Object Localization
The two primary methods of determining the
buccolingual location of objects are:
Right-Angle Technique (Occlusal projection)
Primarily identifies buccolingual location, but may
also confirm mesiodistal location seen on periapical
Tube-shift Technique (SLOB rule, Clark’s rule)
Utilizes two films with different horizontal or vertical
angulations
Right Angle Technique
Once you have identified an object on the periapical
film, you can take an occlusal film with the beam at a
right angle (perpendicular) to the direction of the beam
for the periapical.
The occlusal film below shows that the impacted canine
is lingually positioned.
Right Angle (Occlusal) technique
Tube-Shift Localization (Clark)
SLOB Rule
Same Lingual Opposite Buccal
The SLOB rule is used to identify the buccal or
lingual location of objects (impacted teeth, root
canals, etc.) in relation to a reference object
(usually a tooth).
If the image of an object moves mesially when
the tubehead is moved mesially (same direction),
the object is located on the lingual. If the image
of the object moves distally when the tubehead
moves mesially (opposite direction), the object is
located on the buccal.
In the diagram at right, the
tubehead is moved, but there is no
change in direction of the x-ray
beam, which results in no change
in location of the object of interest
in relation to reference object (see
below). Moving the tubehead
without changing the beam
direction would often result in a
cone cut , depending on how far
the tubehead is moved (see below
right).
When using the SLOB rule, the direction of the beam
must be opposite to the way the tubehead is moved.
Horizontal Tube Shift: When the tubehead is moved
mesially, the beam must be directed more distally (from
the mesial). If the tubehead is moved distally, the
direction of the beam must be more towards the mesial
(from the distal).
Vertical Tube Shift: The SLOB rule also works for
movement of the tubehead in a vertical direction.
Downward movement of the tubehead requires that the
beam be directed upward and when the tubehead is
moved upward, the beam must be directed downward.
mesial
Horizontal movement
In the diagram at left, the
buccal (yellow) and lingual
(red) objects of interest are
superimposed on each other
distal because the beam is directed
perpendicular to both of them
and they are in the same
relative position mesiodistally
and vertically. Both images are
located above the second
molar.
distal mesial
mesial Horizontal movement
In the diagram at left, the
tubehead is moved distally
and the beam is directed
mesially. On the radiograph,
the buccal object of interest
(yellow) moves mesially
distal
(opposite to tubehead
movement) in relation to the
second molar and the lingual
object of interest (red) moves
distally (same direction as
tubehead) in relation to the
second molar.
distal mesial
mesial
Horizontal movement
In the diagram at right, the
tubehead is moved mesially
and the beam is directed
distally. On the radiograph, the
buccal object of interest distal
(yellow) moves distally
(opposite to tubehead
movement) in relation to the
second molar and the lingual
object of interest (red) moves
mesially (same direction as
tubehead) in relation to the
second molar. distal mesial
Vertical movement of the tubehead and x-ray beam
Maxillary PA
BW
Mandibular PA
In moving from the maxillary periapical to the bitewing
and from the bitewing to the mandibular periapical, the
tubehead moves down and the beam is redirected
upward (opposite direction; decreased vertical
angulation).
Vertical movement
In the diagram at left, the
buccal (yellow) and lingual
(red) objects of interest are
superimposed on each other
because the beam is directed
perpendicular to both of them
and they are in the same
relative position mesiodistally
and vertically. Both images are
superimposed over the
mandibular second premolar.
Vertical movement
In the diagram at left, the
tubehead is moved upward
and the beam is directed
downward. On the radiograph,
the buccal object of interest
(yellow) moves down
(opposite to tubehead
movement) in relation to the
second premolar and the
lingual object of interest (red)
moves up (same direction as
tubehead) in relation to the
second premolar.
Vertical movement
In the diagram at left, the
tubehead is moved downward
and the beam is directed
upward. On the radiograph,
the buccal object of interest
(yellow) moves up (opposite
to tubehead movement) in
relation to the second
premolar and the lingual
object of interest (red) moves
down (same direction as
tubehead) in relation to the
second premolar.
premolar molar
For the films above, we know that the tubehead was moved
distally from the premolar to the molar film. The zygomatic
process (red arrows) is located at the distal aspect of the 2nd
molar on the premolar film and it is located over the distal
aspect of the 1st molar on the molar film. This indicates that
it moved mesially as the tubehead moved distally. We know
that the zygomatic process is buccal to the teeth and, using
the SLOB rule, it follows that the x-ray beam was directed
more mesially on the molar film (Buccal object moved
opposite to tubehead movement).
canine film 1 incisor film
The
Is the
restoration
composite isrestoration
located on on
thetooth
buccal.
# 8The
(arrows)
tubehead
moves
locatedmesially
on the buccal
from the
or canine
lingual?film to the incisor film
(x-ray beam projected more distally) and the composite
moves distally, which is the opposite direction.
2 canine film
premolar film
The
The arrow
arrow in the canine
identifies film iscanal.
the lingual pointing
Thetotubehead
the guttamoves
percha from
mesially in which canal of the
the premolar filmmaxillary first premolar?
to the canine film (beam
directed more distally) and the gutta percha indicated by
the arrow also moves mesially. (See following slide).
lingual
buccal PID
When the tubehead is moved mesially, with the beam
directed distally, the two canals, which are initially
superimposed (premolar periapical above) will separate.
The lingual canal (red arrow) will follow the tubehead
movement and the buccal canal (blue arrow) will move in
the opposite direction, as seen on the canine film.
3
This
The
The is
red
Thepink the
post isbuccal
arrow
arrow is canal.
pointing
points
located in to The
ato
the tubehead
the
threaded
lingual gutta goes
percha
post.
canal. In the
As in
which
distally
which
canal
tubehead from
ofcanal
this thethis
of canine
maxillary
moves film
maxillary
left
distally toleft
second
from the
the premolar
first premolar?
premolar
canine film
is
film the
to
and
the the
post gutta percha
located?
premolar film, themoves mesially
post also moves to distally
be
positioned
to cover the over thethat
canal lingual
hascanal which
all gutta has the
percha.
threaded post.
premolar film 4 molar film
TheIstubehead movessecond
the maxillary distally from
the premolar
premolar film to the molar film.
(arrows)
Thedisplaced
second premolar also moves
to the buccal
distally,
or theoverlapping
lingual? the first molar
more in the molar film. In moving
from the premolar periapical to the
bitewing, the tubehead moves
down and the premolar also moves
down. The displacement is to the
premolar bitewing lingual.
incisor film 5 canine film
The
Is the
lateral
displaced
incisor
incisor
is displaced
(arrows)tolocated
the lingual.
on the
The
buccal
or the lingual?
tubehead moves distally from the incisor film to the
canine film. The lateral incisor also moves distally,
covering half the canine on the canine film.
6 canine film
premolar film
Lingual. The tubehead moves mesially from the premolar
film to the canine film. The object also moves mesially,
starting out distal object
Is the radiopaque to the first molarby
identified onthe
thearrows
premolar film and
located
ending up mesial
on the buccal to the
or the first molar on the canine film. This
lingual?
object represents the tip of the palatal root of the second
molar and is located distal to the first molar and in a lingual
relationship (See following slide).
QUIZZZZZZZ……
incisor film
premolar film 7
The maxillary right lateral incisor is tilted out of position.
In which direction (buccal or lingual) is it tipped?
incisor film 8 canine film
The maxillary left canine is impacted. Is it located more
to the buccal or the lingual?
premolar periapical film
9
The amalgam restoration
indicated by the arrow is
located on the buccal or
premolar bitewing film the lingual?
premolar bitewing film
10
The mandibular second
premolar is tilted out of
position. In which
direction (buccal or
premolar periapical film lingual) is it tipped?
molar bitewing film
11
The arrow points to a
retention pin. Is the
pin located in the
buccal or lingual
molar periapical film portion of the tooth?
12
premolar film molar film
Does the arrow point to the mesiobuccal or mesiolingual
canal?
molar bitewing film
13
The amalgam particle
indicated by the arrows
is located bucally or
lingually?
molar periapical film
14 premolar bitewing film
Is the restoration
indicated by the red
arrows located on the
buccal or lingual of the
first premolar?
canine periapical film
premolar periapical film
15
premolar film
incisor film canine film
The gutta percha root canal filling identified by the red
arrows is located in which canal?
