|Year : 2011 | Volume
| Issue : 2 | Page : 105-107
Digital fluoroscopy in prosthodontics
Prachi Gupta1, Ram U Thombare1, AJ Pakhan1, BK Motwani1, B Lakhkar2
1 Department of Prosthodontics, Sharad Pawar Dental College, DMIMS, Sawangi, Wardha, Maharashtra, India
2 Department of Radiodiagnosis, Jawahar Lal Nehru Medical College, DMIMS, Sawangi, Wardha, Maharashtra, India
|Date of Web Publication||17-Sep-2011|
Department of Prosthodontics, Sharad Pawar Dental College, DMIMS, Sawangi, Wardha, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Digital fluoroscopy has an unlimited potential in dentistry. The mysteries of mandibular motion can be unravelled and several facts unearthed. It is revealed from critical review of literature that fluoroscopy has proved its utility in evaluating the function and mobility of dentures and the position of bolus in two-dimensional views.Various applications are summarized as follows: temporo mandibular joint disorders; mandibular movement, which includes contact during mastication, freeway space and position of condyles in glenoid fossa (terminal hinge position). Here we present three case reports in which digital fluoroscopic potential was used as a valuable research tool, diagnostic aid and therapeutic monitor of the progress of treatment in dentistry.
Keywords: Digital fluoroscopy, prosthodontics, cleft palate, denture, temporo mandibular joint
|How to cite this article:|
Gupta P, Thombare RU, Pakhan A J, Motwani B K, Lakhkar B. Digital fluoroscopy in prosthodontics. J Interdiscip Dentistry 2011;1:105-7
| Introduction|| |
Fluoroscopy is a procedure that helps in viewing dynamic structures of the human body. Fluoroscopy is a type of medical imaging that shows a continuous X-ray image on a monitor, much like an X-ray movie. Fluoroscopy was invented by Thomas Edison in 1896. Handheld fluoroscopy was performed in early days and later, it was mounted on X-ray machine (conventional fluoroscopy). During a fluoroscopy procedure, an X-ray beam is passed through the body. The recent advancement in this technology is digital fluoroscopy, where an image is transmitted to a monitor so that the body part and its motion can be seen in detail. Prosthodontics plays a major role in rehabilitation of stomatognathic system. This technique also helps to monitor the progress of active treatment methods, to evaluate prosthodontic treatment functional results and can be used as a jaw tracking device.  It provides a useful research tool, a diagnostic aid, and a therapeutic monitor of the progress. The amount of radiation used during a fluoroscopy procedure is considered as minimal; therefore, the risk for radiation exposure is very low.  An imaging protocol is outlined here with respect to uses, strength, and limitations. The aim of this presentation is to provide an objective basis for diagnosing musculoskeletal disorders of the jaws, to document specific anatomic abnormalities and problems related to speech pathology through three different case reports. This paper also throws light on the essential limitations of this technology, possible direction of functional improvement and specially their scientific and clinical significance in prosthodontic rehabilitation.
| Case Reports|| |
A 13 year old male patient reported to the department of prosthodontics for prosthesis for cleft palate. The chief complaint of the patient was difficulty in speech. Intraoral examination revealed presence of cleft in the anterior region of alveolus (Type 3).  Patient had no relevant medical history. His speech was unclear. Digital fluoroscopy was performed to assess the problem in articulation of tongue with palate while pronouncing letter 'S'. Movements of tongue and soft palate were compared with the normal subject. Significant differences were observed in the movement of tongue due to altered anatomy. In normal subject, tongue was seen clearly touching anterior part of hard palate whereas in cleft palate patient, tongue was not able to touch the anterior part of hard palate [Figure 1] and [Figure 2].
|Figure 1: During 'S' sound, tongue was touching the anterior part of hard palate|
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|Figure 2: During 'S' sound, tongue was not touching the anterior part of hard palate|
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A 28yearold female presented to department of prosthodontics with chief complaint of severe temporo mandibular joint (TMJ) clicking with tenderness present on left side. Intraoral examination revealed generalized attrition. Patient had the habit of clenching her teeth. Fluoroscopy was performed to assess the changes in condyle movement with relation to articular eminence and findings were compared with normal subject. Significant findings [Figure 3] and [Figure 4] include; joint hypermobility in the patient as compared to the normal subject and opening and closing movements of the jaw were evaluated and while closing, jerky movement of the condyle was observed on the left side.
A 65-year-old male reported to the department of prosthodontics with the chief complaint of inability to chew food and problem in speech. Complete denture prosthesis was fabricated for the patient. Fluoroscopy was performed to evaluate the mobility of mandibular complete denture in mouth. It was observed that mobility of denture could be assessed in interference free conditions [Figure 5].
|Figure 5: Mobility of mandibular denture could be assessed in interference free conditions|
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| Discussion|| |
Every patient has unique treatment requirements. Proper diagnosis and treatment plan are important aspects of rehabilitation. The procedure explained in these clinical reports provides a useful and efficient diagnostic aid. Fluoroscopy is an imaging protocol in which continuous X-ray images of the patient's internal structures can be visualized. The procedure was performed with Philips FD 20 Allura XCELRA C-arm equipment. Once it is decided that the procedure is indicated, information is provided to the patient and caregiver regarding digital fluoroscopy procedure, safety, and the rationale for the examination. They are encouraged to ask questions and seek clarification. The next step is to work out the appropriate method of transport to the radiology department and to determine the patient's position to be used for the study. Whenever possible, the patient is seated as upright as possible. All studies are started with the patient in the lateral view and then finished with an anterio-posterior view. With fluoroscopy, anatomic structures and landmarks are identified with mechanism at rest. Various strengths of fluoroscopy can be discussed in view of the three case reports described above. Cleft palate patients usually show altered phonetics due to altered anatomy, which was clearly demonstrated in case 1. Fluoroscopy helps us in assessing the problem in articulation of tongue with palate during speech. Fluoroscopy helps us in designing the prosthesis in palatal section to have clarity of palatodental sounds and to simulate to the normal. It also helps us in deciding the thickness of palatal section of the plate. In the past due to the lack of imaging equipment for observing the opening of mandibular movements, exact etiology could not be known. In case 2, fluoroscopy has proved to be a valuable diagnostic aid for assessing the temporo-mandibular joint abnormality. Hypermobility was observed during opening of the temporo-mandibular joint and jerky movements were present on the left side condyle during closing. Fluoroscopy gives us the opportunity to accurately determine the point in the opening cycle when the disc displacement reduces after providing prosthesis to the patient. In case 3, mobility of mandibular complete denture was assessed. In the past, Ardran and coworkers had also used fluoroscopy as a method to investigate the mobility of mandibular complete dentures. They concluded that stability was mainly dependent upon the freedom of the tongue to move within the arch of the denture. Sheppard and Markus  used fluoroscopy to view the presence or the absence of tooth contacts during mastication and found that during the major part of mastication teeth were out of occlusal contact. Sheppard used fluoroscopy to investigate complete denture base movements during mastication.  In our case, mandibular complete denture was found to be stable under interference free conditions. Fluoroscopy also has other applications in complete denture patients; acts as an important jaw tracking device  (pattern of mandibular movements can be evaluated), phonetics alterations can be evaluated and movements during act of swallowing or mastication can be observed. Limitations of fluoroscopy include technical difficulties in the examination that increase the exposure time, limits the information that can be obtained, cause repetitions that produce new and undesirable exposures. Additionally, this imaging method is difficult to apply for the evaluation of children and patients with motor deficits associated with swallowing disorders.
| Summary and Conclusion|| |
Digital fluoroscopy can be a very useful tool for the evaluation of denture mobility in interference free conditions as well as is a valuable diagnostic aid for temporo-mandibular joint disorders and designing of prosthesis for cleft palate patients.
| References|| |
|1.||Soboïeva U, Lauriòa L, Slaidiòa A. Jaw tracking devices--historical review of methods development. Part I. Stomatologija 2005;7:67-71. |
|2.||Wagner LK, Eifel PJ, Geise RA. Potential biological effects following high x-ray dose interventional procedures. J Vasc Interv Radiol 1994;5:71-84. |
|3.||Shafer, Hine, Levi. Shafer's text book of oral pathology, 5 th edition, Elsevier 2006: p. 23. |
|4.||Sheppard IM, Markus N. Total time of tooth contacts during mastication, J Prosthet Dent 1962;12:460-3. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]