Oral Radiology Dr. Baleegh A.

Alkadasi

Intra-Oral Radiography
It is the technique where small dental films are introduced into the
mouth, and it includes:
1- Periapical radiographic
2- Bite-wing radiographic
3- Occlusal radiographic

Periapical Radiography:
Periapical radiography describes intraoral techniques designed to
show individual teeth and the tissues around the apices. Each film
usually shows two to four teeth and provides detailed information
about the teeth and the surrounding alveolar bone.
The main clinical indications for periapical radiography
include:
1- Detection of apical infection/inflammation
2- Assessment of the periodontal status.
3- After trauma to the teeth and associated alveolar bone.
4- Assessment of the presence and position of unerupted teeth
5- Assessment of root morphology before extractions
6- During endodontics
7- Preoperative assessment and postoperative appraisal of apical
surgery

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 Oral Radiology Dr. Baleegh A. Alkadasi

8- Detailed evaluation of apical cysts and other lesions within the

alveolar bone
9- Evaluation of implants postoperatively.
The ideal requirements for the position of the film packet:
The ideal requirements for the position of the film packet and the
X-ray beam, relative to a tooth, they include:
1- The tooth under investigation and the film packet should be in
contact or, if not feasible, as close together as possible
2- The tooth and the film packet should be parallel to one another.
3- The film packet should be positioned with its long axis
vertically for incisors and canines, and horizontally for premolars
and molars with sufficient film beyond the apices to record the
apical tissues
4- The X-ray tubehead should be positioned so that the beam meets
the tooth and the film at right angles in both the vertical and the
horizontal planes
5- The positioning should be reproducible.
-The anatomy of the oral cavity does not always allow all these
ideal positioning requirements to be satisfied. In an attempt to
overcome the problems, Two techniques for periapical radiography
have been developed:
1- The paralleling technique (Long-Cone Paralleling Technique)
2- The bisected angle technique (Short—cone Bisecting Angle
Technique)

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 Oral Radiology Dr. Baleegh A. Alkadasi

The Paralleling Technique:

Three different names are used for this technique:
a. Paralleling technique:
It is called so because the film is positioned parallel to the long
axis of the tooth.
b. Right angle technique:
It is called so because the central ray is directed perpendicular on
both the film and tooth.
c. Long cone technique:
It is called so because a 16 inch long cone is used during
radiography to obtain almost parallel rays.
Advantages: (compared to Bisecting Angle technique)
1. Better dimensional accuracy
2. Beam alignment simplified
3. Easier to standardize films
4. Head position not critical
Disadvantages: (compared to Bisecting Angle technique)
1. May be uncomfortable
2. Limited by anatomy

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 Oral Radiology Dr. Baleegh A. Alkadasi

Theory:
-The film packet is placed in the mouth parallel to the long axis of
the tooth under investigation.
-The x-ray tube head (CR) is then aimed at right angles (vertically
and horizontally) to both long axes of the tooth and the film
packet.
-Due to the curved anatomy of the palate and the shape of the
arches, the tooth and the film packet cannot be both parallel and in
contact. So the film packet has to be positioned some distance from
the tooth using a film holder.
To prevent the magnification of the image and the loss of
sharpness of the film due to increasing the film-object distance we
need:
A parallel non-diverging, x-ray beam is required, this is achieved
by having a large focal spot to skin distance (increase target film
distance) by using a long cone (16 inch) on the x-ray set, and
parallel rays will be obtained providing a sharper and clearer
image.
A smaller source of x-ray beam is required; this is achieved by

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 Oral Radiology Dr. Baleegh A. Alkadasi

using a collimator with a smaller aperture.

By using a film holder with fixed film packet and x-ray tube head
positioning device, the technique is reproducible and thus any
geometric variations during exposure are avoided.
Film packet holders
It is a device used to hold the film in place in order to achieve
parallelism between the film and the tooth.
A variety of holders has been developed for this technique. The
choice of holder is a matter of personal preference — the Rinn
XCP® holders being favoured by the author.
The different holders vary in cost and design but essentially
consist of three basic components:
1- A mechanism for holding the film packet parallel to the
teeth that also prevents bending of the packet
2- A bite block or platform
3- An X-ray beam-aiming device.

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 Oral Radiology Dr. Baleegh A. Alkadasi

Advantages:
- Avoid exposure of patient's finger and are essential in the
paralleling technique.
Disadvantages:
- Closure of mouth before exposure prevents the operator from
checking the film position. In addition the film sometimes cannot
extend far enough beyond the apical region to allow examination
of periapical tissues.

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 Oral Radiology Dr. Baleegh A. Alkadasi

Positioning techniques
The radiographic techniques for the permanent dentition can be
summarized as follows:
The appropriate holder and size of film packet are selected. For
incisors and canines (maxillary and mandibular) an anterior holder
should be used and a small film packet with its long axis placed
vertically. For premolars and molars (maxillary and mandibular)
we use a posterior holder (right or left as required) and a large film
packet with its long axis placed horizontal.
The patient is positioned with the head supported and with the
occlusal plane horizontal.
The holder and film packet are placed in the mouth.
The patient is requested to bite gently together, to stabilize the
holder in position, with the teeth and the film being parallel to each
other.
The long cone is aligned with the location ring. This automatically
sets the vertical and horizontal angles and centres the x-ray beam
(C.R) onto the film packet and the tooth at right angle to the long
axis of the tooth and the film

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 Oral Radiology Dr. Baleegh A. Alkadasi

- Cotton rolls may be used in any area of the mouth to help support
the biteblock, especially if an edentulous region opposes the teeth
being radiographed. Often makes it more comfortable for the
patient. The cotton roll should be placed against the arch opposite
the one being radiographed.
Maxillary Central-lateral
Film centered on contact between central and lateral incisors.
Make sure mesial edge of film crosses midline slightly. Film
should be placed well
back in the mouth, away
from the teeth

Maxillary Canine
Film centered on
canine. Film should be
placed well back in the
mouth, away from the
teeth.

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 Oral Radiology Dr. Baleegh A. Alkadasi

Maxillary Premolar
Film positioned so that
anterior edge is at least in the
middle of the canine, or more
anterior if possible.
Approximately centered on
2nd premolar. Top edge of
film in center of palate.

Maxillary Molar
Film centered on second
molar. Top edge of film in
center of palate.

Mandibular incisor
Film centered on midline.
Film should be placed away
from the teeth as much as
possible.

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 Oral Radiology Dr. Baleegh A. Alkadasi

Mandibular Canine
Film centered on canine.
Film should be placed away
from the teeth as much as
possible.

Mandibular Premolar
Anterior edge of film is positioned at least in the middle of the
canine, or more anterior if
possible. Approximately
centered on 2nd premolar.
The film should be placed
more toward the middle of
the mouth, away from the
teeth.
This is usually the most
uncomfortable film taken on a patient using the paralleling
technique.
Mandibular Molar
Film centered on second
molar. Film may be placed
next to the teeth.

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 Oral Radiology Dr. Baleegh A. Alkadasi

Bisecting Angle Technique

Theory:
-The theoretical basis of the bisected angle technique can be
summarized as follows:
- The film packet is placed as close to the tooth under investigation
as possible without bending the packet.
- The angle formed between the long axis of the tooth and the long
axis of the film packet is imaginary bisected by an imaginary line
called the "bisector"
- The x-ray tube head is positioned at right angles to this bisecting
line with the central ray of the x-ray beam aimed through the apex
of the tooth.
- Using the geometrical principle of similar triangles, (rule of
isometry) the actual length of the tooth in the mouth will be equal
to the length of the image of the tooth on the film.

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Oral Radiology Dr. Baleegh A. Alkadasi

Advantages: (compared to Paralleling technique)

1. More comfortable
2. No anatomical restrictions
3. Film holder not essential
4. Positioning Techniques
Disadvantages: (compared to Paralleling technique)
1. Images distorted
2. Harder to position beam
3. Film less stable
Positioning Techniques
A. Patient Position:
- The patient should sit up right in the chair.
- The median sagittal plane should be perpendicular to the
plane of the floor.
- The occlusal plane of the teeth being examined should be
parallel to the floor.
For the maxilla: the ala-tragus line should be parallel to the
floor.
- For the mandible: a line from the tragus to the corner of the
mouth should be parallel to the floor i.e. the patient tilts his head
backwards in such position the occlusal plane of the mandibular
teeth is parallel to the floor when the patient opens his mouth.
- Any metallic appliance in patient's mouth should be removed;
eye glasses, earrings, hairpins.

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 Oral Radiology Dr. Baleegh A. Alkadasi

Film Position and Placement:

-The pebbled surface of the film packet should be towards the
tube.
- Avoid excessive bending of the film otherwise distortion of
the image may occur. Slight bending of the corner of the packet
may be allowed in some areas e.g. mandibular premolar region
to relief patient discomfort.
-The patient is then asked to gently support the film packet
using either an index finger or thumb.
-The teeth being examined should be in the centre of the film.
- In the molar and premolar regions the film is placed with it is
long dimension parallel to the occlusal surface while in anterior
teeth the short dimension is parallel to the occlusal surface.
- About 2 to 3 mm (1/4 inch) of the film packet should be left
visible beyond the occlusal plane.
- The patient holds the film with the finger of the hand of the
opposite side, the thumb for maxillary and the index finger for
mandibular teeth.
- Avoid movement of the film, patient or cone (not to obtain a
blurred image).
- The printed dot should be incisally to avoid its superimposition
on the apices.

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 Oral Radiology Dr. Baleegh A. Alkadasi

Angulations during Bisected Angle

Technique: 1- The vertical angulation:
Determines the accurate length of the tooth.
It is the angle made between (CR) and occlusal plane.
It is determined by the movement of the tube head up and down.
a. Vertical angle +ve When the CR is directed from above the
occlusal plane downwards; as for all maxillary teeth.
b. Vertical angle -ve: When the cone is directed from below the
occlusal plane upwards as for mandibular teeth.

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 Oral Radiology Dr. Baleegh A. Alkadasi

c. Zero degree (0) or zero plane:

The cone (CR) would be parallel to the floor.

Average vertical angulations:

It is the angle between the CR and occlusal plane
Average vertical angulation for each region in both jaws.

Teeth ( +ve) maxilla (-ve) mandible

Incisors 40 ° 15 °

Canine 45° 20°

Premolar 30° 10°

Molar 20° 5°

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 Oral Radiology Dr. Baleegh A. Alkadasi

N.B.: Vertical angulation may be slightly changed depending on

anatomical variety.
The Angle is increased by 5 in cases of:
Flat palate vault.
Flat ridge in edentulous mouths.
Shallow floor of the mouth.
Children with arches not fully developed.
Buccally inclined teeth.
The Angle is decreased by 5 in cases of:
High vault.
Deep floor of the mouth.
Horizontal angulation
-The horizontal position of the tube is perpendicular to the mean
tangent of the teeth and parallel to interproximal surface of the
teeth and the C.R pass precisely through the contact area of the
teeth.
- It is responsible for mesiodistal dimension of the teeth such that
there is no superimposition or overlapping of teeth on each other
horizontally.

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 Oral Radiology Dr. Baleegh A. Alkadasi

Maxillary teeth
The line of orientation upon which are located the points of entry
of the CR is the ala-tragus line (it is the line where the apices of
maxillary teeth are positioned).
Incisors: Tip of the nose.

Canine: 5 mm distal to the

ala of the nose.

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 Oral Radiology Dr. Baleegh A. Alkadasi

Premolars: Vertical
line down from the
middle of the eye to the
ala- tragus line.

Molars:
-For the first molar a vertical line drown from the outer canthus of
the eye to the ala-tragus line.
-For the second molar one cm. distal to the canthus of eye to
the ala-tragus.
-for the third molar 2 cm distal to canthus of eye to the ala-tragus.

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Oral Radiology Dr. Baleegh A. Alkadasi

Mandibular teeth
The same landmarks used for maxillary teeth are used for the
lower jaw but the line of orientation is 0.5 cm above the lower
border of the mandible.

Mandibular incisors:

Mandibular canine:

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Oral Radiology Dr. Baleegh A. Alkadasi

Mandibular premolars:

Mandibular molar:

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