"New Normal" Radiology

Abstract

COVID-19, the most recent and globally impactful zoonotic viral pandemic in the last 20 years, has now entered its third year. As the global dental profession returns to providing as full a range of services as possible, in addition to embedding the new infection-control processes that were developed for this pandemic, it should also take full advantage of digital conventional radiology (intraoral, extraoral, and panoramic radiography) and cone-beam computed tomography. Regardless of vaccinations, new or yet-to-manifest variants, and testing, some dentists may be working in communities where the asymptomatic but potentially infectious patient poses a real risk. This needs to be met with not only the whole COVID-19 panoply the dentist is already too familiar with but also the need to minimise aerosol generation production by dental radiography. A flowchart and a table that compares the attributes of the above modalities are included.

Keywords: COVID-19; Cone-beam computed tomography; Radiography; Radiology.

Fig. 1

Flowchart identifying the imaging modalities that may be available in dental offices and their application in patients presenting with a clinically indicated need for radiography and their COVID-19 status. CBCT, cone-beam computed tomography; FOV, field of view; PPE, personal protective equipment. This figure is a development of Figure 1 in MacDonald et al.

Fig. 2

Extraoral bitewing of a child. It, unlike the dental panoramic radiograph, is posteriorly focussed and proximally optimised for interproximal surfaces of posterior teeth. It is therefore better than dental panoramic radiography for identifying caries.

Fig. 3

a, A periapical radiographic display of a previously endodontically treated left maxillary molar. The recurrence of the infection is due to a second mesiobuccal root canal, which was previously missed. b, c, and d represent the 4-cm diameter field-of-view cone-beam computed tomography of this molar. The radiolucency encompasses the mesiobuccal root from apex to the alveolar crest. The cause is a missed second mesiobuccal canal as is clear in b, where only one canal has been filled. The relationship of the lesion with the adjacent anatomy, the floor of the maxillary sinus, is also displayed.

Fig. 4

A medium-sized field of view (cone-beam computed tomography [CBCT] of a neoplasm affecting the anterior sextant of the maxilla extending backwards into the posterior sextant and the anterior wall of the left maxillary sinus. (a) represents the multiplanar reconstruction (MPR), whereas (b) represents the “curved” or “panoramic” or formerly the Dentoscan reconstruction. Each reconstruction displays different aspects of the lesion. The MPR is the default reconstruction for most CBCT software, whereas the “curved” reconstruction is manually generated by first plotting out the alveolar arch on the axial reconstruction from which the panoramic and transaxial reconstruction are generated. The lesion is an odontogenic keratocyst, also known as a keratocytocystic odontogenic tumour. See MacDonald D. Oral and maxillofacial radiology: a diagnostic approach. 2nd Edn. British Columbia: Wiley-Blackwell. 2020.