II- Bite-wing Radiograph

❑It is the technique that shows

the coronal two thirds of

upper and lower teeth in one

film by single exposure.

❑It requires the patient to bite

on a small wing attached to

an intra-oral film packet.

Principle and technique:
❑It is mainly used in posterior teeth.

❑Size 2 or 3 could be used.

❑4 films (size 2) or 2 films (size 3) are used to examine the posterior

teeth.

❑The film packet and the teeth should be parallel and in contact or

as close as possible to the teeth.

❑In the vertical plane, the rays should be directed either with

zero vertical angle (perpendicular to the film) or aimed

downward by about (5-10 degree) to compensate for

upwardly rising curve of Monson.

❑In the horizontal plane, the x-ray should be aimed so that

the beam meets the teeth and the film at right angle and

passes through the contact areas.

IDEAL TECHNIQUE REQUIREMENTS:

These include:
 The tab or bite plate should be positioned on the middle of
the film packet and parallel to the upper and lower edges of
the film packet.
 The film packet should be positioned with its long axis
horizontally for a horizontal bitewing or vertically for a
vertical bitewing.
 The posterior teeth and the film packet should be in contact
or as close together as possible.
IDEAL TECHNIQUE REQUIREMENTS:
❑The patient is instructed to

close slowly, while the film is

parallel to the long axis of the

tooth, on the tab or the wing

in centric occlusion and the

rays are directed at the point

of contact between upper and

lower teeth.
Indications:
❑Detection of incipient interproximal caries.

❑Detection of interproximal calculus deposits.

❑Reveal recurrent caries below restoration.

❑Examination of the alveolar bone crest and change in bone

height.
❑ Detection of overhanging restoration.

❑ Determine the relationship between permanent teeth and

deciduous teeth.

❑ Detection of pulp stones.

❑ Detection of caries extension into the pulp.

Occlusal Techniques
It is the radiographic intra-oral
technique in which the film
packet is placed on the Occlusal
surface.
General Indications
 Large area of maxilla or mandible.
 Foreign bodies in the jaws and stones in S.G.
 Location and extent of fracture.
 Bucco-lingual extension of large lesions.
 Patients with trismus.
 Detection of un-erupted or impacted teeth.
Name of the view Maxillary (CR) V Mandibular (CR) V
angle angle

Cross section 90 -9o

Topographic view 65-70 -(45-55)

Lateral view +(60) -55

❑Types of Occlusal projections
Cross-section views
Topographic views
1- Anterior Topographic
2- Lateral (Oblique) Topographic
Cross section
Cross section(maxillary cross section

For, a true occlusal view of maxilla or cross-section

occlusal view Patient position as in maxillary
topographic view.
Film placement: the film is placed with its long axis
horizontally parallel to occlusal plane and the
same position in the patient’s mouth is repeated
as in maxillary topographic view.
Central ray: The central ray is directed perpendicular
to the centre of the film packet i.e. C.R. directed
to area of interest perpendicular to film and
parallel to long axis of the teeth so the V.A. = 90°.
Maxillary cross-section
Not recommended due
to:

• Superimposition.
• Direct radiation to
eye.
• Lack of detail
B- Cross-section Occlusal techniques:
 Also called right
angle technique.

 The central ray is

directed
perpendicular to the
film
 Mandibular cross-section
Main clinical indications
• Detection of the presence and position of
radiopaque calculi in the submandibular
salivary ducts
• Assessment of the bucco-lingual position
of unerupted mandibular teeth
• Evaluation of the bucco-lingual expansion
of the body of the mandible by cysts,
tumours or osteodystrophies
• Assessment of displacement fractures of
the anterior body of the mandible in the
horizontal plane.
Tomographic occlusal technique
A-Topographic Occlusal Techniques:
1-Anterior Topographic:
 Overall view give a gross survey of the teeth with
their roots and the arches.
Main Clinical Indications of
Topographic Occlusal Radiography
1. Periapical assessment of upper anterior
teeth.
2. Detecting the presence of unerupted
canine, supernumeraries and odontoms
3. Evaluation of the size and extent of the
lession in the anterior maxilla
4. Assessment of fracture of the anterior 
teeth and alveolar bone. •
5- Assessment of fractures of the anterior teeth
and alveolar bone. It is especially useful in
children following trauma because
filmplacement is straightforward..
Principle
 It follows the rule of bisecting-angle technique.
❑Practical steps.
 Patient position.

 Film placement.

 Cone adjustment.
 The maxillary occlusal

The maxillary pediatric occlusal projection is used to

examine the anterior teeth of the maxilla and
is recommended for use in children 5 years old or
younger (Figure-3).
1-The maxillary arch is parallel to the floor
2-The film used is size 2 with the white side facing the maxilla.
3-Position the PID so that the central ray is directed at +60
degree toward center of the film .
4-The top edge of PID is placed between the eyebrows on the
bridge of the nose.

25
 (Figure-3).

Maxillary occlusal pediatric projection.

1-The maxillary arch is parallel to the floor
2-The film used is size 2 ,.
3- the central ray is directed at +60 degree to the plane of the film .
4-The top edge of PID is placed between the eyebrows on the bridge of the nose.
2-Lateral Topographic View:
 Show half of the
alveolar ridge.

 Show the teeth from

lateral incisor to the
third molar.

 Show maxillary
tuberosity and part of
maxillary sinus.
For canine area survey:
V.A.= 60
H.A.= 45 with the mid sagital plane.
Point of entry is the canine fossa at
the infra-orbital foramen.
For sinus survey:
V.A.= 55
H.A.= 90
Point of entry is below outer canthus of the eye
Indication of upper lateral tomographic view

1. Periapical assessment of the upper posterior teeth, especially in adults

unable to tolerate periapical films
2. • Evaluation of the size and extent of lesions such as cysts, tumours or
osteodystrophies affecting the posterior maxilla
3. • Assessment of the condition of the antral floor
4. • As an aid to determining the position of roots displaced inadvertently into
the antrum during attempted extraction of upper posterior teeth
5. • Assessment of fractures of the posterior teeth and associated alveolar
bone including the tuberosity.
❑Topographic view of the mandible
Main Indication of Topographic Occlusal View
of Mandible

1. Periapical assessment of the lower incisor teeth especially

useful in adult and children unable to tolerate periapical
films
2. Evaluation of the size and extent of the lesion such as
Cysts or tumors affecting the anterior part of the
mandible
3. Assessment of Displacement, Fracture of the anterior
body of the mandible in the vertical plan
 The mandibular pediatric occlusal projection is
used to examine the anterior teeth of the mandible
and use in children 5 years old or younger (Fig 6).
1-The mandible is parallel to the floor
2-The film used is size 2
3-Position the PID: central ray is directed at -55 degree.
through the midline of the arch toward center of the
film.
4-The PID is centered over the chin .

33
Figure 6.
A, The central ray (CR) is directed at -55 degrees to the plane of the film.
B, Mandibular occlusal pediatric projection.
 Lower oblique occlusal

 Technique and positioning

1. The film packet, with the white
(pebbly) surface facing downwards, is
inserted into the mouth, on the
occlusal surfaces of the lower teeth, to
the side under investigation, with its
long axis antero-posteriorly.
2. The patient's head is supported, then rotated
away from the side under investigation and the
chin is raised. This rotated positioning allows the
subsequent positioning of the X-ray tube head.
3. The X-ray tube head is aimed upwards and
forwards towards the film from below and behind
the angle of the mandible and parallel to the
lingual surface of the mandible
 Main Indication of Lower oblique occlusal
1. Detection of radiopaque calculi in a submandibular
salivary gland
2. Assessment of the bucco-lingual position of un-
erupted lower wisdom teeth
3. Evaluation of the extent and expansion of cysts, or
tumors in the posterior part of the body and angle
of the mandible
❖Principle and technique
❖Uses of Occlusal as Extra-oral
 Symphyseal fracture (Reverse topographic)

 Stone in the Stenson’s duct of parotid gland.

 Trismus and children.

Object localization
techniques
(I) Right angle technique:
 It depends on using two views taken at right angle
to each other.
 e.g. Using a standard periapical and occlusal view
or two periapical films at right angle to each other.

Application:
 To detect stone in the Submandibular duct that
may appear superimposed on the roots of
mandibular posterior teeth and can be
misinterpreted as radiopacity related to the teeth.
 Right Angle Technique

Right Angle (Occlusal) technique

 (II) Cross-section technique:
 It is most commonly used in the mandibular objects.
 In the maxilla, it is not recommended because of
superimpositions of frontal, nasal and maxillary
bones over the image as the central ray passes through
these structures.
 Its principle depends on the use of the central ray to be
perpendicular on the film to show the bucco-lingual direction of
an object. The film is placed on the occlusal plane and the
central ray is directed perpendicular to the film.
 Application:
 Localization of direction of impacted
or un-erupted tooth.
 Localization of odontom.
 Detection of lesion extension in
bucco-lingual direction.
 (III) Clark's rule
(Buccal object rule.)
Its principle depends on the use of two periapical
radiographs with two different horizontal angulations

It uses SLOB rule (Same Lingual

Opposite Buccal)
(IV) Tube shift technique:
Its principle depends on the use of two periapical

radiograph with two different vertical angulations

  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 tube head is moved mesially (same
direction), the object is located on the lingual.

 If the image of the object moves distally when

the tube head moves mesially (opposite
direction), the object is located on the buccal.

10/24/2022 51
For the SLOB rule to work, there must be a change
in the horizontal or vertical angulation of the x-ray
beam as the tube head is moved. This change in
angulation will alter the relationship between the
object of interest and the reference object,
allowing you to determine the buccal or lingual
location.

10/24/2022 52
 ▪ Buccal and lingual
A objects shift
positions when the
direction of the x-
ray beam is
changed.
▪ A, Buccal (cross-
hatched circle) and
lingual (black circle)
objects are superim-
X-RAY BEAM posed in the original
radiograph.
▪ B, If the tubehead is

B shifted in a distal
direction, the buccal
object moves
mesially and the
lingual object moves
distally.
X-RAY ▪ (Same direction =
BEAM lingual; opposite
direction = buccal.)
Moving the tube head
without changing the
beam direction would
often result in a cone cut ,
depending on how far the
tube head is moved

10/24/2022 55
 In the diagram at right, the
tube head is moved distally
with the x-ray beam
directed more mesially
(from the distal). The object
of interest, located lingual
to the first molar, moves
distally, in the same
direction as the tube head
movement.

10/24/2022 56
Horizontal movement of the tube head and x-ray beam

incisors
canine
premolar

molar

In moving from the incisor film to the canine film, the

canine film to the premolar film and the premolar film to
the molar film, the tube head moves distally and the beam is
directed more mesially.

10/24/2022 58
 mesial
Horizontal movement

In the diagram at left, the

buccal (yellow) and lingual
(red) objects of interest are
distal 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
located above the second molar.

distal mesial

59
Vertical Tube Shift:
The SLOB rule also works for movement of the
tube head in a vertical direction. Downward
movement of the tube head requires that the
beam be directed upward and when the tube head
is moved upward, the beam must be directed
downward.
 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
tube head moves down and the beam is redirected
upward (opposite direction; decreased vertical
angulation). 61
10/24/2022
 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.

10/24/2022 62
 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.

10/24/2022 63
 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.

10/24/2022 64
 Usually when using the tube-shift
method of localization, two film are
taken of the same area using different
beam angulations.

10/24/2022 65
 lingual
buccal PID

When the tubehead is moved, with the beam angulation

redirected in the opposite direction, 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.
10/24/2022 66
Q ?
U ?
E ?
S ?
T ?
I ?
O ?
N ?
S ?