Intraoral Techniques, Periapical Radiographs PDF

INTRAORAL RADIOGRAPHIC TECHNIQUES Periapical Radiographs Prepared by : Dr. Rowa’a Yasin  Intraoral Radiographs Outlines Periapical Radiographs Indications of Periapical Radiographs Periapical Radiographic T...

INTRAORAL RADIOGRAPHIC TECHNIQUES Periapical Radiographs Prepared by : Dr. Rowa’a Yasin  Intraoral Radiographs Outlines Periapical Radiographs Indications of Periapical Radiographs Periapical Radiographic Techniques Bisected Angle Technique DR. ROWA'A YASIN Intraoral Radiographs Film located inside patient’s mouth  Periapical Projections  Bitewing Projections  Occlusal Projections DR. ROWA'A YASIN  Periapical Projections Shows the entire length of teeth and surrounding bone Must show the full length of roots and at least 2mm of the periapical bone  Bitewing Projections Shows crowns of maxillary and mandibular teeth and the adjacent alveolar crest ▪ Occlusal Projections Shows an area of teeth and bone larger than periapical DR. ROWA'A YASIN DR. ROWA'A YASIN  Periapical Radiograph  Are the most common intraoral radiographic images  Provides the dentist with important information An important diagnostic radiograph which contribute to the production of comprehensive treatment plan  Have a higher spatial resolution as compared to extraoral radiographs allowing the detection of subtle changes that occur in dental disease side mouth DR.DR.ROWA'A ROWA'A YASINYASIN  SPECIFIC AREAS  Periapical radiographs can be taken to examine a specific areas DR. ROWA'A YASIN  OR FULL-MOUTH SERIES CONSISTS OF 17 PERIAPICAL FILMS , 4 BITEWING FILMS DR. ROWA'A YASIN INDICATIONS OF PERIAPICAL RADIOGRAPH 1. Detection of apical infection / inflammation 2. Assessment of dental caries extension 3. Assess root morphology before extractions 4. Assessment of the periodontal status 5. Evaluate consequence of traumatic injuries to the teeth and alveolar bone DR. ROWA'A YASIN 6. Evaluate unerupted and impacted teeth 7. Assess pulp morphology 8. During endodontics 9. Detailed evaluation of apical cysts and other lesions within the alveolar bone 10. Preoperative and postoperative evaluation of apical surgery 11. Evaluation of implants postoperatively DR. ROWA'A YASIN  Periapical Radiographic Techniques Two Techniques for Periapical Radiography DR. ROWA'A YASIN  Bisected Angle Technique DR. ROWA'A YASIN  A type of Periapical Intra-oral Radiographic Technique Developed by Weston Price in 1904 Also called Finger Holding Technique Or Short Cone Technique DR. ROWA'A YASIN  Bisected Angle Technique The X-ray Beam is directed perpendicular to an imaginary Bisector line which bisects (divides in half) the angle formed by the long axis of the tooth and the long axis of the receptor DR. ROWA'A YASIN  Basic Concept  The receptor is positioned as close as possible to the lingual surface of the teeth resting in the palate ( maxillary receptor ) or in the floor of the mouth ( mandibular receptor )  The angle formed between the long axis of the tooth and the long axis of the receptor is assessed and mentally bisected  The X-ray tube head is positioned at right angles to this bisecting line with the central ray of the X-ray beam perpendicular to the imaginary bisector DR. ROWA'A YASIN DR. ROWA'A YASIN ADVANTAGES OF BISECTED ANGLE TECHNIQUE 1) Usually no film holders are required 2) Better technique when anatomical variations hinder paralleling technique ( Image receptor placement may be easier ) e.g. Children, adult with small mouth , low palatal vault and presence of torus 3) Use of short PID easier to maneuver DR. ROWA'A YASIN DISADVANTAGES 1) Image Distortion 2) Angulation problems 3) Shadow of the zygomatic bone is frequently seen over the apex of the maxillary molars 4) Estimating the location of imaginary bisector may be difficult DR. ROWA'A YASIN DISADVANTAGES 4) Using a short PID may increase radiation dose 5) Positioning difficulties  Mandibular 3rd molars  Gagging  Endodontics  Children DR. ROWA'A YASIN  PATIENT PREPARATION Prior to start taking films : 1. The patient must be positioned properly 2. Seat the patient and ask them to remove their glasses and any removable appliances 3. Adjust the headrest to support the head while taking films 4. Raise or lower the chair to a comfortable height for the operator 5. Place the lead apron and thyroid collar on the patient DR. ROWA'A YASIN  HEAD POSITION  When using a bisecting holding devices head position is not critical however, when using finger holding method head position is important  For maxillary Receptor the head should be positioned so that the maxillary arch is parallel to the floor  For mandibular Receptor the head is tipped back slightly so that the mandible is parallel to the floor when the mouth is open (The mouth is always open when using finger holding method )  Make sure head is supported by headrest DR. ROWA'A YASIN DR. ROWA'A YASIN Planes / Imaginary Lines  The Midsagittal Plane which divides the head into right and left halves is perpendicular to the floor  The Occlusal plane should be parallel to the floor DR. ROWA'A YASIN  For maxillary radiographs the ala tragus line should be parallel to the floor  For mandibular radiographs a line 1cm above the inferior mandibular border should be parallel to the floor DR. ROWA'A YASIN FILM POSITIONING 1. Finger Holding Method Still widely used The patient support the film packet by using either Index or Thumb DR. ROWA'A YASIN  The patient may bend the film causing Distortion The patient may not hold the film with enough pressure causing it to Slip Patient hand is usually on the path of x-ray beam ( Unnecessary Exposure ) DR. ROWA'A YASIN 2. Film Holders Method Is the recommended technique Reduces patient exposure Reduces film shifts DR. ROWA'A YASIN  FILM HOLDING DEVICES Rinn XCP devices Snap Ray Stable Bite block Snap Ray with arm & ring kit attached DR. ROWA'A YASIN  FILM PLACEMENT Centered the films behind the teeth of interests DR. ROWA'A YASIN  Identification Dot A round raising dot present in the corner of each film allows rapid , proper film orientation and placement The manufacture orients the film in the packet so the convex side of the dot is toward the front of packet and faces source of radiation During film exposure the film oriented to place the dot 2-3mm away from the incisal or occlusal surface DR. ROWA'A YASIN DR. ROWA'A YASIN  ANTERIOR PERIAPICAL FILM  It is positioned Vertically with the all-white side of the film facing the teeth  The identifying dot is placed at the incisal edge of the teeth  The film should extend beyond the incisal edges of the teeth 2-3mm  The thumb or finger is applied to the back (colored) side of the film at approximately the junction of the tooth with the gingiva This provides good support for the film DR. ROWA'A YASIN ANTERIOR PERIAPICAL FILM DR. ROWA'A YASIN  POSTERIOR PERIAPICAL FILM  It is positioned Horizontally with the all-white side of the film facing the teeth  The identifying dot is placed at the occlusal surface of the teeth  The film should extend 2-3mm beyond the occlusal surface of the teeth  The finger is applied to the back (colored) side of the film at approximately the junction of the tooth with the gingiva this provides good support for the film DR. ROWA'A YASIN POSTERIOR PERIAPICAL FILM DR. ROWA'A YASIN FILM SIZE SIZE 2 for Adult ( 31 x 41 mm ) SIZE 0 for Children ( 22 x 35 mm ) DR. ROWA'A YASIN DR. ROWA'A YASIN DR. ROWA'A YASIN  Vertical Angulation DR. ROWA'A YASIN Correct Vertical Angulation Results in a dental image that is the same length as the tooth DR. ROWA'A YASIN DR. ROWA'A YASIN DR. ROWA'A YASIN DR. ROWA'A YASIN DR. ROWA'A YASIN DR. ROWA'A YASIN  Horizontal Angulation  Positioning of the PID and direction of central rays in a horizontal or side to side plane  The central ray is directed perpendicular to the curvature of the arch and through the interproximal contact areas of teeth to avoid overlapping of teeth As a result the contact areas on dental image appear opened ▪ The horizontal angulation is therefore determined by the shape of the arch and the position of teeth DR. ROWA'A YASIN Incorrect Horizontal Angulation Incorrect Horizontal Angulation DR. ROWA'A YASIN DR. ROWA'A YASIN MAXILLARY TEETH DR. ROWA'A YASIN MANDIBULAR TEETH DR. ROWA'A YASIN DR. ROWA'A YASIN DR. ROWA'A YASIN DR. ROWA'A YASIN DR. ROWA'A YASIN DR. ROWA'A YASIN DR. ROWA'A YASIN DR. ROWA'A YASIN DR. ROWA'A YASIN  SUMMARY FOR BISECTED ANGLE TECHNIQUE 1. The appropriate sized film packet is positioned and orientated in the mouth with about 2-3 mm extending beyond the incisal or occlusal edges to ensure that all of the tooth will appear on the film Patient is then asked to gently support (hold ) the film packet using either an index finger or thumb 2. The operator then assesses the vertical , horizontal angulations and positions the tube head independently 3. The exposure is made DR. ROWA'A YASIN