Chapter (4): Intraoral Radiographic Technique

The intraoral imaging examination is an inspection used to examine the teeth

and intraoral adjacent structures. The intraoral imaging examination requires the
use of intraoral receptors which placed inside the mouth to examine the teeth and
supporting structures.

 Types of Intraoral Imaging Examinations

Three types of intraoral imaging examinations are used in dentistry:

1. Periapical examination
2. Interproximal examination
3. Occlusal examination

Each of these examinations has a certain purpose and requires the use of a specific
type of imaging receptor and technique.

1.Periapical Examination

The term peri-apical is derived from the Greek pre x peri- (meaning ―around‖) and
the Latin word apex (referring to the terminal end of a tooth root). Peri-apical
images show the terminal end of the tooth root and surrounding bone as well as the
crown.

Techniques.

Two methods are used for obtaining peri-apical images:

(1) Paralleling technique

(2) Bisecting technique.

(1) Paralleling Technique

The paralleling technique (also known as the extension cone paralleling [XCP]
technique, right-angle technique, and long-cone technique) is one method that can
be used to expose periapical and bite-wing image receptors.

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 Dental Radiograph and Radiology

Principles of Paralleling Technique

As the term paralleling indicates, this technique is based on the concept of

parallelism. The basic principles of the paralleling technique can be described as
follows:

1. The receptor is placed in the mouth parallel to the long axis of the tooth being
radiographed.

2. The central ray of the x-ray beam is directed perpendicular (at a right angle) to
the receptor and the long axis of the tooth.

3. A beam alignment device must be used to keep the receptor parallel with the
long axis of the tooth. The patient cannot hold the receptor in this manner.

To achieve parallelism between the receptor and the tooth, the receptor must be
placed away from the tooth and toward the middle of the oral cavity.

Because of the anatomic configuration of the oral cavity the object receptor
distance (distance between tooth and receptor) must be increased to keep the
receptor parallel with the long axis of the tooth that lead to increased image
magnification.

To compensate image magnification, the target-receptor distance (distance

between source of x-rays and receptor) must be also increased using a long
position-indicating device (PID) (16-inch) target-receptor distance.

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 Dental Radiograph and Radiology

Fig (24): Positions of the receptor, tooth and central ray parallel to each other

Beam Alignment Devices and Receptor

1-Holding Devices

The paralleling technique requires the use of a beam alignment

instrument or a receptor holding device to position the receptor parallel to the long
axis of the tooth. Beam alignment devices are used to position an intraoral receptor
in the mouth and maintain the receptor in position during exposure

Fig(25): Patient indicating device.

The advantages of the paralleling:

1-Accuracy: the paralleling technique produces an image of highly representative

of the actual tooth. The image is free of distortion and exhibits maximum detail
and dentition.

2- Simplicity: the use of a beam alignment device eliminates the need for the
dental radiographer to determine horizontal and vertical angulations and also
eliminates the chances of dimensional distortion.

3-Duplication: the paralleling technique is easy to standardize and can be

accurately duplicated, or repeated, when serial images are indicated.

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 Dental Radiograph and Radiology

Disadvantages of Paralleling Technique

1-Receptor placement: because a beam alignment device must be used with the
paralleling technique, receptor placement may be difficult for patient who has a
small mouth or a shallow palate.

2-Discomfort: the beam alignment device used to position the receptor cause
discomfort for the patient.

(2)Bisecting technique

Terminology

Angle: In geometry, a gure formed by two lines diverging from a common.

Bisect: To divide into two equal parts.

Bisector: it’s a line that divided the angle into two equal halves

The bisecting technique can be described as follows:

1. The receptor must be placed along the lingual surface of the tooth.

2. At the point where the receptor contacts the tooth, the plane of the receptor and
the long axis of the tooth form an angle.

3. An imaginary bisector divided that angle and creates two equal angles and
provides a common side for the two imaginary equal triangles.

4. The central ray directed perpendicular to the imaginary bisector at an angle of 90

degrees.

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 Dental Radiograph and Radiology

Fig(26):bisecting tech.

 Horizontal Angulation

Direction of the central ray in a horizontal, or side-to side, plane the horizontal
angulation does not differ according to the technique used; paralleling, bisecting,
and bite-wing techniques all use the same principles of horizontal angulation.

Correct horizontal angulation= (0) so the central ray is directed

perpendicular to the curvature of the arch and through the contact areas of the teeth

Fig(27) :horizontal angulation

 Vertical Angulation
Vertical angulation refers to the positioning of the PID in a vertical, or up-and-
down, plane. Vertical angulation is measured in degrees and is registered on the
outside of the tube head. Each tooth has its vertical angle as follow:

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 Dental Radiograph and Radiology

Table(2):vertical angulation of each teeth.

Advantages of Bisecting Technique

1-It can be used without a beam alignment device when the anatomy of the patient
(shallow palate, bony growths, sensitive mandibular premolar areas)

2-Decreased exposure time as short (8-inch) PID is used with the bisecting
technique.

Disadvantages of bisecting technique

1-Angulation problems. Any error in vertical angulation will result in image

distortion (elongation or foreshortening).while error in horizontal angle lead to
over lapping.

2-Image distortion. Distortion occurs when a short PID is used; a short PID causes
an increased divergence of x-rays,

3-human variations, that leads to typical reputation of image in same domination

in each capture.

4- Increase patient radiation dose.

Object Localization Techniques

A localization technique is a method used to locate the position of a tooth or an
object in the jaws.

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 Purpose and Use

The dental image is a two-dimensional picture of a three dimensional object.

A dental image depicts an object in superior inferior and anterior-posterior
relationships. Localization techniques can be used to obtain this three-dimensional
information.

Localization techniques may be used to locate the following:

• Foreign bodies • Impacted teeth • Retained roots

• Root positions • Salivary stones • Jaw fractures

• Broken needles and instruments • Dental restorative materials

 Types of Localization Techniques

Two basic techniques are used to localize objects:

(1) The buccal object rule

(2) The right-angle technique.

(1). Principal of The buccal object rule

1- It governs the orientation of structures captured in two images

exposed at different angulations. Using proper technique and
angulation, a periapical or bite-wing receptor is exposed; then, after
changing the direction of the x-ray beam, a second periapical or
bite wing receptor is exposed using a different horizontal or vertical
angulation.
2- After the two exposures are completed, the images are compared
with each other. When the dental structure or object seen in the
second image appears to have moved in the same direction as the
shift of the PID, the structure or object in question is positioned to
the lingual if the horizontal angulation is changed by shifting the
PID mesially, and the object in question moves mesially on the
image, then the object lies to the lingual (lingual = same).
3- Conversely, when the dental structure or object seen in the second
image appears to have moved in the opposite direction opposite as
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 Dental Radiograph and Radiology

the shift of the PID, the structure or object in question is positioned

to the buccal (buccal = opposite).

Same = Lingual; Opposite = Buccal

Fig(28):A, Note the impacted tooth (arrow). B, The pos itionindicatingde vice (PID) was shifted
in a distal direction, so the tooth moved in a distal direction. The tooth is located lingual to the
adjacent teeth.

(2). Principal of Right-Angle Technique.

1-. One periapical receptor is exposed using the proper technique and angulation to
show the position of the object in superior inferior and anterior-posterior
relationships.

2- An occlusal receptor is exposed directing the central ray at a right angle, or

perpendicular (90 degrees), to the receptor. The occlusal image shows the object
in buccal-lingual and anterior-posterior relationships.

3-After the two receptors have been exposed and processed, the images are
compared with each other to locate the object in three dimensions This technique is
primarily used for locating objects in the mandible.

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 Dental Radiograph and Radiology

Fig(29):Right-angle technique . A, The object appears to be located in bone on the periapical

image. B, The occlusal image reveals that the object is actually located in soft tis sue lingual to
the mandible.

Fig(30): Two receptors are exposed at right angle s to each other to identify the location
of a foreign object. The periapical image (A) will demonstrate the superior-inferior and anterior-
posterior positions of objects. A cross sectional mandibular occlusal image (B) will demonstrate
the anterior-posterior and buccal-lingual positions . These two views will demonstrate all three
dimensions of an area, and the location of objects can thus be indented

Chapter (5): Film processing

Film processing refers to a series of steps that produce a visible permanent
image on a dental radiograph.

 The purpose of film processing:

• To convert the latent (invisible) image on the film into a visible image.

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• To preserve the visible image so that it is permanent and does not disappear from
the dental radiograph

 Latent Image
 The latent image is a pattern of stored energy on the exposed film
cannot be seen and remains invisible within the film emulsion until it
undergoes chemical processing.
 As the silver halide crystals in the film emulsion absorb x-radiation
during x-ray exposure and store the energy from the radiation. The
stored energy within the silver halide crystals forms a pattern and
creates an invisible image within the emulsion on the exposed film.
 Film Processing Steps

1. Development 2. Rinsing 3. Fixing

4. Washing 5. Drying

1-Development: A chemical solution known as the developer is used in the

development process. The purpose of the developer is to reduce the exposed,
energized silver halide crystals chemically to black metallic silver.

2-Rinsing: After development, a water bath is used to wash or rinse the film.
Rinsing is necessary to remove the developer from the film and stop the
development process.

3-Fixing: A chemical solution known as the fixer is used in the fixing process.
The purpose of the fixer is to remove the unexposed, energized silver halide
crystals from the film emulsion. The fixer hardens the film emulsion during this
process.

4- Washing: After fixing, a water bath is used to wash the film. A washing step is
necessary to thoroughly remove all excess chemicals from the emulsion.

5-Drying: The final step in film processing is the drying of the films. Films may
be air-dried at room temperature in a dust-free area or placed in a heated drying
cabinet. Films must be completely dried before handling or mounting and viewing

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 Dental Radiograph and Radiology

Fig (31): steps of dental film processing.

 Film Processing Solutions

1-Developing agent

The developing agent (also known as the reducing agent) contains two
chemicals, hydroquinone (paradihydroxybenzene) and Elon (monomethyl-para-
aminophenol sulfate). The purpose of the The purpose of the developing agent is to
reduce the exposed silver halide crystals chemically to black metallic silver.

2- Preservative

The antioxidant sodium sulfate is the preservative used in the developer

solution. The purpose of the preservative is to prevent the developer solution rom
oxidizing in the presence of air.

3-Accelerator

The alkali sodium carbonate is used in the developer solution as an accelerator.

The purpose of the accelerator (also called the activator) is to activate the
developing agents.

4- Restrainer

The restrainer used in the developing solution is potassium bromide. The

purpose of the restrainer is to control the developer and to prevent it from
developing the exposed and unexposed silver halide crystals.

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Table (3): chemical composition of developer.

2-Fixer Solution

The fixer solution contains our basic ingredients:

(1) Fixing Agent

(2) Preservative

(3) Hardening agent

(4) Acidifier

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Table (4): Chemical composition of fixer.

1-Fixing age:

The fixing agent (also known as the clearing agent) is made up of sodium
thiosulfate or ammonium thiosulfate. The purpose of the fixing agent is to remove
or clear all unexposed and undeveloped silver halide crystals rom the film
emulsion.

2-Preservative

The same preservative used in the developer solution, sodium sulfate, is also
used in the fixer solution. The purpose of the preservative is to prevent the
chemical deterioration of the fixing agent.

3-Hardening agent

The hardening agent used in the fixer solution is potassium alum. The purpose of
the hardening agent is to harden and shrink the gelatin in the lm emulsion after the
accelerator in the developer solution has softened it.

4-Acidifier

The acidifier used in the fixer solution is acetic acid or sulfuric acid. The purpose
of the acidifier is to neutralize the alkaline developer

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 Equipment Requirements
1. Darkroom is to provide a completely darkened environment in which x-ray
film can be handled and processed to produce diagnostic radiographs. The
darkroom must be properly designed and well equipped.
2. Correct lighting equipment: Two types of lighting are essential in a
darkroom, as follows:

A-White room lighting is required for procedures not associated with the
processing .

B-Safe lighting: It is a low-intensity light composed of long wavelengths in the

red-orange portion of the visible light spectrum. Safe lighting provides sufficient
illumination in the darkroom for processing without exposing or damaging of the
film.

3. Ample work space with adequate storage

4. Temperature and humidity control
5. Master tank: the master tank suspends both insert tanks and is filled with
circulating water.
6. Insert tanks: Two removable 1-gallon insert tanks hold the developer and
fixer solutions. The insert tanks are placed within the master tank in a
floating position. The temperatures of the circulating water in the master
tank controls the temperatures of the developer and fixer solutions.
7. Thermometer: A non-mercury thermometer is necessary for manual
processing and is used to determine the temperature o the developer
solution.
8. Timer An accurate timer is also necessary for manual processing. X-ray film
is processed in chemical solutions or specific intervals indicated by the
manufacturer of the processing solutions.
9. Film hangers are necessary for manual processing. A film hanger is a device
equipped with clips used to hold films during processing.

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 Dental Radiograph and Radiology

Fig (32): Equipment Requirement

 Film Processing Techniques

1- Fixed time and temperature (manual)
2- Visual methods(manual)
3- Automatic processing
4- Inject able intra-oral films.
5- Self- processing solutions contained intra-oral films

Automatic processing cycle

The cycle is the same as for manual processing except that the rollers
squeeze off any excess developing solution before passing the film on to the
fixer, eliminating the need for the water wash between these two solutions.

Advantages

The main advantages include:

● Time saving – dry films are produced in about five minutes
● The need for a darkroom is often eliminated
● Controlled, standardized processing conditions are easy to maintain
● Chemicals can be replenished automatically by some machines.

Disadvantages
The main disadvantages include:
● Strict maintenance and regular cleaning are essential; dirty rollers produce
marked films
● Equipment is relatively expensive
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 Dental Radiograph and Radiology

● Smaller machines cannot process large extra-oral films.

Fig(33):automatic processor.

Self-developing films

 Self-developing films are an alternative to manual processing. The X-ray

film is presented in a special sachet containing developer and fixer.

Fig(34):Self-developing films

Technique of processing:

Following exposure, the developer tab is pulled, releasing developer

solution which is milked down towards the film and massaged around it.
After about 15 seconds, the fixer tab is pulled to release the fixer solution

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 Dental Radiograph and Radiology

which is similarly milked down to the film. After fixing, the used chemicals
are discarded and the film is
rinsed thoroughly under running water for about 10 minutes.
Advantages
● No darkroom or processing facilities are needed.
● Time saving – the final radiograph is ready in about a minute.
Disadvantages
● Poor overall image quality
● The image deteriorates rapidly with time
● There is no lead foil inside the film packet
● The film packet is very flexible and easily bent and relatively expensive.

Chapter (6): Normal Anatomical Radiographic Landmarks

Radiodensity: The degree to which the subject attenuates the x-ray beam
Radiolucencies: Marrow spaces Foramina Canals (N.B. the walls of the canal are
opaque) Fissures Fossae Meati Sinuses Sutures Dental pulp

Radiopacities: Bone Condyles Eminences Processes Tuberosities Walls of canals

Tubercles Ridges Trabeculae Teeth Enamel Dentin Cementum

 Anatomical Landmarks may be related to:

A)Teeth B)supporting C) Landmarks of D) Landmarks of

tissues maxilla. Mandible.

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 Dental Radiograph and Radiology

1- Enamel. 1. Periodontal 1- Median palatine 1- Lingual foramen

2- Dentin. ligament space. suture. 2- Genial tubercles.
3- Cementum. 2. Alveolar 2- Nasal fossa. 3- Mental ridge.
4- Pulp chamber bone. 3- Nasal septum. 4- Mental foramen.
and canal(s). 3.Lamina dura. 4-Anterior nasal 5- Mental fossa.
5- Tooth germ. spine. 6-External oblique
5- Incisive foramen. line.
6-Lateral fossa. 7- Internal oblique
7- Maxillary sinus. line.
8- Malar bone. 8- Mylohyoid line or
9-Maxillary ridge.
tubrosity. 9-Mandibular
10-Hamular process. foramen.
11- Nasolacremal 10- Inferior dental
duct. canal.
11- Submandibular
gland fossa.
12-Interdental
nutrient canals.
13- Pharyngeal
space.
)A) The Teeth:

a) Enamel 90% mineralized tissue and appears as a clear radiopaque

band that covers the anatomical crown.
b) Dentin 75% mineralized , It appears on the x-ray film as a radiopaque
area but with less opacity than enamel
c) Cementum 50% mineralized Pulp Soft tissue. It appears radiopaque
but it is not differentiable radiographically from the dentin of the root
because they closely comparable composition.
d) Pulp chamber and canal(s): They normally occupied by soft tissue and
appear as a central radiolucent strip extending from the apex of the
root into the base of the tooth crown.

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 Dental Radiograph and Radiology

Fig(65): Periapical radiograph showing: (a)enamel,(b)dentin, (c)cementum and

(d)pulp.

B) Supporting structures:

1- Periodontal ligament space: It is primarily compsed of collagen, so it appears

as a narrow radiolucent line between tooth root and lamina dura.

Fig(66): Periapical radiograph showing Periodontal ligament space.

2- Lamina dura: or a cribriform plate of compact bone lining the tooth socket. It
appears as thin radio-opaque line lining the tooth socket. It is thicker than the
surrounding trabecular bone.

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 Dental Radiograph and Radiology

Fig(67): Periapical radiograph showing lamina dura.

3-Alveolar bone: or the supporting spongy bone. Normally the trabeculae of

cancellous bone appear as a combination of radio-opacity (cortical plates and rods)
and radiolucency (bone marrow spaces in a mesh or spongiose structure pattern.

 Bone in the Anterior Maxilla: Trabecular are thin and numerous Small
marrow spaces. While in the Posterior Maxilla, marrow spaces are slightly
larger.
 Bone in the Anterior Mandible :Trabeculae are thicker than in the maxilla in
a horizontal pattern

(A) (B)
Fig(68): Periapical radiograph showing(A) Trabecular bone in maxilla, (B) in mandibule.

(C) Landmarks of maxilla

1-Median palatal suture: it lies between the two palatal processes of the maxilla.
It appears as a radiolucent line extending in the midline between the maxillary
central incisors and extends back to the posterior aspect of the palate.

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 Dental Radiograph and Radiology

2-Nasopalatine (Incisive) Foramen: it usually appears as a prominent radiolucent

area above/or between the roots of two central incisors. It may be a symmetrically
oval, round, or heart-shaped radiolucency.

3- Nasal fossa: Appears as two radiolucent areas on either side of the midline
above or related to the roots of lateral incisors.

4-Nasal septum: Appear as a radio-opaque line separates two nasal fossa in the
midline.

4
3

1
2

Fig(69): Periapical radiograph showing:(1) median palatine suture,(2)nasopalatin

foramrn,(3)nasal fossa,(4)nasal septum.

5- Anterior nasal spine: Appears as a v-shaped radio-opaque structure in the

midline above the incisive foramen.

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 Dental Radiograph and Radiology

Fig(70): Periapical radiograph showing(5) Anterior nasal spine

6- Lateral Canine Area (radiopaque-light) The inverted –Y is an important

anatomical landmark.It is formed by the cortical lining of the anterior wall of the
maxillary sinus(1) and the floor of the nasal fossa (2).

Fig(71): Periapical radiograph showing inverted –Y shape.

7-Maxillary sinus: The maxillary sinus is one of the paired paranasal sinuses. The
margin of the cavity is a thin layer of dense bone that appears as a white smooth or
irregular line. it is located above the posterior teeth on the right and left sides of the
maxilla. The sinus cavities are horizontally oblong bilateral structures with fine
radiopaque borders. The maxillary sinus may contain septa which appear as
radiopaque lines within the body of the sinus cavity.

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 Dental Radiograph and Radiology

8- The zygomatic bone (process): is the small quadrangular bone. The general
shape of the inferior border of the malar bone on the radiograph roughly resembles
the letter „U‖.

Fig(72): Periapical radiograph showing Maxillary sinus and The zygomatic bone.

9-Maxillary tuberosity :( radiopaque-light) The maxillary tuberosity is the area

distal to the third molar.

9-The hamular process (H) extends inferiorly from the medial pterygoid plate of
the sphenoid bone. This process is seen just posterior to the maxillary tuberosity of
the maxilla and extends downward.

(A) (B)
Fig(73): Periapical radiograph showing: (A) Maxillary tuberosity and (B) The hamular process.

10-coronoid process: The coronoid process is the superior aspect of the anterior
portion of the ramus of the mandible. It appears as a triangular radiopaque
structure projected into the same general area of maxillary periapical film. This is
typically due to the posterior placement of the image receptor and holder.

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 Dental Radiograph and Radiology

Fig(74): Periapical radiograph showing coronoid process.

(D).Landmarks of the mandible:

1- Lingual foramen: It set in the midline deep to the root apices of the anterior
teeth. It appears as a small radiolucent dot at the symphysis area. It usually
surrounded with a radiopaque structure.

2- Genial Tubercles: Or the superior and inferior mental spines. They are four
small bony spines located toward the inferio lingual border of the mandible
adjacent to midline; They appear as a radiopaque circle that surrounds the lingual
foramen, just below the apices of the incisors at attachment of genyoglossal muscle
and the genyohyoid muscle.

Fig(75): Periapical radiograph showing(1) lingual foramen and (2) genial turbercle.

3- Mental ridge: It is a bony prominence found on the labial aspect of the

mandible near its inferior border and extended from the premolar region to the
symphysis area. It appears as a radiopaque line below the apices of anterior teeth.

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 Dental Radiograph and Radiology

Fig(76): Periapical radiograph showing Mental ridge.

4-Mental foramen: It appears as a radiolucent ill-defined area between the apices

of the bicuspids. It represent the anterior terminates of the mandibular canal.

Fig(77): Periapical radiograph showing mental foramen.

5- Mental Fossa: It is a slight depression in the bone one the labial aspect of the
mandible. It appears as a faint radiopaque structure related to bicuspid areas.

Fig(78): Periapical radiograph showing mental fossa.

6- External oblique line: It is a bony ridge located along the facial aspect of
mandible and appears as radiopaque line extending from anterior border of the

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 Dental Radiograph and Radiology

ramus of the mandible and descends to the third molar area. It serves as attachment
point to buccinators muscle.

7- Internal oblique line: It is a bony ridge located along the lingual aspect of
mandible and appear a appears as a radiopaque line descends downward and
forward from coronoid process; in a more horizontal position; stop at the third
molar area or become continuos with the mylohyoid line. Its place below the
external oblique line.

8- Mylohyoid line or ridge: It is a radiopaque line below the external oblique line
and it is the anterior continuity of the internal oblique line. It extends downward
and forward from the ramus of the mandible to the bicuspid areas.

Fig(79): Periapical radiograph showing (1)external oblique ridge, (2) internal oblique ridge.

9- Mandibular foramen: It is a radiolucent area upon the ramus of the mandible.

10- Inferior dental canal; mandibular canal, or inferior alveolar canal. Its
characteristic image is therefore likely to be a radiolucent passage along the
mandible just deep to the roots of the teeth, terminating at the mental foramen and
bounded by radiopaque margins representing the walls of thin cortical bone
bounding the canal.

Fig(80): Periapical radiograph showing mandibular canal.

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 Dental Radiograph and Radiology

11- Submandibular gland fossa: It is a depression on the lingual aspect of the

mandible on which submandibular glands are present. It appears as a zone of
radiolucency below the lower molars.

Fig(81): Periapical radiograph showing Submandibular gland fossa.

12- Interdental nutrient canals: They are very small circular or linear
radiolucencies are often seen in the bone supporting the incisor teeth.

Fig(82): Periapical radiograph showing interdental nutrient canals.

Chapter (7): Plain extra-oral film projections

 Basic Concepts

Extra oral imaging is used to view large areas of the jaws or the skull. A variety of
projections are used in extra oral imaging, and the choice of projection depends on
what information is needed.

Frankfort plane: it is a plane extending from the bottom of the eye socket to the
top of the ear canal and aligned parallel to the floor.
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 Dental Radiograph and Radiology

The mid-sagittal plane: an imaginary plane that divides the face in half.

 Purpose and Use

The extra-oral image shows an overall view of the jaws and skull.

• To evaluate large areas of the skull, the temporomandibular joint area and jaws

• To evaluate growth and development

• To evaluate impacted teeth

• To detect diseases, lesions, and conditions of the jaws

• To examine the extent of large lesions

• To evaluate trauma

•In some cases, an extra oral projection is indicated because the patient has
swelling or discomfort and is unable to tolerate the placement of intraoral
receptors.

 Equipment

1-X-Ray Units: A standard intraoral x-ray machine may be used for some extraoral
images (e.g., lateral jaw and transcranial projections). To aid in patient positioning
and alignment of the x-ray beam, special head-positioning and beam alignment
devices can be added to the intraoral x-ray machine.

Some panoramic x-ray units may also be used for obtaining extraoral projections.
The cephalostat includes a receptor holder and head positioner, which allows the
dental radiographer to position both the receptor and the patient easily.

2-digital or film-based; the Screen film is used for extraoral exposures. The screen
lm is sensitive to the light emitted from intensifying screens

Extraoral Projection Techniques

Extra-oral projection techniques are classified by the area of interest and include:

II. Lateral jaw imaging

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 Dental Radiograph and Radiology

III. Skull imaging

IV. Temporomandibular joint imaging

I. Lateral jaw imaging:

Lateral jaw imaging does not require the use of a special x-ray unit; a
standard intraoral x-ray machine can be used. The receptor in this extra oral
projection is positioned lateral to the jaw during exposure

The following two techniques are used with lateral jaw projection:

• Body of mandible

• Ramus of mandible

1-Body of Mandible

Indication: The purpose of the lateral jaw projection— body of mandible is to

evaluate impacted teeth, fractures, and lesions located in the body of the mandible.
This projection demonstrates the mandibular premolar and molar regions as well as
the inferior border of the mandible

Film placement: The receptor is placed at against the patient’s cheek and is
centered over the body of the mandible. The receptor must also be positioned
parallel with the body of the mandible. The patient must hold the receptor in
position

Head position: The head is tipped approximately 15 degrees toward the side being
imaged. The chin is extended and elevated slightly.

Beam alignment: The central ray is directed to a point just below the inferior
border of the mandible on the side opposite the receptor. The beam is directed
upward (−15 to −20 degrees) and centered on the body of the mandible.

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 Dental Radiograph and Radiology

Fig(47): technique of body of mandible projection

2-Ramus of Mandible

Purpose: This projection demonstrates a view of the ramus from the angle of the
mandible to the condyle the lateral jaw projection—ramus of mandible is to
evaluate impacted third molars, large lesions, and fractures that extend into the
ramus of the mandible.

Receptor placement: The receptor is placed at against the patient’s cheek and is
centered over the ramus of the mandible. The receptor is also positioned parallel
with the ramus of the mandible. The patient must hold the receptor in position,
with the thumb placed under the edge and the palm placed against the outer
surface.

Head position: The head is tipped approximately 15 degrees toward the side being
imaged. The chin is extended and elevated slightly.

Beam alignment: The central ray is directed to a point posterior to the third molar
region on the side opposite the receptor. The beam is directed upward (−15 to −20
degrees) and centered on the ramus of the mandible. The beam must be directed
perpendicular to the receptor.

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Fig (48): Ramus of Mandible projection.

II- Skull Imaging: Skull imaging is used to examine the bones of the face and
skull and is most often used in oral surgery and orthodontics. Most skull
projections require the use of an extra oral x-ray unit and cephalostate.

1. Lateral Cephalometric Projection:

Purpose: The purpose of the lateral cephalometric projection is to evaluate facial

growth and development, trauma, and disease and developmental abnormalities.

A filter is placed at the x-ray source or between the patient and the receptor
to remove some of the x-rays that pass through the soft tissue of the face, thus
enhancing the image of the soft tissue pro le of the face. soft tissue outline of the
face is more readily seen when a filter is used.

Receptor placement: The receptor is placed perpendicular to the floor in a

receptor-holding device.

Head position: The left side of the patient’s head is positioned adjacent to the
receptor. The mid-sagittal plane must be aligned perpendicular to the floor and
parallel to the receptor. Frankfort plane is aligned parallel to the floor.

Beam alignment: The central ray is directed through the center of the receptor and
perpendicular to the receptor.

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Fig(49):Lateral Cephalometric Projection

a- Postero anterior Projection

Purpose: The purpose of the postero anterior projection is to evaluate facial
growth and development, trauma, and disease, developmental abnormalities,
frontal and ethmoid sinuses, the orbits, and the nasal cavity.

Receptor placement: The receptor is positioned perpendicular to the floor in a

receptor-holding device. The long axis of the receptor is positioned vertically.

Head position: The patient faces the receptor; the forehead and nose both touch the
receptor. The midsagittal plane is aligned perpendicular to the floor, and the
Frankfort plane is aligned parallel to the floor.

Beam alignment: The central ray is directed through the center of the head and
perpendicular to the receptor.

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Fig(50): Postero anterior Projection.

b- Waters Projection

Purpose: The purpose of the Waters projection is to evaluate the maxillary sinus
area. This projection also demonstrates the frontal and ethmoid sinuses, the orbits,
and the nasal cavity

Receptor placement: The receptor is positioned perpendicular to the floor in a

receptor-holding device. The long axis of the receptor is positioned vertically.

Head position: The patient faces the receptor and elevates the chin; the chin
touches the receptor, and the tip of the nose is positioned 0.5 to 1 inch away from
the receptor. The mid sagittal plane must be aligned perpendicular to the floor, and
the head is centered over the receptor.

Beam alignment: The central ray is directed through the center of the head and
perpendicular to the receptor.

Beam alignment. The central ray is directed through the center of the head and
perpendicular to the receptor.

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Fig(51):Waters Projection

d-Submentovertex Projection

Purpose: The purpose of the submentovertex projection is to evaluate fractures of

the zygomatic arch, identify the position of the condyles, demonstrate the base of
the skull. This projection also demonstrates the sphenoid and ethmoid sinuses and
the lateral wall of the maxillary sinus.

Receptor placement: The receptor is positioned perpendicular to the floor in a

receptor-holding device. The long axis of the receptor is positioned vertically.

Head position: The patient’s head and neck are tipped back as far as possible; the
vertex (top) of the skull touches the receptor.

Beam alignment: The central ray is directed through the center of the head blow
the chin of patient and perpendicular to the receptor.

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`
Fig (52): Submentovertex Projection.

Reverse Towne Projection

Purpose: The purpose of the reverse Towne projection is to identify fractures of

the condylar neck and ramus area.

Receptor placement: The receptor is positioned perpendicular to the floor in a

receptor-holding device. The long axis of the receptor is positioned vertically.

Head position: The patient faces the receptor, with the head tipped down and the
mouth open as wide as possible; the chin rests on the chest, and the top of the
forehead touches the receptor.

Beam alignment: The central ray is directed through the center of the head and
perpendicular to the receptor.

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Fig(43):Reverse Towne Projection.

e-Transcranial Projection

Purpose: The purpose of the transcranial projection is to evaluate the superior

surface of the condyle and the articular eminence. This projection can also be used
to evaluate movement of the condyle when the mouth is opened and to compare
the joint spaces (right versus left).

Receptor placement: The receptor is placed at against the patient’s ear and is
centered over the TMJ.

Beam alignment: The central ray is directed toward a point 2 inches above and 0.5
inch behind the opening of the ear canal. The beam is directed downward (a
vertical angulation of +25 degrees) and forward and is centered on the TMJ that is
being imaged.

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Fig(54): Transcranial Projection

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