RADIOLOGY: BISECTING TECHNIQUE
Supervised by: Lusi Epsilawati., drg
By KPBI GROUP 2:
Yong Ker Loon Nirossha.S Suganya.M Uthaiya Githa .S - 160110083006 - 160110083008 - 160110083009 - 160110083011
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Introduction:
Other name: bisecting angle technique, bisection-of-the-angle technique and short cone technique. Used to expose periapical films.
Terminology:
Angle: a figure formed by two lines diverging from a common point. Bisect: to divide into two equal parts. Isometry : equality of measurement. Long axis of the tooth: an imaginary line that divides the tooth longitudinally into two equal halves. Central ray: the central portion of the primary beam of x-radiation.
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Principles:
Based on a geometric principle of bisecting a triangle or the RULE OF ISOMETRY. The rule of isometry states that two triangles are equal if they have two equals angles and share a common side.
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The film must be placed along the lingual surface of the tooth. When the film contacts the tooth, the plane of the film and the long axis of the tooth form an angle. Visualize a plane that divides in half or bisect, the angle formed by the film and the long axis of the tooth: imaginary bisector. The imaginary bisector creates two equal angles and provides a common side for the two imaginary equal triangles.
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The dental radiographer must then direct the central ray of the x ray beam perpendicular to the imaginary bisector. The hypotenuse of one imaginary triangle is represented by the long axis of the tooth, the other hypotenuse is represented by the plane of the film.
Film Stabilization:
There are two methods: using film holder and finger holding method. Used to position an intraoral film in the mouth and retain the film in position during exposure. Film holders are recommended: reduces the patients exposure to radiation.
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Film Holder:
Examples of intraoral film holders: a) Rinn Bisecting Angle Instruments (BAI) b) EEZEE-Grip film holder or Snap-A-Ray c) Stabe bite block
Finger Holding:
Known as the digital method: patients thumb or finger is used to stabilize the periapical film and always placed at lingual side of the teeth. Always use the hand opposite to the side of the mouth being radiographed.
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The DISADVANTAGES in this method is: a) Patients hand is in the path of the primary beam, resulting in UNNECESSARY RADIATION. b) Patients may use excessive force to stabilize the film, causing the film to bend and resulting in IMAGE DISTORTION. c) Patient may allow the film to slip from its position, resulting in INADEQUATE EXPOSURE of the prescribed area. d) Without the film holder with aiming ring, the dental radiographer may align incorrectly, causing a PARTIAL IMAGE OR CONE CUT.
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Film Placement:
Usually, size 2 intraoral film is used. Anterior region: film is always placed in the vertical or upright direction. Posterior region: film is always placed in the horizontal or sideways direction.
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Angulation:
Angulation: alignment of the central ray of the x-ray beam in the horizontal and vertical planes. Angulation can be changed by moving the position indicating device (PID) in either a horizontal or vertical direction.
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Angulation:
MAXILLA VERTICAL ANGULATION INCISORS CANINE PREMOLARS MOLARS
55 0
INCISORS
50 45
CANINE
40 75
PREMOLARS
35 90
MOLARS
HORIZONTAL ANGULATION
MANDIBULA VERTICAL ANGULATION HORIZONTAL ANGULATION
-25 0
-20 45
-15 75
-5 90
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Horizontal Angulation:
Positioning of the tubehead and direction of the central ray in a horizontal or side-toside plane. Remains the same in both paralleling or bisecting technique.
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Horizontal Angulation:
CORRECT horizontal angulation: the central ray is directed perpendicular to the curvature of the arch and through the contact areas of the teeth. INCORRECT horizontal angulation results in overlapped (unopened) contact areas cannot be used to examine the interproximal areas of the teeth.
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Vertical Angulation:
Positioning of the tubehead and direction of the central ray in a vertical or up-and-down plane. Differs according to the radiographic technique being used.
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Vertical Angulation:
With the paralleling technique, the VA of the central ray is directed perpendicular to the film and the long axis of the tooth. With the bisecting technique, the vertical angulation of the central ray is directed perpendicular to the imaginary bisector.
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Vertical Angulation:
CORRECT vertical angulation results in a radiographic image that is the same length as the tooth. INCORRECT vertical angulation results in an image that is not the same length as the tooth being radiographed. The image appears either elongated or foreshortened.
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FORESHORTENED
ELONGATED
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BASIC RULES
Film placement Film position Vertical angulation Horizontal angulation Film exposure
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1. Patient should be seated 2. Briefly explain the radiograph procedure 3. Position the patient upright in the chair. The level of chair must be adjusted to a comfortable working height for the dental radiograph 4. Adjust the headrest to support the patients head. 5. Place and secure the lead apron with thyroid collar over the patient 6. Remove all objects from the patients mouth (dentures, retainers, chewing gum) that may interfere with film exposure. Eyeglasses must also be removed
1. Set the exposures factors (kilovoltage, milliamperage & time) on the x-ray unit 2. Either a short (8-inch) or long (16-inch) cone may be used. Typically the short cone is preferred.
Exposure sequence for film placements
1. When exposing periapical films always START with the anterior teeth (canines and incisors) 2. The reason; anterior placements are less likely to cause the patient to gag 3. With size 2 film, a total of 6 anterior film placement are used in this bisecting technique
Sequence;
1. Begin with the maxillary right canine 2. Expose all the maxillary anterior teeth from right to left 3. End with the maxillary left canine 4. Next, mandibular arch. Begin with mandibular left canine 5. Expose all the mandibular anterior teeth from left to right 6. Finish with the mandibular right canine
Posterior;
In each quadrant, always expose the premolar film first and then molar film 8 posterior film placement are used in the bisecting technique (4 maxillary and 4 mandibular exposures)
Sequence;
1. Begin with maxillary right quadrant 2. Expose the premolar film first then the molar film 3. Move to mandibular right quadrant 4. Expose the premolar film first then the molar film 5. Move to maxillary left quadrant 6. Expose the premolar film first then the molar film 7. Finish with the mandibular left quadrant 8. Expose the premolar film first then the molar film
Maxillary Canine Exposure
1.Center the film packet on the canine
3. Instruct the patient to slowly close on the bite block
2. Position the lower edge of the film parallel to the occlusal plane so that 1/8 inch extends below the incisal edge of the canine
4. Vertical angulation=50, horizontal angulation=45 5. Expose the film
THE ENTIRE CROWN AND ROOT OF THE CANINE MUST BE SEEN. THE INTERPROXIMAL ALVEOLAR BONE AND MESIAL CONTACT OF THE CANINE MUST ALSO BE VISIBLE.
Maxillary Incisors Exposure
1.Center the film packet on the contact between the 2 central incisors
3. Instruct the patient to slowly close on the bite block
2. Position the lower edge of the film parallel t the occlusal plane so that 1/8 inch extends below the incisal edge of the canine
4. Vertical angulation=55, horizontal angulation=0 5. Expose the film
ENTIRE CROWN AND ROOTS OF ALL FOUR MAXILLARY INCISIORS MUST BE SEEN. THE INTERPROXIMAL ALVEOLAR BONE BETWEEN CENTRAL.I AND C.I AND L.I MUST ALSO BE VISIBLE
Mandibular Canine Exposure
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Central film
Upper edge of film parallel to occlusal plane 2 1/8 inch extends above the incisal edge of canine. Central ray is perpendicular to the imaginary bisector. X ray 4 vertical angulation (-20) horizontal angulation (45)
Instruct patient to slowly close on to a bite block or film holder. 3
RESULTS
Clearly seen crown, root, periodontal membrane, lamina dura, periapical, alveolar bone
Mandibular Incisor Exposure
Central film
Upper edge of film parallel to occlusal plane 2 1/8 inch extends above the incisal edge of canine.
Central ray is perpendicular to the imaginary bisector. X ray vertical angulation (-25) horizontal angulation (0) 4
RESULTS
Instruct patient to slowly close 3 on to a bite block or film holder.
Clearly seen crown, root, periodontal membrane, lamina dura, periapical, alveolar bone
Maxillary Premolar Exposure
Central film 1
Lower edge of film parallel to occlusal plane 1/8 inch extends above the incisal edge of canine.
Central ray is perpendicular to the imaginary bisector. X ray vertical angulation (40) 4 horizontal angulation (75)
RESULTS
Instruct patient to slowly close 3 on to a bite block or film holder. Clearly seen crown, root, periodontal membrane, lamina dura, periapical, alveolar bone
Maxillary Molar Exposure
Central film 1
Lower edge of film parallel to occlusal plane 1/8 inch extends above the incisal edge of canine.
Central ray is perpendicular to the imaginary bisector. X ray vertical angulation (35) 4 horizontal angulation (90)
RESULTS
Instruct patient to slowly close 3 on to a bite block or film holder. Clearly seen crown, root, periodontal membrane, lamina dura, periapical, alveolar bone
Mandibular Premolar Exposure: Bisecting Technique
Center the film holder and film packet on the 2nd premolar
Position the upper edge of the film to the occlusal 1/8 inch extending.
Correct vertical angulation
Slowly close on the film holding device
Correct horizontal angulation
Position the PID
Mandibular Molar Exposure: Bisecting Technique
Center the film holder and film packet on the 2nd molar
Position the upper edge of the film to the occlusal 1/8 extending.
Slowly close on the film holding device
Position the PID
Correct horizontal angulation
Correct vertical angulation
Expose the film
Mandibular Incisor Exposure: Finger Holding Method
Center the film packet btwn 2 central incisor
Position the upper edge of the film to the occlusal 1/8 extending.
Instruct patienthold the film using the index finger of either hand.
Correct horizontal angulation
Correct vertical angulation
Exert light but firm pressure in the area whr the teeth meet gingival tissue
Position the PID
Expose the film
Maxillary Premolar Exposure: Finger Holding Technique
Center the film packet on the 2nd premolar.
Position the upper edge of the film to the occlusal 1/8 extending.
Instruct patient- hold the film using the thumb opposite the side the film is placed.
Correct horizontal angulation
Correct vertical angulation
Exert light but firm pressure in the area whr the teeth meet gingival tissue
Position the PID
Expose the film
Advantages of Bisecting Technique
It can be used without a film holder when the anatomy of the patient precludes the use of a film-holding device. Decreased exposure time.
Disadvantages of Bisecting Technique
Image distortion Angulation problems Unnecessary exposure
