GOOD MORNING

INTRA ORAL RADIOGRAPHIC

TECHNIQUES

Presented by
L.Janeswari
II MDS
Oral Medicine and Radiology
CONTENTS
• Introduction
• Periapical Radiography
• Paralleling Technique
• Bisected Angle Technique
• Bitewing Radiography
• Occlusal Radiography
• Localisation techniques
• Full mouth radiography
• Special considerations
• Research studies
• Conclusion
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• References
 INTRODUCTION

First intra oral radiograph

Otto Walkhoff-1986 C. Edmund Kells-1986

Kell’s film holder
Khare P, Nair P, Khare A, Singh V, Chatterjee R. The road to radiation protection: a rocky path. Journal of clinical and diagnostic research: JCDR. 2014
Dec;8(12):ZE01.
The basic principles of projection geometry are :

1. The focal spot (source of radiation) should be as small as possible .

2. The focal spot-object distance should be as long as Possible.

3. The object-film distance should be as small as possible.

4. The long axis of the object and the film planes should be parallel

5. The X-ray beam should strike the object and the film planes at right angles .

6. There should be no movement of the tube, film or patient during exposure.

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Intraoral radiographs can be divided into three categories:

1. Periapical radiographs
a. Paralleling technique
b. Bisecting angle technique

2. Bitewing radiographs

3. Occlusal radiographs
CRITERIA OF QUALITY

Should record
complete area
of interest

should have Should have

least possible optimal density
distortion and contrast

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 GENERAL STEPS FOR MAKING AN
EXPOSURE
1. Prepare unit for exposure

2. Greet and seat the patient

3. Adjust the X-ray unit setting

4. Wash hands thoroughly

5. Examine the oral cavity

6. Position the tube head

7. Position the receptor

8. Adjust the X-ray tube

9. Make the exposure

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 PERIAPICAL RADIOGRAPHY
• Obtains a view of the entire tooth and its surrounding structures.
INDICATIONS

• Apical infection/inflammation.

• periodontal status.

• Trauma.

• presence and position of unerupted teeth.

• Root morphology before extractions.

• During endodontics.

• Preoperative assessment and postoperative appraisal of apical surgery.

• Detailed evaluation of apical cysts and other lesions within the alveolar bone.

• Evaluation of implants postoperatively.

BISECTING ANGLE
TECHNIQUE
BISECTING ANGLE TECHNIQUE
 BEAM ANGULATION
• Vertically the beam should be perpendicular to the long axis of tooth and film.

• Horizontally the beam should be perpendicular to the specific interproximal

space(s).

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Foreshortening Elongation.

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 HORIZONTAL ANGULATION

• The central ray should be perpendicular to the facial surfaces of

the teeth and parallel to the mesial and distal surfaces

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 HOLDING DEVICES
• Various film holding devices may be used to secure the film in
place when using the bisecting technique

• When film holding devices are not available, the finger or

thumb may be used.

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PARALLELING
TECHNIQUE
PARALLELING TECHNIQUE
 RECEPTOR-HOLDING INSTRUMENTS
• A great variety of film holders are commercially available − simple, complex, light, heavy,
reusable, disposable, autoclavable, and non-autoclavable.

• Guiding ring is used to align the x-ray aiming cylinder and ensures that the receptor is
centered in the beam behind the teeth of interest and that the receptor and teeth are
perpendicular to the x-ray beam
XCP with localizing rings Stabe biteblock
 PATIENT POSITIONING:

MAXILLA: MANDIBLE:
MAXILLARY CENTRAL INCISOR
PROJECTION

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MAXILLARY LATERAL INCISOR
PROJECTION

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MAXILLARY CANINE
PROJECTION

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MAXILLARY PREMOLAR
PROJECTION

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MAXILLARY MOLAR
PROJECTION

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MAXILLARY DISTAL OBLIQUE
MOLAR PROJECTION

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MANDIBULAR CENTROLATERAL
PROJECTION

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MANDIBULAR CANINE
PROJECTION

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MANDIBULAR PREMOLAR
PROJECTION

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MANDIBULAR MOLAR
PROJECTION

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MANDIBULAR DISTAL OBLIQUE
MOLAR PROJECTION

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Comparison between bisecting
angle and paralleling technique

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 Short cone technique Long cone technique

Distortion of the image Sharp details of the image will be obtained

Increased chances of elongation Image obtained is of the same ,size and shape as the
or shortening of the image object.

Distorted image of the teeth is due to oblique Image of the teeth nearly anatomically accurate due
exposure and from bending of the film to usage of right angle exposure and flat surface of
the film
Shadows of the alveolar bone tend to fill the Alveolar crest seen in true relationship to the teeth.
interproximal spaces.

More vertical angulation. Less vertical angulation, thus similar buccal and
lingual parts of the teeth appear close to each other in
the radiograph, and more tooth area underneath
restorations is revealed.

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Superimpositon of the shadow of the zygomatic arch Less vertical angulation in the maxillary molar region
on teeth. avoids the superimposition of zygomatic arch.

Easier technique to maneuver and requires less Needs a larger working space
space.

More effective when the palate is shallow. In a similar situation occurs, apices of teeth may be cut
off.

In rare cases when the teeth are longer than film, This is not possible in the long cone technique.
the entire tooth may be seen, by over angulating
the vertical angulation.

Cone cut is a common error especially, in the The PID, helps reduce such errors.
maxillary third molar area.

Curved film due to incorrect finger pressure. Use of film holding device prevents such an error.

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 BITEWING RADIOGRAPHY
• Introduced by Raper in 1925.
• Interproximal radiographs.

Bitewing radiographs are parallel films.

A bitewing tab is utilized to stabilize the film as the patient bites together

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 INDICATIONS
• Interproximal caries.
• Monitoring the progression of dental caries.
• Assessment of existing restorations.
• Assessment of the periodontal status.

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 BITEWING RECEPTORS
HORIZONTAL BITEWING RECEPTORS :
• The XCP bitewing instrument has an external guide ring for positioning the
tube head.
• The guide bar is placed parallel with the direction of the beam that opens the
contacts of the dentition being examined.
VERTICAL BITEWING RECEPTORS :
• Moderate to extensive alveolar bone loss.
• Residual alveolar crests in the maxilla and the mandible will be recorded on
the radiograph.

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 BEAM ANGULATION
VERTICAL ANGULATION:

• Bitewing radiographs are usually exposed with an vertical angulation of

+10
• This angulation provides an acceptable compromise for the differences
between the long axis inclinations of the maxillary and mandibular teeth.

HORIZONTAL ANGULATION:

• Horizontal angulation is aligned with the direction of the contact, and

the central ray is directed between the contacts of the teeth to be
radiographed.

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PREMOLAR BITEWING PROJECTION

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MOLAR BITEWING PROJECTION

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Intraoral Occlusal Radiography

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 OCCLUSAL RADIOGRAPHS
• Supplementary-provide a more extensive view of the maxilla and mandible.

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 INDICATIONS
• Locate roots and supernumerary, unerupted, and impacted teeth.

• Localize foreign bodies.

• Evaluate the integrity of the anterior, medial, and lateral outlines of the maxillary sinus

• Trismus.

• Fractures.

• To determine the medial and lateral extent cysts and tumours.

• Location of objects in 3 dimensions. 45

 ANTERIOR MAXILLARY
OCCLUSAL PROJECTION

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CROSS-SECTIONAL MAXILLARY
OCCLUSAL PROJECTION

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LATERAL MAXILLARY OCCLUSAL
PROJECTION

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MAXILLARY VERTEX OCCLUSAL

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ANTERIOR MANDIBULAR
OCCLUSAL PROJECTION

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CROSS-SECTIONAL MANDIBULAR
OCCLUSAL PROJECTION

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 LATERAL MANDIBULAR
OCCLUSAL PROJECTION

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OBLIQUE MANDIBULAR
OCCLUSAL

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 INTRAORAL LOCALIZATION
TECHNIQUES
• The dental radiograph is a two dimensional picture of a three
dimensional object. It depicts the object in the superior-rinferior and
anterior-posterior relationship.

• These are methods used to locate the position of a tooth or an object

in the jaws.

1. Tube shift technique or clarks rule or buccal object rule

2. Right angle technique

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 INDICATIONS
• Foreign bodies.
• Impacted teeth.
• Unerupted teeth.
• Retained roots.
• Salivary stones.
• Jaw fractures.
• Broken needles and instruments.
• Root positions.
• Filling materials.

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SLOB RULE

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 RIGHT ANGLE TECHNIQUE

Two projections are taken at right angles to each other, which helps to
localize an object in the maxilla or mandible.

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FULL MOUTH SURVEY

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PRIMARY DENTITION (3 TO 6
YEARS)

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MIXED DENTITION (7 TO 12
YEARS)

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DENTULOUS ADULT

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 SPECIAL
CONSIDERATIONS
The radiographic procedures may need to be modified
for patients who have unusual difficulties.

• INFECTION

• TRAUMA

• PATIENTS WITH MENTAL DISABILITIES

• PATIENTS WITH PHYSICAL DISABILITIES

• GAG REFLEX

• PREGNANCY

• EDENTULOUS PATIENTS 63
 EXTRAORAL PERIAPICAL RADIOGRAPHY: AN ALTERNATIVE
APPROACH TO INTRAORAL PERIAPICAL RADIOGRAPHY

• Newman and Friedman recommended a new technique of extraoral film placement.

• This technique was used to obtain the radiographs for the patients with severe gag reflex,
pediatric dental patients, and patients with restricted mouth opening.

• This technique can be recommended as an alternative to conventional intraoral periapical

technique in cases where intraoral film placement is difficult to achieve.

Imaging Sci Dent 2011; 41 :161-5 64

 CONCLUSION
• Intraoral radiographic imaging is a valuable tool for proper patient care providing critical

information for the diagnosis and treatment of dental disease and other oral conditions. To

ensure the production of high-quality diagnostic images, the clinician must attend to the

principles of accurate image projection when acquiring intraoral radiographic images.

• In addition, the clinician must be able to manage the patient effectively during

radiographic procedures and be well-versed in the identification and correction of errors

when they occur. The clinician is also responsible for eliminating unnecessary retakes and

minimizing radiation exposure to the patients under their care.

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 REFERENCES
• Essentials of Dental Radiography and Radiology (4th Edition)
by Eric Whaites

• Oral Radiology: Principles and Interpretation

By Stuart C. White, DDS, PhD and Michael J. Pharoah, DDS

• TEXT BOOK OF ORAL RADIOLOGY : Freny karjodkar

• Principles of Dental Imaging :Langland ,Langlais, Preece 2 nd edition

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• Dental Radiography: Principles and Techniques
by Joen I. Haring, Laura Jansen 3rd edition.

• Khare P, Nair P, Khare A, Singh V, Chatterjee R. The road to

radiation protection: a rocky path. Journal of clinical and
diagnostic research: JCDR. 2014 Dec;8(12):ZE01.

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THANK
YOU
COMPLETELY
EDENTULOUS

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