1. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson The Occlusal Examination Chapter 17

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Objectives Define the key words. State the purpose of the occlusal examination. List the indications for occlusal radiographs. Match the topographical and cross-sectional techniques with the condition to be imaged.

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Objectives Compare the patient head positions for the topographical and the cross-sectional techniques. Demonstrate the steps for the maxillary and mandibular topographical surveys. Demonstrate the steps for the mandibular cross-sectional survey.

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Introduction The purpose of the occlusal examination is to view large areas of the maxilla (upper jaw) or the mandible (lower jaw) on one radiograph. The image receptor is placed in the mouth between the occlusal surfaces of the maxillary and mandibular teeth. The patient occludes lightly on the image receptor to stabilize it.

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Types of Occlusal Examinations Topographical technique Cross-sectional technique

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 17-1 A comparison of topographical and cross-sectional occlusal radiographs. (A) The topographical occlusal radiograph of the anterior mandible closely resembles a periapical radiograph. Note how the large occlusal film images a larger portion of the region. (B) The cross-sectional occlusal radiograph of the mandibular anterior region reveals more information about the sublingual area (under the tongue) and conditions of the soft tissue than about the teeth and the supporting structures.

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Fundamentals of Occlusal Radiographs Locate supernumerary, unerupted, or impacted teeth. Locate retained roots of extracted teeth. Detect the presence, locate, and evaluate the extent of disease and lesions. Locate foreign bodies in the jaws.

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Fundamentals of Occlusal Radiographs Reveal the presence of salivary stones in the ducts of the sublingual and submandibular glands. Aid in evaluating fractures of the maxilla or mandible. Show the size and shape of mandibular tori

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Fundamentals of Occlusal Radiographs Aid in examining patients with trismus who can open their mouths only a few millimeters. Evaluate the borders of the maxillary sinus. Examine cleft palate patients.

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Fundamentals of Occlusal Radiographs Substitute for a periapical examination on young children who may not be able to tolerate periapical image receptor placement. Image receptor requirements Orientation of the image receptor Patient positioning Exposure factors

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 17-2 Patient positioning for mandibular crosssectional occlusal radiographs. Patient reclined in the chair so that the head is tipped back, positioning the occlusal plane perpendicular to the plane of the floor. The central rays of the x-ray beam are directed toward the image receptor perpendicularly.

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson TABLE 17-1 Recommended Vertical Angulation Settings for Occlusal Radiographs

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 17-3 Angulation theory of topographical occlusal radiographs. The image receptor placement for occlusal radiographs is not parallel to the long axes of the teeth being imaged. Based on the bisecting technique, vertical angulation for (A) maxillary and(B) mandibular topographical radiographs is determined by directing the central rays of the x-ray beam perpendicular to the imaginary bisector between the plane of the image receptor and the long axes of the teeth of interest.

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson TABLE 17-2 A Summary of Occlusal Radiographic Technique

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 17-4 Maxillary topographical occlusal radiograph (anterior). (A) Diagram showing relationship of tube head and PID to image receptor and patient. Exposure side of the image receptor faces the maxillary arch with longer dimension buccal-to-buccal (across the arch). The central ray is directed perpendicular in the horizontal dimension to the patient’s midsagittal plane through the maxillary central incisor embrasure. The vertical angulation is directed approximately +65° through a point near the bridge of the nose toward the center of the image receptor. (B) Patient showing position of image receptor and 8-in. (20.5-cm) circular PID. (C) Anterior maxillary topographical occlusal radiograph.

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 17-5 Maxillary topographical occlusal radiograph (posterior). (A) Diagram showing relationship of tube head and PID to image receptor and patient. The image receptor is positioned over the left or right side, depending on the area of interest. Exposure side of the image receptor faces the maxillary arch with longer dimension along the midline (anterior-to-posterior). The central ray is directed perpendicular in the horizontal dimension to patient’s midsagittal plane through the maxillary posterior embrasures. The vertical angulation is directed approximately +45° through a point on the ala–tragus line below the outer canthus of the eye toward the center of the image receptor. (B) Patient showing position of image receptor and 8-in. (20.5-cm) circular PID. (C) Posterior maxillary topographical occlusal radiograph.

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 17-6 Mandibular topographical occlusal radiograph (anterior). (A) Diagram showing relationship of tube head and PID to image receptor and patient. Exposure side of the image receptor faces the mandibular arch with longer dimension buccal-to-buccal (across the arch). The central ray is directed perpendicular in the horizontal dimension to patient’s midsaggittal plane through the mandibular central incisor embrasure. The vertical angulation is directed -55° approximately through a point in the middle of the chin toward the center of the image receptor. (B) Patient showing position of image receptor and 8-in. (20.5-cm) circular PID. (C) Anterior mandibular topographical occlusal radiograph.

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 17-7 Mandibular topographical occlusal radiograph (posterior). (A) Diagram showing relationship of tube head and PID to image receptor and patient. The image receptor is positioned over the left or right side, depending on the area of interest. Exposure side of the image receptor faces the mandibular arch with longer dimension along the midline (anterior-to-posterior). The central ray is directed perpendicular in the horizontal dimension to patient’s midsagittal plane through the mandibular posterior embrasures. The vertical angulation is directed approximately -45° through a point on the inferior border of the mandible directly below the second mandibular premolar toward the center of the image receptor. (B) Patient showing position of image receptor and 8-in. (20.5-cm) circular PID. (C) Posterior mandibular topographical occlusal radiograph.

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 17-8 Mandibular cross-sectional occlusal radiograph. (A) Diagram showing relationship of tube head and PID to image receptor and patient. The exposure side of the image receptor faces the mandibular arch with the longer dimension buccal-to-buccal (across the arch). The central ray is directed perpendicular in both the horizontal and vertical dimensions toward the image receptor. Positioning the open end of the PID parallel to the image receptor achieves the required perpendicular alignment. The vertical angulation is directed approximately 0º through a point 2 in. (5 cm) back from the tip of the chin toward the center of the image receptor. (B) Patient showing position of image receptor and 8-in. (20.5-cm) circular PID. (C) Mandibular cross-sectional occlusal radiograph.

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Review: Chapter Summary The purpose of occlusal examinations is to image a larger area than that produced on a periapical radiograph. Occlusal radiographs are used to view conditions of the teeth and supporting structures such as impactions, large apical lesions, calcifications in soft tissue, and fractures.

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Review: Chapter Summary The horizontal angulation used to produce a topographical occlusal radiograph is determined in the same manner as for periapical and bitewing radiographs, where the central rays of he x-ray beam are directed perpendicularly to the image receptor through the embrasures of the teeth of interest.

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Review: Chapter Summary The vertical angulation used to produce a topographical occlusal radiograph is determined in a similar manner to the bisecting technique used to produce periapical radiographs, where the central rays of the x-ray beam are directed perpendicularly to the bisector between the long axes of the teeth and the plane of the image receptor.

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Recall: Study Questions General Chapter Review

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study Consider the following cases. After determining the radiographic assessment for each of these three, write out a detailed procedure chart that a radiographer can follow to obtain the needed radiographs. Begin with patient positioning. Be sure to include the steps for determining the correct film packet placement, x-ray beam angles, and landmarks for determining point of entry.

26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study 1.An adult patient presents with a sub-lingual swelling indicating the possibility of a blocked salivary gland. What type of occlusal radiograph will this patient most likely be assessed for?

27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study 2.An adult patient presents with severe pain in the mandibular left posterior region, indicating the possibility of an impacted third molar. The pain and swelling in this region is preventing the patient from opening more than a few millimeters. What type of occlusal radiograph will this patient most likely be assessed for?

28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study 3.A child patient presents with trauma to the maxillary anterior teeth after a fall off her bicycle. What type of occlusal radiograph will this patient most likely be assessed for?

29. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Relate: Laboratory Application Proceed to Chapter 17, Laboratory Application, to complete this activity.