INTRAORAL
RADIOGRAPHY
Introduction
● Radiography is an essential diagnostic tool in dentistry.
● Intraoral radiographs are films/sensors placed inside the mouth.
● They help in diagnosis of caries, periapical pathology, bone loss, impacted teeth,
and root morphology.
● Definition:
Intraoral radiography is a technique in which the radiographic film or digital sensor
is placed inside the oral cavity to obtain images of teeth and surrounding structures.
PERIAPICAL RADIOGRAPH
A periapical radiograph shows:
● The entire tooth From crown to
root apex
● Along with the surrounding
periapical and alveolar bone
Indications (Implications) of Periapical Radiography
1 Related to Teeth
Dental caries (especially deep caries)
Pulp infections (irreversible pulpitis)
Periapical infections
Developmental anomalies
Fractures
Regressive alterations
Presence of unerupted tooth
Other conditions:
Pulp stones, Hypercementosis,Unerupted teeth position
2 During Treatment
● Working length determination in RCT
● Assessment before, during, and after endodontic treatment
● Before extraction to check root morphology
3 Related to Alveolar Bone
● Periodontal bone loss
● Changes in lamina dura
● Trauma to alveolar bone
4 Related to Surrounding Bone
● Detection of cysts, Tumors
PARALLELING TECHNIQUE
● Film/Sensor is kept parallel to the long axis of the tooth
● X-ray beam is directed perpendicular to both tooth and film
Also called:
● Long cone technique
● Extension cone paralleling technique (XCP)
PRINCIPLE
● Film is placed parallel to the tooth
● X-ray beam is directed at right angle (90°) to:
● Tooth
● Film
● To achieve parallelism:
● Film is kept slightly away from the tooth
● Long cone is used to increase focal spot–film distance
This reduces magnification and distortion
DISADVANTAGES
● Film placement may be uncomfortable
● Can cause gag reflex
● Difficult in patients with:
● Shallow palate
● Small mouth
● Holder placement may be difficult for beginners
● Slightly more time-consuming
BISECTING ANGLE
TECHNIQUE
●Also called Short Cone Technique
●Film is placed close to the tooth
●X-ray beam is directed towards the bisecting line
PRINCIPLE
● Based on Cieszynski’s Rule of Isometry
● If two triangles have:
● Two equal angles
● One common side
They are equal in size
● Aim: To make the image of the tooth same size as real tooth
Steps in Taking Periapical
Radiography
1 Proper Positioning of Patient
● Explain procedure to patient
● Seat patient upright in chair
● Adjust chair to comfortable working height
● Support head with headrest
● Place lead apron with thyroid collar
● Remove dentures, spectacles, retainers
● 2 Proper Evaluation of Target Area
● Examine complete oral cavity
● Identify correct tooth/region
● Plan correct film placement
● Proper evaluation prevents retakes
Reduces unnecessary radiation exposure
3 Placement of Film
● White side of film faces teeth
● Anterior teeth Film placed vertically
● Posterior teeth Film placed horizontally
● Identification dot Toward occlusal surface
● Centre film over area to be examined
● 4 Head Orientation
● Arch being radiographed Parallel to floor
● Midsagittal plane Perpendicular to floor
Maxillary projection:
● Ala-tragus line parallel to
floor
Mandibular projection:
● Line 1 cm above lower
border of mandible parallel to
floor
5 Tube Head Positioning
● Adjust vertical angulation (tilt up & down)
● Adjust horizontal angulation
● Direct X-ray beam at correct point of entry
Vertical Angulation in Periapical Radiography
● Vertical angulation is determined by imaginary bisecting line between the
tooth and the film
(According to Cieszynski’s rule)
● Angulation is checked using the angle meter on the tube head.
Direction of Angulation
Maxillary teeth
● Tube head directed downward
● Called Positive angulation (+)
Mandibular teeth
● Tube head directed upward
● Called Negative angulation (−)
Teeth Maxillary Angulation Mandibular Angulation
Incisors +40° −15°
Canines +45° −20°
Premolars +30° −10°
Molars +20° −5°
Horizontal Angulation
Definition
● Horizontal angulation refers to side-to-side positioning of the tube
head.
Key Points
● Horizontal angulation should be 0°
● No tilting of tube head to right or left
● X-ray beam should pass through contact areas at 90°
● Incorrect angulation causes:
Overlapping of teeth
Unclear interproximal areas
BITEWING RADIOGRAPHY
● A type of intraoral radiography
● Shows crowns of upper and lower teeth together in one radiograph
Why called Bitewing?
● Patient bites on a wing/tab (bite loop or bite tab)
● The tab holds the film in correct position
Mainly used to detect:
● Proximal caries
● Interdental bone levels
● Recurrent caries
Film Sizes in Bitewing
Size Dimensions (mm) Indication
0 22 × 35 Posterior teeth in small children (<5 yrs)
Anterior adults & posterior children (5–9
1 24 × 40
yrs)
2 31 × 41 Posterior teeth in adults (>9 yrs)
3 27 × 54 All posterior teeth on one side
Advantages
● Simple and inexpensive
● Disposable tabs Less contamination
● XCP holder reduces overlapping
● Shows 4–6 teeth in one film
● Reduces patient exposure
Disadvantages
● Film dislodgement if manual tab used
● Overlapping if beam not centered through contact areas
OCCLUSAL RADIOGRAPHY
● This technique is used to examine large areas of the upper
and lower jaw.
Indications
● To locate retained roots of extracted teeth.
● To locate supernumerary, unerupted or impacted teeth (especially impacted canine and
third molars).
● To locate foreign bodies in the maxilla or mandible.
● To locate salivary stones in the duct of the submandibular gland.
● To locate and evaluate the extent of lesions (e.g., cysts, tumors, malignancies) in the maxilla
or mandible. It is especially indicated to determine the mesial and lateral extent of the
lesion and its extent on the palate.
● To evaluate boundaries of the maxillary sinus (anterior, mesial and lateral outline).
● To evaluate fractures of the maxilla and mandible (location, extent and displacement).
● To aid in the examination of patients who cannot open their mouths more than a few
millimeters, or in adults and children who are unable to tolerate periapical films.
● To examine area of cleft palate.
● To measure changes in the size and shape of the maxilla and mandible.
● Classification of Occlusal Views
I. Maxillary
● Cross-sectional
● Topographic
i. Anterior
ii. Posterior/lateral
II. Mandibular
● Cross-sectional
● Topographic
i. Anterior
ii. Posterior/lateral
Basic Principle
● Film is positioned with the white side facing the arch that is being
exposed.
● Film is placed in the mouth between the occlusal surfaces of the
maxillary and mandibular teeth.
● The film is stabilized when the patient gently bites on the surface
of the film.
● For maxillary occlusal films, the patient’s head must be positioned
so that the upper arch is parallel to the floor and the midsagittal
plane is perpendicular to the floor.
● For mandibular occlusal films, the patient’s head must be reclined
and positioned so that the occlusal plane is perpendicular to the
floor.
Object Localization
Introduction
● Object localization refers to methods used to determine the
buccolingual position (depth) of a tooth, foreign body, or anatomical
structure within the jaws.
● A dental radiograph produces a two-dimensional image of a three-
dimensional object. While it shows the mesiodistal and superoinferior
relationships, it fails to demonstrate the buccolingual dimension.
● Localization techniques are therefore used to overcome this limitation
and obtain three-dimensional information.
1. Right-Angle Technique
Principle
● Two radiographs are taken at right angles (90°) to each other to obtain
three-dimensional information.
One radiograph is usually:
● A periapical view
The second radiograph is:
● An occlusal view (cross-sectional)
● By comparing the position of the object in both views, its buccolingual
location can be determined.
2. Tube-Shift Technique
(Buccal Object Rule / Clark’s Rule)
Principle
● The relative position of the radiographic images of two objects
changes when the projection angle is altered.
● When the X-ray tube is shifted, the image of the object moves relative
to a reference structure.
SLOB Rule
● S = Same Lingual
O = Opposite Buccal
● If the object moves in the same direction as the tube shift it is
lingual.
● If the object moves in the opposite direction it is buccal.
PRINCIPLE OF PROJECTION GEOMETRY