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Intraoral Radiography Chapter 41 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

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Presentation on theme: "Intraoral Radiography Chapter 41 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved."— Presentation transcript:

1 Intraoral Radiography Chapter 41 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

2 Chapter 41 Lesson 41.1 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

3 Pronounce, define, and spell the Key Terms. Pronounce, define, and spell the Key Terms. Explain the advantages and disadvantages of the paralleling and bisecting techniques. Explain the advantages and disadvantages of the paralleling and bisecting techniques. Name the two primary types of projections used in an intraoral technique and describe the differences. Name the two primary types of projections used in an intraoral technique and describe the differences. Explain the basic principle of the paralleling technique. Explain the basic principle of the paralleling technique. State the five basic rules of the paralleling technique. State the five basic rules of the paralleling technique.(Contd) Learning Objectives Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

4 (Contd) Explain why a film holder is necessary with the paralleling technique. Explain why a film holder is necessary with the paralleling technique. Describe how to prepare a patient for dental x-rays. Describe how to prepare a patient for dental x-rays. Expose a full series of radiographs using the paralleling technique. Expose a full series of radiographs using the paralleling technique. Label and identify the parts of the Rinn XCP (extension-cone paralleling) instruments. Label and identify the parts of the Rinn XCP (extension-cone paralleling) instruments. Learning Objectives Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

5 Introduction It is possible for every dental assistant to successfully produce quality dental radiographs radiographs that are free from distortion, with the correct density and contrast, that can be used in the detection of dental disease. You can create such radiographs by carefully following the proper steps in film placement, exposure, and processing. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

6 Fig Steps to quality radiographs. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

7 Full-Mouth Survey No dental examination is complete without dental radiographs, and in almost all cases the full-mouth survey is the most preferred technique. No dental examination is complete without dental radiographs, and in almost all cases the full-mouth survey is the most preferred technique. An intraoral full-mouth examination (FMX) contains both periapical and bite-wing radiographs. An intraoral full-mouth examination (FMX) contains both periapical and bite-wing radiographs. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

8 The FMX An intraoral FMX is composed of both periapical and bite-wing projections. An intraoral FMX is composed of both periapical and bite-wing projections. This technique requires the use of intraoral film, which is placed inside the mouth and is used to examine the teeth and supporting structures. This technique requires the use of intraoral film, which is placed inside the mouth and is used to examine the teeth and supporting structures. In the average adult, a full-mouth series consists of 18 to 20 films. Generally there are 14 periapicals and 4 to 6 bite-wings, but the number may vary. In the average adult, a full-mouth series consists of 18 to 20 films. Generally there are 14 periapicals and 4 to 6 bite-wings, but the number may vary. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

9 Fig Mounted full-mouth series with eight anterior films, taken with the use of the parallel technique. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

10 The Bite-Wing Radiograph The bite-wing radiograph shows the upper and lower teeth in occlusion. The bite-wing radiograph shows the upper and lower teeth in occlusion. Only the crowns and a small portion of the root of the teeth are seen. Only the crowns and a small portion of the root of the teeth are seen. It is used for to detect interproximal decay, periodontal disease, and recurrent decay under restorations and to assess the fit of metallic fillings or crowns. It is used for to detect interproximal decay, periodontal disease, and recurrent decay under restorations and to assess the fit of metallic fillings or crowns. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

11 Fig Bite-wing radiograph. Note that only the crowns and alveolar ridge, not the roots, are visible. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

12 The Periapical Radiograph The periapical radiograph shows the entire tooth from occlusal surface or incisal edge to 2 to 3 mm beyond the apex to show the periapical bone. The periapical radiograph shows the entire tooth from occlusal surface or incisal edge to 2 to 3 mm beyond the apex to show the periapical bone. The periapical is used to diagnose pathologic conditions of the tooth, root, and bone, as well as tooth formation and eruption. The periapical is used to diagnose pathologic conditions of the tooth, root, and bone, as well as tooth formation and eruption. Periapical views are essential in endodontic and oral surgery procedures. Periapical views are essential in endodontic and oral surgery procedures. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

13 Fig A, Anterior periapical. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

14 Fig B, Posterior periapical. Note that the entire tooth and surrounding bone are visible in the radiograph. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

15 Introduction to Techniques There are two basic techniques for obtaining periapical radiographs: There are two basic techniques for obtaining periapical radiographs: Paralleling Paralleling Bisection of the angle Bisection of the angle The American Academy of Oral and Maxillofacial Radiology and the American Association of Dental Schools recommend the use of the paralleling technique because it provides the most accurate image. The American Academy of Oral and Maxillofacial Radiology and the American Association of Dental Schools recommend the use of the paralleling technique because it provides the most accurate image. In some situations the operator may have to use the bisection technique. In some situations the operator may have to use the bisection technique. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

16 The Paralleling Technique: Basic Rules Film placement: Position the film so that it will cover the teeth. Film placement: Position the film so that it will cover the teeth. Film position: Position the film parallel to the long axis of the tooth. The film in the film holder must be placed away from the teeth and toward the middle of the mouth. Film position: Position the film parallel to the long axis of the tooth. The film in the film holder must be placed away from the teeth and toward the middle of the mouth. Vertical angulation: Direct the central ray of the x-ray beam perpendicular to the film and the long axis of the tooth. Vertical angulation: Direct the central ray of the x-ray beam perpendicular to the film and the long axis of the tooth. Horizontal angulation: Direct the central ray of the x-ray beam through the contact areas between the teeth. Horizontal angulation: Direct the central ray of the x-ray beam through the contact areas between the teeth. Central ray: Center the x-ray beam on the film to ensure that all areas of the film are exposed. Central ray: Center the x-ray beam on the film to ensure that all areas of the film are exposed. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

17 Tips for Film Placement The white side of the film always faces the teeth. The white side of the film always faces the teeth. Anterior films are always placed vertically. Anterior films are always placed vertically. Posterior films are always placed horizontally. Posterior films are always placed horizontally. The identification dot on the film is always placed in the slot of the film holder (dot in the slot). The identification dot on the film is always placed in the slot of the film holder (dot in the slot). Always position the film holder away from the teeth and toward the middle of the mouth. Always position the film holder away from the teeth and toward the middle of the mouth. Always center the film over the areas to be examined. Always center the film over the areas to be examined. Always place the film parallel to the long axis of the teeth. Always place the film parallel to the long axis of the teeth. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

18 Fig Position of the film, teeth, position-indicator device (PID), and central ray of the x-ray beam in the paralleling technique. (From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 3, St Louis, 2006, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

19 Fig The x-rays pass through the contact areas of the premolars because the central ray is directed through the contacts and perpendicular to the film. If the central ray (CR) is not directed through the contacts, overlap of the premolar contacts occurs. (From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 3, St Louis, 2006, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

20 Fig This radiograph demonstrates a cone cut that is, a clear exposed area on the film. (From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 3, St Louis, 2006, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

21 Preparation Before Seating the Patient Prepare the operatory with all infection-control barriers. Prepare the operatory with all infection-control barriers. Determine the number and type of films to be exposed. Determine the number and type of films to be exposed. Label a paper cup with the patient's name and the date. Label a paper cup with the patient's name and the date. This is the transfer cup for storing and moving exposed films. This is the transfer cup for storing and moving exposed films. Turn on the x-ray machine and check the basic settings. Turn on the x-ray machine and check the basic settings. Wash and dry your hands. Wash and dry your hands. Dispense the desired number of films and store them outside the room in which the x-ray machine is being used. Dispense the desired number of films and store them outside the room in which the x-ray machine is being used. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

22 Positioning the Patient Seat the patient comfortably in the dental chair, with the back in an upright position and the head supported. Seat the patient comfortably in the dental chair, with the back in an upright position and the head supported. Ask the patient to remove eyeglasses and bulky earrings. Ask the patient to remove eyeglasses and bulky earrings. Have the patient take any removable prosthetic appliances out of his or her mouth. Have the patient take any removable prosthetic appliances out of his or her mouth. Position the patient with the occlusal plane of the jaw being radiographed parallel to the floor when the mouth is in the open position. Position the patient with the occlusal plane of the jaw being radiographed parallel to the floor when the mouth is in the open position. Drape the patient with a lead apron and thyroid collar. Drape the patient with a lead apron and thyroid collar. Wash and dry your hands and put on clean examination gloves. Wash and dry your hands and put on clean examination gloves. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

23 The Exposure Sequence When exposing radiographs, establish an exposure sequence, or definite order, for periapical film placement. When exposing radiographs, establish an exposure sequence, or definite order, for periapical film placement. Without an exposure sequence, there is a good chance that you will omit an area or expose the same area twice. Without an exposure sequence, there is a good chance that you will omit an area or expose the same area twice. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

24 The Anterior Exposure Sequence When exposing periapical films with the paralleling technique, always start with the anterior teeth (canines and incisors), because: When exposing periapical films with the paralleling technique, always start with the anterior teeth (canines and incisors), because: The size 1 film used for anteriors is small, less uncomfortable, and easier for the patient to tolerate. The size 1 film used for anteriors is small, less uncomfortable, and easier for the patient to tolerate. It is easier for the patient to become accustomed to the anterior film holder. It is easier for the patient to become accustomed to the anterior film holder. The anterior film placements are less likely to cause the patient to gag. The anterior film placements are less likely to cause the patient to gag.(Contd) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

25 The Anterior Exposure Sequence (Contd) Begin with the maxillary right canine (tooth 6). Begin with the maxillary right canine (tooth 6). Expose all of the maxillary anterior teeth from right to left. Expose all of the maxillary anterior teeth from right to left. End with the maxillary left canine (tooth 11). End with the maxillary left canine (tooth 11). Next, move to the mandibular arch. Next, move to the mandibular arch. Begin with the mandibular left canine (tooth 22). Begin with the mandibular left canine (tooth 22). Expose all of the mandibular anterior teeth from left to right. Expose all of the mandibular anterior teeth from left to right. Finish with the mandibular right canine (tooth 27). Finish with the mandibular right canine (tooth 27). Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

26 The Maxillary Canine Region Insert the number 1 film packet vertically into the anterior bite-block. Insert the number 1 film packet vertically into the anterior bite-block. Position the film packet with the canine and first premolar centered. Position the film as far to the posterior as possible. Position the film packet with the canine and first premolar centered. Position the film as far to the posterior as possible. With the film-holding instrument and film in place, instruct the patient to close his or her mouth slowly but firmly. With the film-holding instrument and film in place, instruct the patient to close his or her mouth slowly but firmly. Position the localizing ring and PID, then expose the film. Position the localizing ring and PID, then expose the film. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

27 Maxillary Central/Lateral Incisor Region Insert the number 1 film packet vertically into the anterior bite-block. Insert the number 1 film packet vertically into the anterior bite-block. Center the film packet between the central and lateral incisors and position the film as far to the posterior as possible. Center the film packet between the central and lateral incisors and position the film as far to the posterior as possible. With the film-holding instrument and film in place, instruct the patient to close his or mouth slowly but firmly. With the film-holding instrument and film in place, instruct the patient to close his or mouth slowly but firmly. Position the localizing ring and PID, then expose the film. Position the localizing ring and PID, then expose the film. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

28 The Mandibular Canine Region The Mandibular Canine Region Insert the number 1 film packet vertically into the anterior bite-block. Insert the number 1 film packet vertically into the anterior bite-block. Center the film on the canine. Position the film as far in the lingual direction as the patients anatomy will allow. Center the film on the canine. Position the film as far in the lingual direction as the patients anatomy will allow. A cotton roll may be placed between the maxillary teeth and bite-block to prevent rocking of the bite-block on the canine tip and to increase patient comfort. A cotton roll may be placed between the maxillary teeth and bite-block to prevent rocking of the bite-block on the canine tip and to increase patient comfort. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

29 The Mandibular Canine Region Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

30 The Mandibular Incisor Region The Mandibular Incisor Region Insert the number 1 film packet vertically into the anterior bite-block. Insert the number 1 film packet vertically into the anterior bite-block. Center the film packet between the central and lateral incisors and position the film as far in the lingual direction as the patient's anatomy will allow. Center the film packet between the central and lateral incisors and position the film as far in the lingual direction as the patient's anatomy will allow. With the instrument and film in place, instruct the patient to close his or her mouth slowly but firmly. With the instrument and film in place, instruct the patient to close his or her mouth slowly but firmly. Position the localizing ring and PID, then expose the film. Position the localizing ring and PID, then expose the film. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

31 Mandibular Incisor Region Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

32 The Posterior Exposure Sequence After completing the anterior teeth, begin the posterior teeth. After completing the anterior teeth, begin the posterior teeth. Always expose the premolar film before the molar film because: Always expose the premolar film before the molar film because: Premolar film placement is easier for the patient to tolerate than molar film placement. Premolar film placement is easier for the patient to tolerate than molar film placement. Premolar exposure is less likely to evoke the gag reflex. Premolar exposure is less likely to evoke the gag reflex. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

33 The Maxillary Premolar Region Insert the film packet horizontally into the posterior bite-block, pushing the film packet all the way into the slot. Insert the film packet horizontally into the posterior bite-block, pushing the film packet all the way into the slot. Center the film packet on the second premolar. Position the film in the midpalate area. Center the film packet on the second premolar. Position the film in the midpalate area. With the instrument and film in place, instruct the patient to close his or her mouth slowly but firmly. With the instrument and film in place, instruct the patient to close his or her mouth slowly but firmly. Position the localizing ring and PID, then expose the film. Position the localizing ring and PID, then expose the film. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

34 The Maxillary Premolar Region Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

35 The Maxillary Molar Region Insert the film packet horizontally into the posterior bite-block. Insert the film packet horizontally into the posterior bite-block. Center the film packet on the second molar. Position the film in the midpalate area. Center the film packet on the second molar. Position the film in the midpalate area. With the instrument and film in place, instruct the patient to close his or her mouth slowly but firmly. With the instrument and film in place, instruct the patient to close his or her mouth slowly but firmly. Position the localizing ring and PID, then expose the radiograph. Position the localizing ring and PID, then expose the radiograph. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

36 The Maxillary Molar Region Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

37 The Mandibular Premolar Region Insert the number 2 film horizontally into the posterior bite-block. Insert the number 2 film horizontally into the posterior bite-block. Center the film on the contact point between the second premolar and first molar. Position the film as far in the lingual direction as the patient's anatomy will allow. Center the film on the contact point between the second premolar and first molar. Position the film as far in the lingual direction as the patient's anatomy will allow. With the instrument and film in place, instruct the patient to close his or her mouth slowly but firmly. With the instrument and film in place, instruct the patient to close his or her mouth slowly but firmly. Slide the localizing ring down the indicator rod to the patient's skin. Slide the localizing ring down the indicator rod to the patient's skin. Position the localizing ring and PID, then expose the film. Position the localizing ring and PID, then expose the film. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

38 The Mandibular Premolar Region Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

39 The Mandibular Molar Region Insert the number 2 film horizontally into the posterior bite-block. Insert the number 2 film horizontally into the posterior bite-block. Center the film on the second molar. Position the film as far in the lingual direction as the tongue will allow. This position will be closer to the teeth than that for the premolar and anterior views. Center the film on the second molar. Position the film as far in the lingual direction as the tongue will allow. This position will be closer to the teeth than that for the premolar and anterior views. With the instrument and film in place, instruct the patient to close his or her mouth slowly but firmly. With the instrument and film in place, instruct the patient to close his or her mouth slowly but firmly. Position the localizing ring and PID, then expose the film. Position the localizing ring and PID, then expose the film. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

40 The Mandibular Molar Region Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

41 Chapter 41 Lesson 41.2 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

42 Explain the procedural principles of the bisecting technique. Explain the procedural principles of the bisecting technique. Identify the types of film holders that can be used with the bisecting technique. Identify the types of film holders that can be used with the bisecting technique. Describe the appearance of opened and overlapped contact areas on a dental radiograph. Describe the appearance of opened and overlapped contact areas on a dental radiograph. Describe the correct vertical angulation. Describe the correct vertical angulation.(Contd) Learning Objectives Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

43 (Contd) Describe incorrect vertical angulation. Describe incorrect vertical angulation. Identify the film size used in the bisecting technique. Identify the film size used in the bisecting technique. Expose a full series of radiographs using the bisecting angle technique. Expose a full series of radiographs using the bisecting angle technique. Learning Objectives Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

44 The Bisecting Technique The bisection of the angle technique is based on a geometric principle of bisecting a triangle (bisecting means dividing into two equal parts). The bisection of the angle technique is based on a geometric principle of bisecting a triangle (bisecting means dividing into two equal parts). The angle formed by the long axis of the teeth and the film is bisected, and the x-ray beam is directed perpendicular to the bisecting line. The angle formed by the long axis of the teeth and the film is bisected, and the x-ray beam is directed perpendicular to the bisecting line. Perpendicular means at a right angle to the film. Perpendicular means at a right angle to the film. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

45 Fig A, A diagram of an anterior tooth with the central ray perpendicular to the imaginary bisector of the angle between the long axis of the tooth and the film plane. B, A posterior tooth using the bisecting-angle concept. (From Miles D, et al: Radiographic imaging for dental auxiliaries, ed 3, Philadelphia, 1999, Saunders.) A B Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

46 Film Holders Although you may see operators asking patients to hold the film with their fingers to stabilize the film in the mouth, it is not recommended. This practice exposes the patients hand and finger to unnecessary radiation. Although you may see operators asking patients to hold the film with their fingers to stabilize the film in the mouth, it is not recommended. This practice exposes the patients hand and finger to unnecessary radiation. The following are types of commercial film holders that are available: The following are types of commercial film holders that are available: Rinn BAI Rinn BAI Rinn Eezee-Grip Film Holder (Snap-A-Ray) Rinn Eezee-Grip Film Holder (Snap-A-Ray) Rinn Stabe Bite-Block Rinn Stabe Bite-Block Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

47 PID Angulations: Bisecting Technique In the bisecting technique, the angulation of the PID is critical. In the bisecting technique, the angulation of the PID is critical. Angulation is a term used to describe the alignment of the central ray of the x-ray beam in the horizontal and vertical planes. Angulation is a term used to describe the alignment of the central ray of the x-ray beam in the horizontal and vertical planes. Angulation can be changed by moving the PID in either a horizontal or vertical direction. Angulation can be changed by moving the PID in either a horizontal or vertical direction. BAIs with aiming rings dictate the proper PID angulation. BAIs with aiming rings dictate the proper PID angulation. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

48 Horizontal Angulation Horizontal angulation refers to the positioning of the tubehead and direction of the central ray in a horizontal, or side-to-side, plane. Horizontal angulation refers to the positioning of the tubehead and direction of the central ray in a horizontal, or side-to-side, plane. The horizontal angulation remains the same whether you are using the paralleling or bisecting technique. The horizontal angulation remains the same whether you are using the paralleling or bisecting technique. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

49 Fig The arrows indicate movement in a horizontal direction. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

50 Correct Horizontal Angulation With correct horizontal angulation, the central ray is directed perpendicular to the curvature of the arch and through the contact areas of the teeth. With correct horizontal angulation, the central ray is directed perpendicular to the curvature of the arch and through the contact areas of the teeth. Incorrect horizontal angulation results in overlapped (unopened) contact areas. Incorrect horizontal angulation results in overlapped (unopened) contact areas. A film with overlapped contact areas cannot be used to examine the interproximal areas of the teeth. A film with overlapped contact areas cannot be used to examine the interproximal areas of the teeth. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

51 Fig Correct horizontal angulation. (From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 3, St Louis, 2006, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

52 Fig Incorrect horizontal angulation. (From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 3, St Louis, 2006, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

53 Fig Overlapped contact areas. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

54 Vertical Angulation Vertical angulation refers to the positioning of the PID in a vertical, or up-and-down, plane. Vertical angulation refers to the positioning of the PID in a vertical, or up-and-down, plane. The vertical angulation differs depending on the radiographic technique being used: The vertical angulation differs depending on the radiographic technique being used: With the paralleling technique, the vertical angulation of the central ray is directed perpendicular to the film and the long axis of the tooth. With the paralleling technique, the vertical angulation of the central ray is directed perpendicular to the film and the long axis of the tooth. With the bisecting technique, the vertical angulation is determined by the imaginary bisector; the central ray is directed perpendicular to the imaginary bisector. With the bisecting technique, the vertical angulation is determined by the imaginary bisector; the central ray is directed perpendicular to the imaginary bisector. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

55 Fig Vertical angulation of the PID refers to PID placement in an up-and-down (head-to-toe) direction. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

56 Correct Vertical Angulation Correct vertical angulation results in a radiographic image that is the same length as the tooth. Correct vertical angulation results in a radiographic image that is the same length as the tooth. Incorrect vertical angulation results in an image that is not the same length as the tooth being radiographed. Incorrect vertical angulation results in an image that is not the same length as the tooth being radiographed. The image appears longer or shorter: The image appears longer or shorter: Elongated Elongated Foreshortened Foreshortened Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

57 Fig A, If the vertical angulation is to too steep, the image on the film is shorter than the actual tooth. B, Foreshortened images. (From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 3, St Louis, 2006, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

58 Fig A, If the vertical angulation is to too flat, the image on the film is longer than the actual tooth. B, Elongated images. (From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 3, St Louis, 2006, Saunders.) A B Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

59 Film Size and Placement In the bisection technique, the film is placed close to the crowns of the teeth to be radiographed and extends at an angle into the palate or floor of the mouth. In the bisection technique, the film is placed close to the crowns of the teeth to be radiographed and extends at an angle into the palate or floor of the mouth. The film packet should extend beyond the incisal or occlusal aspect of the teeth by about 1/8 to 1/4 inch. The film packet should extend beyond the incisal or occlusal aspect of the teeth by about 1/8 to 1/4 inch. Film holders for the bisection of the angle technique, including some with alignment indicators, are available commercially. Film holders for the bisection of the angle technique, including some with alignment indicators, are available commercially. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

60 Beam Alignment The x-ray beam is directed to pass between the contacts of the teeth being radiographed in the horizontal dimension, just as it does in the paralleling technique. The x-ray beam is directed to pass between the contacts of the teeth being radiographed in the horizontal dimension, just as it does in the paralleling technique. The vertical angle, however, must be directed at a 90-degree angle to the imaginary bisecting line. The vertical angle, however, must be directed at a 90-degree angle to the imaginary bisecting line. Too much vertical angulation will produce images that are foreshortened. Too much vertical angulation will produce images that are foreshortened. Too little vertical angulation will result in images that are elongated. Too little vertical angulation will result in images that are elongated. The beam must be centered to help prevent cone cutting. The beam must be centered to help prevent cone cutting. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

61 Maxillary Canine Exposure Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

62 Maxillary Incisor Exposure Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

63 Mandibular Canine Exposure Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

64 Mandibular Incisor Exposure Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

65 Maxillary Premolar Exposure Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

66 Maxillary Molar Exposure (Patient photo from Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 3, St Louis, 2006, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

67 Mandibular Premolar Exposure (Patient photo from Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 3, St Louis, 2006, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

68 Mandibular Molar Exposure (Patient photo from Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 3, St Louis, 2006, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

69 Chapter 41 Lesson 41.3 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

70 Explain the basic rules for the bite-wing technique. Explain the basic rules for the bite-wing technique. Explain the recommended vertical angulation for all bite-wing exposures. Explain the recommended vertical angulation for all bite-wing exposures. Expose and mount a series of bite-wing radiographs. Expose and mount a series of bite-wing radiographs. Explain the technique for exposing occlusal radiographs. Explain the technique for exposing occlusal radiographs.(Contd) Learning Objectives Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

71 (Contd) (Contd) Expose a maxillary and mandibular occlusal radiograph. Expose a maxillary and mandibular occlusal radiograph. Describe techniques for managing patients with physical and mental disabilities. Describe techniques for managing patients with physical and mental disabilities. Describe techniques for managing the patient with a hypersensitive gag reflex. Describe techniques for managing the patient with a hypersensitive gag reflex. Mount and label a full series of dental radiographs. Mount and label a full series of dental radiographs. Learning Objectives Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

72 Bite-Wing Examinations Bite-Wing Examinations A bite-wing radiograph shows the crowns and interproximal areas of the maxillary and mandibular teeth and the areas of crestal bone on one film. A bite-wing radiograph shows the crowns and interproximal areas of the maxillary and mandibular teeth and the areas of crestal bone on one film. Bite-wing radiographs are used to detect interproximal caries (tooth decay) and are particularly useful in detecting early carious lesions that are not clinically evident. Bite-wing radiographs are used to detect interproximal caries (tooth decay) and are particularly useful in detecting early carious lesions that are not clinically evident. Bite-wing radiographs are also useful in examining the crestal bone levels between the teeth. Bite-wing radiographs are also useful in examining the crestal bone levels between the teeth. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

73 Basic Principles of the Bite-Wing Technique The film is placed in the mouth parallel to the crowns of both the upper and lower teeth. The film is placed in the mouth parallel to the crowns of both the upper and lower teeth. The film is stabilized when the patient bites on the bite-wing tab or bite-wing film holder. The film is stabilized when the patient bites on the bite-wing tab or bite-wing film holder. The central ray of the x-ray beam is directed through the contacts of the teeth, using a +10-degree vertical angulation. The central ray of the x-ray beam is directed through the contacts of the teeth, using a +10-degree vertical angulation. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

74 Fig Vertical angulation of +10 degrees is used to compensate for the slight bend of the upper portion of the film and the tilt of the maxillary teeth. (From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 3, St Louis, 2006, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

75 Fig Bite-wing tab and film holder. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

76 Bite-Wing Film Placement The film is positioned (with either a bite tab or a film-holding device) parallel to the crowns of both upper and lower teeth, and the central ray is directed perpendicular to the film. The film is positioned (with either a bite tab or a film-holding device) parallel to the crowns of both upper and lower teeth, and the central ray is directed perpendicular to the film. The premolar bite-wing radiograph should include the distal half of the crowns of the canines, both premolars, and often the first molars on both the maxillary and mandibular arches. The premolar bite-wing radiograph should include the distal half of the crowns of the canines, both premolars, and often the first molars on both the maxillary and mandibular arches. The molar bite-wing should be centered over the second molars. The molar bite-wing should be centered over the second molars. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

77 Premolar bite-wing. A, Film placement. B, Resultant radiograph. A B Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

78 Molar bite-wing. A, Film placement. B, Resultant radiograph. A B Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

79 The Occlusal Technique The occlusal technique is used to examine large areas of the upper or lower jaw. The occlusal technique is used to examine large areas of the upper or lower jaw. In the occlusal technique, size 4 intraoral film is used. The film is so named because the patient bites, or occludes, on the entire film. In the occlusal technique, size 4 intraoral film is used. The film is so named because the patient bites, or occludes, on the entire film. In adults, size 4 film is used in the occlusal examination. In adults, size 4 film is used in the occlusal examination. In children, size 2 film can be used. In children, size 2 film can be used. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

80 Basic Principles of the Occlusal Technique The film is positioned with the white side facing the arch exposed. The film is positioned with the white side facing the arch exposed. The film is placed in the mouth between the occlusal surfaces of the maxillary and mandibular teeth. The film is placed in the mouth between the occlusal surfaces of the maxillary and mandibular teeth. The film is stabilized when the patient gently bites on the surface of the film. The film is stabilized when the patient gently bites on the surface of the film. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

81 A, The central ray (CR) is directed at an angle of +65 degrees to the plane of the film. B, Relationship of film and PID. A B +65° Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

82 Patients with Special Needs Radiographic examination techniques must often be modified to accommodate patients with special needs. Radiographic examination techniques must often be modified to accommodate patients with special needs. The dental radiographer must be competent in altering radiographic technique to meet the specific diagnostic need of the individual patient. The dental radiographer must be competent in altering radiographic technique to meet the specific diagnostic need of the individual patient. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

83 Physical Disabilities Physical Disabilities A person with a physical disability may have problems with vision, hearing, or mobility. A person with a physical disability may have problems with vision, hearing, or mobility. You must make every effort to meet the individual needs of such patients. You must make every effort to meet the individual needs of such patients. In many cases, a family member or caretaker accompanies the person with a physical disability to the dental office. In many cases, a family member or caretaker accompanies the person with a physical disability to the dental office. You can ask the caretaker to assist you in communicating with regard to the physical needs of the patient. You can ask the caretaker to assist you in communicating with regard to the physical needs of the patient. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

84 Fig Wheelchair-bound patient having x-rays taken. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

85 Patients with Special Dental Needs Reasons for radiographs in the edentulous patient: Reasons for radiographs in the edentulous patient: To detect the presence of root tips, impacted teeth, and lesions (cysts, tumors). To detect the presence of root tips, impacted teeth, and lesions (cysts, tumors). To identify objects embedded in bone. To identify objects embedded in bone. To observe the quantity and quality of bone that is present. To observe the quantity and quality of bone that is present. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

86 Exposure Techniques for the Edentulous Patient The radiographic examination of an edentulous patient may include a panoramic radiograph, periapical radiographs, or a combination of occlusal and periapical radiographs. The radiographic examination of an edentulous patient may include a panoramic radiograph, periapical radiographs, or a combination of occlusal and periapical radiographs. Radiographic images must be made in all teeth- bearing areas of the mouth, whether or not teeth are present. Radiographic images must be made in all teeth- bearing areas of the mouth, whether or not teeth are present. In edentulous patients, either bisection of the angle or the paralleling technique may be used. In edentulous patients, either bisection of the angle or the paralleling technique may be used. Because there are no teeth present, the distortion inherent in the bisecting technique does not interfere with the diagnostic intrabony conditions. Because there are no teeth present, the distortion inherent in the bisecting technique does not interfere with the diagnostic intrabony conditions. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

87 Fig Mixed occlusal-periapical edentulous survey. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

88 Radiographs in the Pediatric Patient In children, radiographs are useful in detecting conditions of the teeth and bones, in showing changes related to caries and trauma, and in evaluating growth and development. In children, radiographs are useful in detecting conditions of the teeth and bones, in showing changes related to caries and trauma, and in evaluating growth and development. Explain the radiographic procedures you are about to perform in terms that the child can easily understand. For example, you can refer to the tubehead as a camera, the lead apron as a coat, and the radiograph as a picture. Explain the radiographic procedures you are about to perform in terms that the child can easily understand. For example, you can refer to the tubehead as a camera, the lead apron as a coat, and the radiograph as a picture. Exposure factors (milliamperage, kilovoltage, time) must be reduced because of the smaller size of the pediatric patient. Exposure factors (milliamperage, kilovoltage, time) must be reduced because of the smaller size of the pediatric patient. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

89 Fig XCP instruments can also be used for the pediatric patient, but the exposure time is reduced. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

90 Radiographs for the Endodontic Patient It often is difficult to obtain accurate radiographs during endodontic (root canal) treatment because of the rubber dam clamp, endodontic instruments, or filling material extending from the tooth. It often is difficult to obtain accurate radiographs during endodontic (root canal) treatment because of the rubber dam clamp, endodontic instruments, or filling material extending from the tooth. The Endoray II film holder can be used to aid in positioning the film during this portion of the root canal procedure. The Endoray II film holder can be used to aid in positioning the film during this portion of the root canal procedure. This holder fits around a rubber dam clamp and allows space for endodontic instruments and filling materials to protrude from the tooth. This holder fits around a rubber dam clamp and allows space for endodontic instruments and filling materials to protrude from the tooth. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

91 Fig Endoray II film holder. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

92 The Patient Who Gags To help prevent the gag reflex, you must convey a confident attitude. To help prevent the gag reflex, you must convey a confident attitude. In a patient with a hypersensitive gag reflex, you should expose the maxillary molars last. In a patient with a hypersensitive gag reflex, you should expose the maxillary molars last. When you place films in the maxillary posterior, do not slide them along the palate. When you place films in the maxillary posterior, do not slide them along the palate. There may be times when you will encounter a patient with an uncontrollable gag reflex. There may be times when you will encounter a patient with an uncontrollable gag reflex. When this occurs, you must use extraoral radiographs such as panoramic or lateral jaw radiographs. When this occurs, you must use extraoral radiographs such as panoramic or lateral jaw radiographs. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

93 Normal Anatomic Landmarks To correctly mount dental radiographs, the dental assistant must be able to recognize the normal anatomic landmarks on intraoral radiographs. To correctly mount dental radiographs, the dental assistant must be able to recognize the normal anatomic landmarks on intraoral radiographs. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

94 Maxillary Anterior Landmarks Median palatine suture Median palatine suture Incisive foramen Incisive foramen Anterior nasal spine Anterior nasal spine Nasal septum Nasal septum Nasal fossa Nasal fossa Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

95 Landmarks of the Mandible Genial tubercles Genial tubercles Lingual foramen Lingual foramen Nutrient canals Nutrient canals Mandibular canal Mandibular canal Coronoid process Coronoid process Mylohyoid ridge Mylohyoid ridge External oblique ridge External oblique ridge Mental ridge Mental ridge Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

96 Tips for Mounting Radiographs Handle films only by the edges. Handle films only by the edges. Label and date the film mount before mounting the films. Label and date the film mount before mounting the films. Include the patients full name and date of exposure and the dentists name. Include the patients full name and date of exposure and the dentists name. Work with clean, dry hands. Work with clean, dry hands. Use a definite order for mounting films. Use a definite order for mounting films. Use the smile line to mount bite-wing radiographs. Use the smile line to mount bite-wing radiographs. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.


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