RD 3.

1 Radiografi plak arteri karotis

• Carotid artery calcification is a cardiovascular disease, which usually occurs in patients
who have risk factors such as smoking, hypertension and periodontitis.
• Dentists in interpreting the panoramic images are experted to analyze the area around the
C3 and C4 to identify if there is calcification of the carotid artery, so that patients can be
referred to a specialist

Pengenalan
• Panoramic radiography is often used as an additional examination by a dentist, to help
establish the diagnosis.
• Sometimes abnormalities are found not only in the upper jaw and lower jaw, but can also
be found in the bone sorrounding the cervical region between 3 and 4 of carotid artery
plaque. (Color Dppler)

Radiografi panoramik konvensional sering digunakan oleh dokter gigi dalam menegakkan
diagnosa (White and Pharoah 2005). Salah satu kasus yang sering membutuhkan radiografi
panoramik adalah periodontitis (ada radang pada jaringan penyangga gigi)

• Penyakit Periodontal merupakan keadaan kronis yang mempengaruhi jaringan penyangga

gigi yang disebabkan bakteri plak gigi
• Diduga ada hub antara Plak arteri karotis dengan periodontitis kronis (Yoon et al 2008)

• Penyakit periodontitis ini dimulai dengan adanya inflamasi pada jaringan lunak
• Perkembangan selanjutnya menyebabkan kerusakan pada jaringan ikat dan tulang
alveolar (Eric Whaites, 2007)

Gingivitis > Periodontitis kronis (Kerusakan tulang) > radiografi

Penyakit sistemik lainnya yang dapat menyebabkan kerusakan tulang alveolar adalah Diabetes
Mellitus. Pada Diabetes Mellitus terjadi juga kehilangan tinggi tulang alveolar yang mana sulit
kita tentukan apabila mengakkan diagnosa hanya radiografi

Pemeriksaan yang menyeluruh diperlukan terutama dalam menegakkan diagnosa penyakit

sistemik yang mempunyai manifestasi di rongga mulut

Radiografi panoramik konvensional > Perubahan densitas radiografik dibaca dalam grading,
langsung dari gambar radiografik (Iskandar, 2002; Iannuci, 2006; White and Pharoah, 2009).
DDPR > Perubahan densitas radiografik ditampilkan dalam histogram dengan rentang hitam-
putihgray scale, berkisar antara 0 – 256 (Iannuci, 2006)
Anatomi normal arteri karotis

• Carotid artery is part of the blood circulation system contained in the two ;the left carotid
artery and the right carotid artery.
• Carotid artery serves to channel blood from the aorta to the face and brain.

Disturbances in the carotid arteries can cause disruption of blood supply to the brain can cause
strokes

Faktor risiko
Can not be controlled: Age, Genetic, Gender
Can be controlled: Hyperlipidemia, Hypertension, Smoking, Diabetes, Obesity

Kalsifikasi arteri karotis pada gambaran panoramik

• Normal anatomy with pathologic picture in panoramic radiography must be distinct for
support in making the diagnosis
• The location of the carotid artery calcification in soft tissue in the neck, 1.5 to 2.5 cm
inferior and posterior to the mandibular angle
• Carotid artery calcification may also appear as nodular radiopaque mass or vertical lines
inferior or posterior to the mandibula angle (C3 – C4)
Diagnosis banding
• Epiglotis and tiroid cartilage
• Triceal cartilage
• Calcification of nodes limfe

• Keterangan:
• 1. Coronoid Process
• 2. Sigmoid Notch
• 3. Mandibular Condyle
• 4. Condylar Neck
• 5.Mandibular Ramus
• 6. Angle of Mandible
• 7. Inferior Border of Mandible
• 8. Lingula
 • 9. Mandibular Canal
• 10. Mastoid Process
• 11. External Auditory Meatus
• 12. Glenoid Fossa
• 13. Articular Eminence
• 14. Zygomatic Arch
• 15. Pterygoid Plates
• 16. Pterygomaxillary Fissure
• 17. Orbit
• 18. Inferior Orbital Rim
• 19. Infraorbital Canal
• 20. Nasal Septum
• 21. Inferior Turbinate
• 22. Medial Wall of Max. Sinus
• 23. Inferior Border of Max. Sinus
• 24. Posterolateral Wall of Max. Sinus
• 25. Malar Process
• 26. Hyoid Bone
• 27. Cervical Vertebrae 1- 4
• 28. Epiglottis
• 29. Soft Tissues of Neck (Look Vertically For Carotid Artery Calcifications Here)
• 30. Auricle
• 31. Styloid Process
• 32. Oropharyngeal Air Space
• 33. Nasal Air Space
• 34. Mental Foramen
• 35. Hard Palate

Kesimpulan
Periodontitis dapat dideketeksi melalui radiografi. Perlu hati – hati dalam membaca hasil
radiografi konvensional ataupun DDPR. Ada area yang perlu menjadi perhatian. Berbagai
penyakit sistemik mempunyai manifestasi di rongga mulut

• Color Doppler imaging is that using the principle of ultrasonic waves

• Ultrasonography is describing the structure in the body by recording by reflections
(echoes) with pulses of ultrasonic waves directed into tissues
• Some experts do not indicate the use panoramic images to detect carotid artery
calcification for diagnosis with panoramic images have a low level of sensitivity (31.1%)

• Carotid artery calcification can be detected accidentially by a dentist

• Panoramic images in tha form radiopaque near level C3-C4 (1.5 – 2.5 inferior and
posterior to the mandibular angle