection of the Maxillary Cheek Teeth 338Ventral Dorsal Oblique Projection of the Maxillary Cheek Teeth 340Ventral Dorsal Oblique Projection of the Mandibular Cheek Teeth 340Dorsal Ventral Oblique Projection of the Mandibular Cheek Teeth 340Occlusal Intraoral View of the Maxillary Incisors and Canines 340Occlusal Intraoral View of the Mandibular Incisors and Canines 343Evaluation of an Image 346Labial Mounting 346Radiographic Anatomy 347Radiographic Changes in Dental Disease 350Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) 352Apical Infections 353Periodontal Disease 354Sinusitis 356Neoplasia 357Other Suggested Abnormalities to be Radiographed 358Conclusion 360Acknowledgment 372References 37210 Advanced Imaging of the Oral Cavity 373Stephanie GoldschmidtIntroduction to the Use of Advanced Imaging Techniques in the Maxillofacial Region 373Magnetic Resonance Imaging (MRI) 373Technical Principles of MRI 373T1- and T2-Weighted Sequences 374Other MRI Sequences 375Indications for Use of MRI over CT in the Maxillofacial Region 376Temporomandibular Joint Disease (TMD) 376Salivary Gland Disease 376Abnormalities in the Muscles of Mastication and Inability to Open/Close the Mouth 376Conclusions on the Clinical Indication for Use of MRI 377Computed Tomography (CT) 379Technical Principles of Multidetector CT (MDCT) Scanners 380Technical Principles of Cone Beam CT (CBCT) Scanners 382Viewing CT Images 383Differences in Image Characteristics Between CBCT and MDCT 387Spatial Resolution 387Soft Tissue Imaging 387Artifacts 389Other Impactful Differences in Practical Use Between MDCT and CBCT 389Indications for Use of Either MDCT or CBCT in the Maxillofacial Region 389Maxillofacial Trauma 389Bony Pathology 390Osteomyelitis/Osteonecrosis 390Fibro-Osseous Disease 390Osseous Neoplasia 391Clefts 392Indications for Multidetector CT only (not CBCT) in the Maxillofacial Region 395Oral Neoplasia with a Soft Tissue Component 395Soft Tissue Pathology 395Indications for CBCT only (not MDCT) in the Maxillofacial Region 395Dentoalveolar Trauma 396Periodontal Disease 396Endodontic Disease 396Tooth Resorption 399Diagnosis and Treatment of Missing Teeth 401Conclusions on the Clinical Indication for Use of CBCT Versus MDCT 402References 402Index 407