Trauma (see Chapters 37 and 38)Intraoral films can target specific areas of traumatic damage.Sometimes, full skull radiographs give a broader picture of the extent of damage.Figure 3.38 Some teeth that appear to have classic resorptive lesions display no odontoclastic activity (no replacement resorption) on radiographs. These teeth are more periodontally involved, with root exposure due to attachment loss (gingiva and bone loss) and subsequent erosion of the exposed portion of the root, but the submerged root remains intact, along with a distinct periodontal ligament space.Figure 3.39 Odontoclastic lesions (replacement resorption) of feline teeth need to be assessed radiographically. Often seen is the presence of root resorption with indistinguishable root, periodontal ligament space, and alveolar bone.Patients with trauma have 1.6–2 times more injuries as noted by CT which are missed with conventional radiology [8]. That is an average of three injuries per patient missed when three‐dimensional imaging is not utilized.
NeoplasiaAny suspicious lesion should be radiographed and biopsied (Figure 3.41).Be cautious with gingival enlargement: many benign‐looking changes are actually invasive painful growths, while not all show radiographic changes (Figure 3.42). All types of oral biopsies should be sent to an oral pathologist† for more definitive identification.Figure 3.40 When resorption is on the external surface and involving only the tooth root but not the neck or crown of the tooth, as seen here in a dog, no treatment is needed. If the resorption extends to the neck or crown of the tooth, and has access to the oral cavity, it is painful requiring extraction.Figure 3.41 Radiographs may give an indication as to the severity of oral masses, particularly their osseous involvement, as in this aggressive squamous cell carcinoma in a feline mandible.Figure 3.42 (a) Presumed gingival enlargement and periodontal disease. (b) Four months later, the mass effect has become apparent. Radiographic signs of neoplasia were not present on initial presentation. Other cases may progress much faster than four months.While conventional radiographs are fine (80% accurate) at detecting bone invasion with maxillary masses, they are three times less sensitive than CBCT in detecting invasion of adjacent structures, an important prognostic indicator [11].
Post‐procedure: it is essential to have pre‐ and post‐extraction radiographs [2]. A study of reported complete carnassial extractions in dogs and cats showed that tooth fragments remained in place 82–92% of the time [1].
It is not possible to practice appropriate veterinary dentistry without utilizing dental radiography.
See also the following chapters:
Abbreviations
CBCT = cone beam computed tomography
HDVI = high‐definition volumetric imaging
IRR = intentional (resorbing) root retention
MET = modified extraction technique
PDL = periodontal ligament
SLOB = same lingual, opposite buccal
TMJ = temporomandibular joint;
TR = tooth resorption
References
1 1. Moore JI, Niemiec BA. Evaluation of extraction sites for evidence of retained tooth roots and periapical pathology. J Am Anim Hosp Assoc 2014; 50:77–82.
2 2. Bellows J, Berg ML, Dennis S, et al. 2019 AAHA Dental Care Guidelines for Dogs and Cats. J Am Anim Hosp Assoc 2019; 55(2):49–69.
3 3. Roza MR, Silva LAF, Barriviera M, et al. Cone beam computed tomography and intraoral radiography for diagnosis of dental abnormalities in dogs and cats. J Vet Sci 2011; 12(4):387–392.
4 4. Niemiec BA. Oral radiology and imaging. In: Lobprise HB, Dodd JR, eds. Wiggs’s Veterinary Dentistry: Principles and Practice, 2nd edn. Hoboken, NJ: Wiley Blackwell, 2019:46, 48, 133, 240.
5 5. Heney CM, Arzi B, Kass PH, et al. The diagnostic yield of dental radiography and cone‐beam computed tomography for the identification of dentoalveolar lesions in cats. Front Vet Sci 2019; 6:42.
6 6. Heney CM, Arzi B, Kass PH, et al. Diagnostic yield of dental radiography and cone‐beam computed tomography for the identification of anatomic structures in cats. Front Vet Sci 2019; 6:58.
7 7. Hansen KS, Kent MS. Imaging in non‐neurologic oncologic treatment planning of the head and neck. Front Vet Sci 2019; 6:90.
8 8. Bar‐Am Y, Pollard RE, Kass PH, Verstraete FJM. The diagnostic yield of conventional radiographs and computed tomography in dogs and cats with maxillofacial trauma. Vet Surg 2008; 37(3):294–299.
9 9. Martin‐Flores M, Scrivani PV, Loew E, et al. Maximal and submaximal mouth opening with mouth gags in cats: implications for maxillary artery blood flow. Vet J 2014; 200(1):60–64.
10 10. Hale FA. Localized intrinsic staining of teeth due to pulpitis and pulp necrosis in dogs. J Vet Dent 2001; 18(1):14–20.
11 11. Ghirelli CO, Villamizar LA, Pinto AC. Comparison of standard radiography