Successful - Intraoral - Brochure - 1
Successful - Intraoral - Brochure - 1
Successful
Intraoral Radiography
Successful Intraoral Radiography
Every dental professional would like to achieve the goal First, the film must be properly positioned to ensure
of producing consistent, quality intraoral radiographs. A proper geometry and prevent distortion and overlap.
quality intraoral radiograph will reveal maximum image Second, the exposure technique factors must be
detail with anatomic accuracy and optimal density and appropriate for the patient and the film selected.
contrast, providing the highest diagnostic yield. This And last, proper processing time, temperature and
pamphlet will address some of the common errors in handling requirements must be followed to produce
capturing and processing intraoral radiographs and explain a quality radiograph.
how to prevent and correct them. For similar information
on panoramic radiography, please refer to the publication
entitled “Successful Panoramic Radiography”.
Quality Radiography
The goal of all radiography should be to produce a
Positioning
high quality radiograph. Such a radiograph will exhibit
maximum detail to resolve fine objects. It will show
the teeth and anatomic structures accurately without
distortion or magnification. It will have the optimal density
and contrast (visual characteristics) to maximize its use
for the detection of dental disease. To create such a film,
Exposure Processing
the dental staff must pay attention to all three steps in
the production of the radiograph including: positioning,
exposure and processing. Figure 1 Three steps In producing a quality radiograph
Proper Film Positioning
Step 1: Proper Film Positioning
Film placement for proper anatomic coverage is beyond
the scope of this pamphlet and can be reviewed in any
quality dental radiography text. This document will discuss
improper film placement that can lead to errors such as
overlapped contacts and distorted teeth and roots. These
problems occur due to the fact that dental radiography
is a shadow casting technique. In other words, we cast
an image of the tooth onto the film. Shadow casting can
cause geometric distortions in the final radiograph such as
elongation, magnification and overlapping contacts.
Figure 3 Excessive vertical angulation, Geometric distortion can be minimized by using a long
note inferior border of mandible visible,
elongation of roots. Correct by moving
x-ray source to object distance. This can be obtained
film further back into the mouth using a long cone (40 cm/16 inch) technique. Geometric
distortion can also occur if the film is not at right angles
to the beam. For this reason, it is recommended to always
use a film-holding and position indicating device (PID).
Many practitioners assume these devices can control
all angulation problems; however, they merely hold the
film perpendicular to the x-ray beam. They do not totally
prevent errors in the vertical and horizontal angulation of
the film to the tooth itself. This can lead to commonly seen
errors of overlapped contacts and vertical distortion of
teeth on the radiograph. These issues can be minimized by
proper use of the paralleling technique.
Figure 4 Distortion from film bending in Figure 5 Bent film corners causing black
corner of arch. Correct by placing film lines on film. Correct with proper film
further into center of the mouth placement, use soft film packets. Handle
film packets as carefully as possible
4
Distortion (vertical angulation)
Although film-holding devices position the film at right proper position
angles to the x-ray beam, they do not prevent rotation of
the whole device in a vertical axis. This rotation places the film packet
Overlapped contacts
(horizontal angulation)
In order to maximize the amount of contact opening, the
beam should be directed at right angles to the contact
area. In the mandible this is fairly straightforward. In the
maxilla, however, the molar contacts are often directed
Figure 7 Improper horizontal mesially due to the triangular shape of the maxillary
angulation, contacts overlapped molars. This means that the beam must also be directed
from the mesial to open these contacts. Often times the
reverse is done. The beam is directed from the mesial in
the bicuspid area and at right angles or distal in the molar
region. This will most often result in overlapped contacts.
Contact areas should always be visualized prior to taking
bitewing radiographs.
Figure 8 Proper horizontal
angulation, contacts open
Figure 9
5
Cone cuts Reversed films
Dental x-ray beams are collimated or restricted to a Dental x-ray film is marked with an indicator dot to help
diameter of 7 cm/2.75 inches at the end of the cone or indicate the tube side of the film and to help distinguish
even less when a rectangular collimator is used. When the patient’s right or left side. In addition, the film packet
the exit pattern of the beam is not aligned with the film, contains a sheet of lead foil which prevents unnecessary
part of the film will not be exposed to radiation and will radiation from passing through into the patient and
appear clear. This is known as a cone cut. Proper use reduces scatter radiation. This sheet of lead foil is marked
of position indicating devices (PIDs) will help to prevent with a special pattern. When a film is exposed from the
these cone cuts, which can occur with either round or wrong side, the pattern is visible on the radiograph. Due
rectangular cones. to the attenuation of the foil, the radiograph also appears
overall light in density.
Figure 10
Figure 11 Cone cut using Figure 12 Cone cut using
round cone rectangular cone
6
Film Exposure
Step 2: Film Exposure Influence of milliamperes
Most modern dental x-ray machines no longer allow for
Selecting a Film the adjustment of mA or milliamperage. Since the effect
Film selection is important to both radiographic success of increasing or decreasing mA is the same as for exposure
and to provide the lowest practical exposure to the time, it is common to combine the two and talk of mAs
patient. To achieve consistent quality radiographs you must or milliamp-seconds. In dentistry we are mainly concerned
use a consistent quality film. Low cost films may vary from with exposure time as discussed below.
batch to batch or may come from different manufacturers.
This makes establishing consistent exposure and
development technique factors very difficult. Influence of time
Dental films are provided in different speed groups. Film density (how light or dark the overall film is) is
D-speed films are the slowest speed films and F-speed directly related to exposure time. The longer the exposure
films are the fastest. time the more x-ray photons reach the film and expose
it. Therefore, the film is darker. The x-ray timer can be
INSIGHT dental film is an F-speed film that can provide an thought of as a faucet. It turns the flow of x-rays on or off.
additional 20% reduction in exposure over E-speed films If you open the faucet twice as long, you will get twice as
(and a 60% reduction in exposure over D-speed films) with many x-rays out of the machine. If you double the time,
consistent image contrast and quality. In accordance with the film will be approximately twice as dark.
the ALARA principle (keep doses As Low As Reasonably
Achievable), the use of F-speed film is highly encouraged.
For helpful exposure guidelines, please see pages 11 and
12. Using these guidelines, the practitioner can verify that
their exposure factors are within the suggested normal
ranges for good radiographic techniques.
7
Figure 17 0.25 second exposure Figure 18 0.5 second exposure Figure 19 1.0 - second exposure
(underexposed) (properly exposed) (over exposed)
kVp has two effects on the quality of the final radiograph. Figure 20 kV is like a spray nozzle
First, it affects the contrast or gray scale. Low kVp is like
opening the nozzle. The lower energy x-rays have less
penetrating power. This provides a high contrast image
with an obvious black and white appearance. High kVp is
like closing the nozzle. The beam is “harder” with higher
energy. High kVp gives a low contrast image, but with
Figure 21 Low contrast long gray scale above, high contrast short gray
more shades of gray to show subtle contrast changes. scale below
Second, using higher kVp produces more x-rays. This is
not a linear relationship, but rather the density of the film
varies as the square of the kVp. A good standard to
follow is:
8
An increase of 15 kVp = 2 X an Increase in Density
Other errors that can occur during exposure include Table 3 kVp errors
9
Recommended exposure settings for Carestream Dental intraoral films
Ultra-speed*
Settings kV 60 65 65 65 70 70 70 80
mA 7 7.5 8 10 7 8 10 10
Maxillary Incisor 0.55 0.32 0.30 0.24 0.27 0.24 0.19 0.10
Cuspid 0.55 0.32 0.30 0.24 0.27 0.24 0.19 0.10
Bicuspid 0.73 0.43 0.40 0.32 0.37 0.32 0.26 0.13
Molar 0.82 0.48 0.45 0.36 0.41 0.36 0.29 0.14
20 cm/8 inches
Mandibular Incisor 0.46 0.27 0.25 0.20 0.23 0.20 0.16 0.08
Cuspid 0.46 0.27 0.25 0.20 0.23 0.20 0.16 0.08
Bicuspid 0.50 0.29 0.28 0.22 0.25 0.22 0.18 0.09
Molar 0.55 0.32 0.30 0.24 0.27 0.24 0.19 0.10
Bite-Wing Anterior (Incisor) 0.46 0.27 0.25 0.20 0.23 0.20 0.16 0.08
Posterior (Bicuspid) 0.55 0.32 0.30 0.24 0.27 0.24 0.19 0.10
Occlusal 0.91 0.53 0.50 0.40 0.46 0.40 0.32 0.16
Maxillary Incisor 2.19 1.28 1.20 0.96 1.10 0.96 0.77 0.38
Cuspid 2.19 1.28 1.20 0.96 1.10 0.96 0.77 0.38
Bicuspid 2.93 1.71 1.60 1.28 1.46 1.28 1.02 0.51
Molar 3.29 1.92 1.80 1.44 1.65 1.44 1.15 0.58
40 cm/16 inches
Mandibular Incisor 1.83 1.07 1.00 0.80 0.91 0.80 0.64 0.32
Cuspid 1.83 1.07 1.00 0.80 0.91 0.80 0.64 0.32
Bicuspid 2.01 1.17 1.10 0.88 1.01 0.88 0.70 0.35
Molar 2.19 1.28 1.20 0.96 1.10 0.96 0.77 0.38
Bite-Wing Anterior (Incisor) 1.83 1.07 1.00 0.80 0.91 0.80 0.64 0.32
Posterior (Bicuspid) 2.19 1.28 1.20 0.96 1.10 0.96 0.77 0.38
Occlusal 3.64 2.12 2.00 1.60 1.84 1.60 1.28 0.64
*Class: D-speed
Note: for large patients increase time by approximately 25%; for children and / or small patients decrease time by approximately 30%; to
convert to impulses, multiply by 60.
10
INSIGHT*
Settings kV 60 65 65 65 70 70 70 80
mA 7 7.5 8 10 7 8 10 10
Maxillary Incisor 0.25 0.14 0.14 0.11 0.12 0.11 0.09 0.04
Cuspid 0.25 0.14 0.14 0.11 0.12 0.11 0.09 0.04
Bicuspid 0.33 0.19 0.18 0.14 0.16 0.14 0.12 0.06
Molar 0.37 0.22 0.20 0.16 0.19 0.16 0.13 0.06
20 cm/8 inches
Mandibular Incisor 0.21 0.12 0.11 0.09 0.10 0.09 0.07 0.04
Cuspid 0.21 0.12 0.11 0.09 0.10 0.09 0.07 0.04
Bicuspid 0.23 0.13 0.12 0.10 0.11 0.10 0.08 0.04
Molar 0.25 0.14 0.14 0.11 0.12 0.11 0.09 0.04
Bite-Wing Anterior (Incisor) 0.21 0.12 0.11 0.09 0.10 0.09 0.07 0.04
Posterior (Bicuspid) 0.25 0.14 0.14 0.11 0.12 0.11 0.09 0.04
Occlusal 0.41 0.24 0.23 0.18 0.21 0.18 0.14 0.07
Maxillary Incisor 0.99 0.58 0.54 0.43 0.49 0.43 0.35 0.17
Cuspid 0.99 0.58 0.54 0.43 0.49 0.43 0.35 0.17
Bicuspid 1.32 0.77 0.72 0.58 0.66 0.58 0.46 0.23
Molar 1.48 0.86 0.81 0.65 0.74 0.65 0.52 0.26
40 cm/16 inches
Mandibular Incisor 0.82 0.48 0.45 0.36 0.41 0.36 0.29 0.14
Cuspid 0.82 0.48 0.45 0.36 0.41 0.36 0.29 0.14
Bicuspid 0.91 0.53 0.50 0.40 0.45 0.40 0.32 0.16
Molar 0.99 0.58 0.54 0.43 0.49 0.43 0.35 0.17
Bite-Wing Anterior (Incisor) 0.82 0.48 0.45 0.36 0.41 0.36 0.29 0.14
Posterior (Bicuspid) 0.99 0.58 0.54 0.43 0.49 0.43 0.35 0.17
Occlusal 1.65 0.96 0.90 0.72 0.82 0.72 0.58 0.29
*Class: F-speed
Note: For large patients increase time by approximately 25%; for children and / or small patients decrease time by approximately 30%; to convert to
impulses, multiply by 60.
In manual processing environment, the film is E-speed. Increase exposure time by approximately 20%.
11
Processing
Step 3: Processing Development CONTAMINATED OR DEPLETED CHEMISTRY = INCOMPLETE
Even with the excellent automatic processors available DEVELOPMENT = LIGHT FILM
today, many errors can occur during film processing. Many Developer must be replenished following manufacturer’s
of these errors are due to improper film handling, but recommendations or it will become exhausted. These
some can be caused by the processor itself. Processing is a recommendations are usually based on the amount of
chemical reaction therefore: radiographs processed. However, developer exhaustion
is determined by the surface area of the films processed
INCREASED TEMPERATURE = INCREASED DEVELOPMENT = not the number of films. For example, if large numbers
DARKER FILM of panoramic or cephalometric films are processed, more
INCREASED TIME = INCREASED DEVELOPMENT = frequent replenishment will be needed.
DARKER FILM
Too dark Temperature too high or time too Check temperature and adjust
long development time as needed
Too light Contaminated or weak developer Replace or replenish developer.
Follow dilution instructions
Too dark (fogging) Over concentrated developer Follow dilution instructions
12
Manual Processing of Intraoral Carestream Dental Films
10 DRY
Note: The times indicated are
Suspend hanger from a drying rack in dust-free
appropriate with correct exposure area. Use a fan to accelerate drying. When dry,
time of the intraoral films. remove films from hanger, mount and identify.
13
Handling
Film must be handled carefully under proper safelight powder-free gloves should contact the bare film prior to
conditions during processing. Most dental films processing. Unprocessed film should not come in contact
recommend red safety filters such as GBX-2 safelight filter. with wet or contaminated surfaces as this may lead to
If a daylight loader is used in a brightly lit room, the use of film spotting.
another type of filter can result in film fogging. Care must
also be taken when feeding film into a processor. Opening Carestream Dental Films with a ClinAsept barrier not only
the lid too soon on a daylight loader can result in room aids in infection control but also allows film to be handled
light fogging the trailing edge of the film. with clean hands after removal from the barrier envelope,
preventing discoloration and cross-contamination.
It can take up to 15-20 seconds for film to completely
enter an automatic processor. Film fed too quickly or After processing, films must not come into contact until
too close together can overlap or stick together. Other completely dry as the wet emulsions can stick together
errors can occur from emulsion tears, fingerprints, static and peel off the films when they are separated.
electricity and chemical spills onto the film. Only clean, dry,
14
Handling Errors
Radiograph Handling Problem Fix
Too dark (similar to fogging) Improper safelight Use GBX-2 Safelight Filters or filter with wavelength >520 nm
Random sized dark spots: Stored in humid or hot conditions Store film between 10 to 24 °C (50-75 °F) and between
v shaped, mottle “noise” 30-50% rH.
Dark rectangle on film Overlap during processing Feed films slowly or side by side
Dark edge on film Exposed to light before safely in Allow 15-30 seconds from last film to enter processor. Listen
processor for click or watch for ready light on processor to indicate
when safe to feed next film
Fingerprints Improper handling Clean, dry hands and hold the film on the edges
Dark spots Developer stains Keep darkroom clean, wipe up any spilled chemistry to avoid
spotting films
White spots Fixer stains Keep darkroom clean, wipe up any spilled chemistry to avoid
spotting films
Streaks or scratches Emulsion tears Never allow wet films to contact one another or fingernails,
emulsion is delicate when wet. Keep films away from
extreme sides of processor
Dark spots or lines in a pattern Roller marks Use Roller Transport Clean-up Film daily and/or clean rollers
with mild detergent and rinse throughly
Dark spots-branched or dots Static (most common in winter months) Add humidifer and or open packets slowly to minimize static
discharge. Do not refrigerate film
Yellowish color Poor fixing/washing or exhausted fixer Change chemistry
15
Summary of Intraoral Errors
Problem Error and Fix
Teeth elongated, cusps don’t overlap, sinus structures Excessive vertical angulation, correct film placement
or inferior border of mandible visible
Contacts of teeth overlapped Improper horizontal angulation, visualize contact area and adjust
Dark lines on corner of film Film bent, use of Carestream Dental Poly-Soft packets and proper placement
to reduce bending
Clear area on one edge of the film either Cone cut, use position indicating device
in arc or straight
Film light in density, unusual pattern across film Film was reversed and exposed through the back side, pattern is from lead foil,
(“tire tracks” or “herringbone”) assure correct side toward tube
Too dark Exposure too long, shorten time
kV too high, reduce kV
Processor temperature to high, reduce temperature
Development time too long, shorten time
Over concentrated developer, follow dilution directions
Improper safelight, follow recommendations
Too light Exposure too short, lengthen time
kV too low, raise kV
Processor temperature too low, raise temperature
Development time too short, increase time
Contaminated or weak developer (replace or replenish solutions)
Too much contrast kV low, adjust kv
Too washed out or gray kV high, adjust kV
Blurring of structures Patient movement, use F-speed film for shorter exposure time. Use head rest.
Multiple images on film Double exposure, separate exposed packets from unexposed packets
Mottle “noise” Stored in humid or hot conditions, store as directed on package
Dark rectangular area on film Overlap during processing, feed as directed
Dark edge on film Exposed to light before safely in processor, do not open or turn on light too
soon
Fingerprints Clean, dry hands and hold the film on the edges
Dark spots Developer stains, practice darkroom cleaniness
White spots Fixer stains, practice darkroom cleaniness
Clear streaks, splotches or scratches Emulsion tears, keep separated while wet
Dark spots in pattern Dirty processor rollers, clean processor daily
Dark spots branched or dots Static due to over-dry conditions, adjust humidity, open packets slowly
16
Carestream Dental Chemistry*
Chemistry for manual processing
Product Processing Ready to Use or Concentrate
Rapid Access Developer Developing: 15 sec. 20°C/68°F Ready to use
Rapid Access Fixer Fixing: 15 sec.** 20°C/68°F
Rapid Access Twin Pack Wash: 1 - 2 min. 20°C/68°F
(for archiving refix and wash as directed)
GBX Developer and Replenisher Developing: Concentrate – requires dilution
GBX Fixer and Replenisher 5 min. 20°C/68°F follow instructions on product
GBX Twin Pack 4 1/2 min. 21°C/70°F
4 min. 22°C/72°F
3 min. 24.5°C/76°F
2 1/2 min. 26.5°C/80°F
Rinse: 30 sec. agitating continuously
Fixing: 2-4 min. or 2X clearing time with
intermittent agitation
15.5-29.5°C/60-68°F
Wash: 10 min. in running water
GBX Developer and Replenisher see above Concentrate – requires dilution
follow instructions on product
GBX Fixer and Replenisher see above Concentrate – requires dilution
follow instructions on product
*Check with distributor for availability in your area. All chemistries are not available in all countries.
**May need extra if near end of solution potency.
17
Ordering Information for INSIGHT Film
Size Description Code Films/Pkgs REF No
Size 0 Super Poly-Soft packets IP-01 100 867 5332
Size 0 Super Poly-Soft packets (double film) IP-02 100 128 0619
Size 0 Super Poly-Soft packets with ClinAsept barrier IP-01C 75 120 0328
Size 1 Paper packets IP-11 100 112 4981
Size 1 Paper packets (double film) IP-12 100 805 5402
Size 2 Super Poly-Soft packets IP-21 150 116 3401
Size 2 Super Poly-Soft packets (double film) IP-22 130 179 8628
Size 2 Super Poly-Soft packets with ClinAsept barrier IP-21C 100 153 9931
Size 2 Super Poly-Soft packets with ClinAsept barrier (double film) IP-22C 100 156 0390
Size 2 Paper packets IP-21 150 176 3960
Size 2 Paper packets (double film) IP-22 150 107 9086
Size 2 Bite-wing paper packets IB-21 50 180 7650
Size 3 Bite-wing paper packets IB-31 100 829 8929
Size 4 Occlusal paper packets IO-41 25 116 9143
18
Ordering Information for Ultra-speed
Size Description Code Packets/Package REF No
Size 0 Super Poly-Soft packets DF-54 100 122 8840
Size 0 Super Poly-Soft packets (double film) DF-53 100 122 8931
Size 0 Super Poly-Soft packets with ClinAsept barrier DF-54C 75 144 5360
Size 1 Paper packets DF-56 100 127 3747
Size 1 Paper packets (double film) DF-55 100 127 3721
Size 2 Super Poly-Soft packets DF-58 150 165 8194
Size 2 Super Poly-Soft packets (double film) DF-57 130 175 3664
Size 2 Paper packets DF-58 150 149 1737
Size 2 Paper packets (double film) DF-57 150 149 1752
Size 2 Bite-wing paper packets DF-40 50 839 3043
Size 2 Super Poly-Soft packets with ClinAsept barrier DF-58C 100 171 7131
Size 2 Super Poly-Soft packets with ClinAsept barrier (double film) DF-57C 100 898 7877
Size 3 Bite-wing paper packets DF-42 100 129 6771
Size 4 Occlusal paper packets DF-50 25 166 6163
19
Other Publications in the
Dental Radiography Series
• Exposure and Processing in Dental Film Radiography
• Guidelines for Prescribing Dental Radiographs
• Radiation Safety in Dental Radiography
• Successful Panoramic Radiography
• Quality Assurance in Dental Film Radiography
© Carestream Health, Inc. 2015. Carestream, INSIGHT, Ultra-speed, READYMATIC, and READYPRO are trademarks of Carestream Health.
8665 DE Intraoral Film BR 0917 CHSP-8545; Rev: 7