Intraoral Techniques (Bitewing & Occlusal) PDF

Bitewing 1 10/13/2024 Technique Indications of Bitewing Radiographs  Detection of incipient interproximal caries  Detection of recurrent caries below the restorations  Detection of overhanging restorations  Detection of pulp stones  Detection of inter...

Bitewing 1 10/13/2024 Technique Indications of Bitewing Radiographs  Detection of incipient interproximal caries  Detection of recurrent caries below the restorations  Detection of overhanging restorations  Detection of pulp stones  Detection of interproximal calculus deposits  Examination of alveolar bone crest and evaluating the periodontal conditions  Bitewing Head Position 3 10/13/2024 The head should be positioned so that the maxillary arch is parallel to the floor, both side-to-side and front-to-back.  Bitewing Film Placement 4 10/13/2024 Front edge anterior to Film centered on second middle of mandibular molar (if 3rd molars are canine (approximately erupted; otherwise center centered on 2nd on contact between 1st and premolar 2nd molar). 5 10/13/2024 6 10/13/2024  7 10/13/2024 The stick-on bitewing tab is always centered top-to-bottom with the film oriented horizontally The tab is placed on the all-white side of the film. When some teeth are missing, the tab may be placed more anteriorly or posteriorly to allow maximum contact with the teeth that are present.  8 10/13/2024 cotton roll Cotton rolls can also be used to help support the tab in edentulous areas.  9 10/13/2024 The film is placed in the mouth between the teeth and the tongue. Hold on to the tab and instruct the patient to close slowly and completely. Always start with the premolar bitewing, then proceed to the molar bitewing on that same side.  10 10/13/2024 10° positioning guide The vertical angulation is always set at +10 degrees (the tube head is pointing downward). Make sure the patient’s head is positioned properly before attempting PID alignment.  11 10/13/2024 correct incorrect The HA is adjusted so that a line connecting the front and back edge of the PID is parallel with the buccal surfaces of the premolars and molars. Instruct the patient to open their lips so that you can see the buccal surface (see next slide). Make sure they remain closed on the tab. The front edge of the PID should be ¼” anterior to the front edge of the film. 12 10/13/2024  13 10/13/2024 Premolar Bitewing On a premolar bitewing, the contact between the canine and 1st premolar should be clearly visible.  14 Molar Bitewing 10/13/2024 Molar periapical films should always be centered on the 2nd molar. In film above, the film was too posterior, showing the posterior edentulous area  15 10/13/2024 Premolar bitewing, too posterior  16 10/13/2024 Molar bitewing, too anterior Vertical Bitewings 17 10/13/2024 Vertical bitewings, with the long axis of the film vertical, are used when there is extensive bone loss due to periodontal involvement. They can be used both anteriorly (2 for canines, 1 for incisors) or posteriorly (premolar and molar on each side).  Occlusal Radiography It is an intra-oral technique in which the film packet is placed on the occlusal surface. Occlusal Film Indications 19 10/13/2024 1) Identify large lesions in the maxilla and mandible. 2) Buccolingual location of large lesions in both jaws. 3) Location of foreign bodies. 4) Location of salivary gland stones in the submandibular salivary gland duct. 5) Imaging patients with trismus. 6) Examination of cleft palate. 7) Imaging developing anterior dentition.  Dr.Jehan Omar 20 10/13/2024 Indications  Classification of Occlusal Views 1) Topographic views 2) Cross sectional (right angle) views  1)Maxillary Topographic Indications It shows the anterior maxilla and its dentition, anterior floor of the nasal cavity and from the canine to the other canine. Periapical assessment of the upper anterior teeth. Detect the presence of unerupted canines and supernumerary teeth. Size of cysts and tumors in the anterior maxilla. Assessment of fractures of the anterior teeth and alveolar bone.  Maxillary Topographic occlusal “Procedure” Patient position patient sits in an upright position with the midsagittal plane perpendicular to the floor and the occlusal plane is parallel to the floor. Film placement The film is placed between the occlusal surfaces of the maxillary and mandibular teeth and positioned horizontally. The white side is facing the tube. The film is positioned horizontally and extend posteriorly as far as possible (till the posterior edge of the packet touches the ascending ramus). The patient bites gently on the film. Cone adjustment VA=65º, HA=zero, point of entry= nasion (above the bridge of the nose). Maxillary Topographic Occlusal 24 10/13/2024  Dr.Jehan Omar 25 10/13/2024  2)Mandibular Topographic Occlusal View It shows the lower anterior teeth from canine to canine with their roots, the anterior portion of the mandible and the inferior border of the mandible. Indications: Periapical assessment of the lower incisor teeth. Evaluation of the size and extent of lesions such as cysts or tumors. Location of impacted canines. Imaging of anterior developing dentition. Mandibular Topographic Occlusal “Procedure” Patient position: Seat the patient tilted back so that the occlusal plane is 45 degrees above the horizontal plane Film placement: The film is placed with the tube side facing the tongue and pushed posteriorly until touching the ascending ramus. Cone adjustment: V.A= -45 with the occlusal plane, point of entry=below the chin at the midline. Cross-section Occlusal Techniques  Maxillary Cross Section View (Vertex Radiograph) This view reveals the palate, zygomatic process of the maxilla, anteroinferior aspect of each antrum, nasolacrimal canals, nasal septum and teeth from second molar to second molar. N.B This projection requires more radiation since it passes through dense structures of the skull. And is of limited value because of the multiple superimpositions. Mandibular cross-sectional Occlusal 30 10/13/2024 Mandibular cross-sectional Occlusal Indications Detection of stones in the ducts of the submandibular S.G Detection of bucco-lingual position of unerupted or impacted teeth. Evaluate the bucco-lingual expansion of the pathological lesions. Assessment of the horizontal displacement of mandibular body fracture.  Mandibular cross-sectional Occlusal “procedure” Patient position: The patient tilts his head backwards such that the M.S.P is parallel to the floor and the occlusal plane is perpendicular to the floor. Film placement: The anterior border of the film should be at least ½ inch anterior to the mandibular central incisors Cone adjustment: The central ray is directed from under the mandible perpendicular to the film at the midline through the floor of the mouth about 3 cm below the chin,V.A= -90º 33 # 4 size film used in adults for occlusal 34 films. In the film at 10/13/2024 Dr.Jehan Omar right, the location of the impacted canine is revealed. # 2 size film used for occlusal in children to image anterior developing dentition (see film at left) Thank You 35 10/13/2024