Intraoral Radiographic Procedures

Question 1

Full mouth examination

Answer 1

No dental examination is complete without radiography and almost all cases the full mouth survey is most preferred technique.

The dentists cannot see beneath the gum tissue. Radiographs are use to detect disease, foreign objects and retained roots.

Intraorl full mouth survey (fMS or FMX):: consists of 18-20 intraoral exposure, typically containing 16 periodical and 4 bite wing radiographs.

periodical: Radiograph that shows the desired teeth and surrounding area.

In average adult, a full mouth series connsists of 18 to 20 films. Generally there are 14 periodical and four to six bite wings, but the number can vary.

Question 2

Intraoral X-ray techniques

Answer 2

two techinqes for obtaining periodical radiographs:

• paralleling
• Bisection of angle

American academy of oral and maxillofacial Radiology and American association of dental school, recommend the use of the paralleling technique because it provides the most accurate image. In same situations the operator might have to use the bisection technique.

Steps for periodical:
- Ensure the operatory has all protective barriers in place.

• Label a paper cup with the patient’s name and data. Use this as transfer cup for storing and moving exposed film.
• Turn on the x-ray machine and check the basic setting.

-wash and dry hands
- set aside the desired number of film and store then outside the r-ray room.

• Seat the patient comfortably in the dental chair, with the check in an upright position and head supported.
• Ask the patient to remove eyeglasses and bulky earring or oral piercings.
• have the patient take out removable oral prosthetic appliances.
• explain the process to patient
  -place the lead apron and thyroid collar.

-position the patient with occlusal plane of the jaw being radiography parallel to the floor when the mouth is in the open position.

-Wash and dry your hands and put on clean examination gloves.

Question 3

Paralleling techniqe

Answer 3

Paralleling techniqe: x-ray film packet is placed lingual to tooth, centering on the tooth needed, with film extending to the coronal and apical areas of the tooth.

Rules:

• Flim placement: will cover the teeth.
• Film position: film parallel to long axis of the tooth. the film in the film holder must be placed qway the teeth and toward the middle of the mouth.
• Vertical Angulation: dirct central ray of x-ray of the x-ray beam perpendicular to the film and the long axis of the tooth.

Horizontal Angulation: direct the cental x-ray beam through the contact area between the teeth.

Central ray: center the r-ray beam on the film to ensure that all areas of the film are exposed.

Question 4

Vertical Angulation:

Answer 4

positioning of the PID in vertical or up and down plane.

• with the parealleling technique the Vertical Angulation of the central ray os directed perpendicular tot he film and long axis of the tooth.
• with the bisecting technique, Vertical Angulation: is determined by imaginary bisector: the central ray is directed perpendicular to the imaginary bisector.

Correct Vertical Angulation results in a radiographic image that is the same length as the tooth being radiographed.

The image appears elcongated (longer)or foreshortened (shorter)

Question 5

Horizontal Angulation:

Answer 5

Horizontal Angulation: positioning of the tub head and direction of the central ray in ta horixontal (side by side plane.

Horizontal Angulation same for both paralleling and bisecting technique.
If done incorrectly the angulation will result in the overlapped cotact area. The film overlaped contact areas cannot be used to examine the inter-proximal area of the teeth.

Question 6

Tips using paralleling technique

Answer 6

The x-ray must pass through the contact area of the premolars. if the central ray (CR) is not directly through the contracts, overlap occurs. The dentist must be able to see the contract area without overlapping.

Question 7

Exposure sequence

Answer 7

when exposing radiographs, establish an exposure sequence or definite order, for periodical film placement.

without an exposure sequence there is good chance that area will be missed or sam area will be missed or same area will be exposed twice.

When exposing periapical film with the paralleling technique, always start with anterior tooth because

• size 1 film used for anterior is small, less uncomfortable and easier for patient to tolerate.
• easier for the patient to become accustomed to the anterior dilm holder
• anterior film placement are less likely to cause the patient to gag.

Question 8

Recommended Anterior exposure sequence

Answer 8

After completing anterior teeth being the posterior teeth. Aways expose the premolar film before the molar film because:

• premolar film placement is easier for patient to tolerate than molar film placement
• premolar exposure is less likely to evoke the gag reflex
• begin with maxillary right canine (tooth 6). expose all the maxillary anterior teeth from the right to left
• end with maxillary let canine tooth 11
• next, move to the mandibular arch

*begin with the mandibular left canine tooth 22

• expose all the mandibular anterior teeth from left to right
• finish with mandibular right canine tooth 27

Question 9

Periapical radiograph

Answer 9

Periapical radiograph shows the entire tooth from occlusal surface or incisal edge o 2 to 3 mm beyond the apex to show the periapical bone.

The Periapical radiograph is used to diagnose pathologic conditions of the tooth, rot, and bone, as well as tooth formation and eruption. Periapical view are essential endodontic and oral surgery procedures.

Question 10

Maxillary canine region

Answer 10

exposing the maxillary canine region involves four steps

• step1: insert the number 1 film packet vertically into the anterior bite block

-step2: position the film packet with the canine and the first premolar centered position the film as far to the posterior as possible.

-step3: With the film holding instrument and film in place instruct the patient to close his or her mouth slowly but firmly.

-step4: position the localizing ring and PID then expose the film

Question 11

Maxillary central/lateral incisor region

Answer 11

to expose the maxillary centeral/lateral incisor region follow these steps

1. inset the number 1 film packet vertically into the anterior bit block
2. center the film packet between the central and lateral incisors and place the film as far to the rear of the mouth as possible
3. position the localizing ring and PID; then expose the film

Question 12

Mandibular canine region

Answer 12

To expose the mandibular canine region follow these steps

1. Inset the number 1 film packet vertically into the anterior bit block.
2. center the film on canine. Position the film as far in the lingual direction as the patient will allow.
3. place a cotton roll between the maxillary teeth and bite block to prevent rocking of the bits block canine tip and to increase patient comfort.

Question 13

Mandibular incisor region

Answer 13

to expose the mandibular incisor region follow these steps

1. Insert number 1 film packet vertically into the anterior bit-block
2. center the film packet between the central and lateral incisors and position the film as far in the lingual direction as the patient will allow
3. with the instrument and film in place, instruct the patient to close his or er mouth slowly but firmly.
4. position the localizing ring and PLD, then expose the film.

Question 14

maxillary premolar region

Answer 14

to expose the maxillary premolar region:

1. insert the film packet horizontally into the posterior bit block, pushing the film packet all way into the slot
2. ceneter the film packet on second premolar. Position the film in the mid palatal area
3. with the instrument and dilm in place, instruct the patient to close his or her mouth slowly but firmly
4. position the localizing ring and PID then expose the film

Question 15

maxillary molar region

Answer 15

to expose the maxillary molar region follow these steps

1. Insert the film packet horizontally into the posterior bite-block.
2. center the film packet on the seond molar. Position the film in the mid palatal area.
3. with the instrument and silm in place, instruct the patient to close his or her mouth slowly but firmly
4. Positio the localizing ring and PID then expose the radiograph.

Question 16

Mandibular premolar regins

Answer 16

to expose the mandibular premolar region follow these steps

1. Insert number 1 film packet horizontally into the posterior bit-block
2. center the film packet between the contact point between the second premolar and first molar.position the film as far in the lingual direction as the patient’s anatomy will allow.
3. with the instrument and film in place, instruct the patient to close his or er mouth slowly but firmly.
4. slide the localization ring down the indicator rod to the patient’s skin
5. position the localizing ring and PLD, then expose the film.

Question 17

Mandibular molar region

Answer 17

to expose the mandibular molar region follow these steps

1. Insert number 2 film horizontally into the posterior bit-block
2. center the film packet on the second molar. position the film as far in the lingual direction as the tongue will allow. This position will be closer to the teeth than that for premolar and anterior view
3. with the instrument and film in place, instruct the patient to close his or er mouth slowly but firmly.
4. slide the localization ring down the indicator rod to the patient’s skin
5. position the localizing ring and PLD, then expose the film.

Question 18

The bisecting technique

Answer 18

The bisecting of the angle technique is based on a geometric principle of bisecting a triagle. The angle formed by the ling axis of the teeth and film is bisecting and the x-ray beam is directed prependicular to the bisecting line. Unlike paralleling in which the film is placed away from the teeth , bisecting angle places the film directly aginst the teeth. One disavantage of this approach is that the images might be distorted.

patient should never be asked to hold the film with their finger to stabilize the film in the mouth. The practice exposes the patient’s hand and finger to unnecessary radiation.

The x-ray bean is directly to pass between the contacts of the teeth being radiographed in horizantal dimension, just as it does in the paralleling radiographyed in the horixontal dimension, just as it does in the paralleling technique. The vertical angle, however, must be directed at a paralleling technique. The vertical angle, however, must be directed at a 90 degree angle to the imaginary bisecting line for the following reasons:

• Too much vertical angulation will produce images that are foreshortened
• too litter vertical angulation will result in images that are elongate
• the beam must be centered to help prevent cone cutting.

Question 19

Bite wing technique film placement

Answer 19

the film is position
(with either a bite tab or a film holding device) parallel to the crown of the both upper and lower teeth, and central ray is directed perpendicular to the film.

The premolar bite-wing radiograph include the distal half
of the crowns of the canines, both premolars, and often the first molars on both the maxilliay and manibuar arches. be sure that the patient’s occlusal plane is parallel to the floor; adjust as needed. the most mesial portion of the film should be aligned with the enter of the mandibular canine.

The molar bite wing should be centered over the second molars. zRemind the patient to remain still and to not move the film with his or her tongue

position the identification dot toward the occlusal surface on all bite wings.

Question 20

The occlusion technique

Answer 20

The occlusion technique is used to examine lager areas of the upper lower jaw. The occlusion technique , intraoral film is used. the film is so named because the patient bits or occludes, on the entire film. although size 4 works well for adults, size 2 fils can used with children.

Basic principles of occlusal technique include:

• Film is positioned with the white side facing the arch exposed
• flim is placed in the mouth between the occlusal surface of the maxillary and mandibular teeth

-central ray is directed at an angle of 65+ to the place of the film

• film is stabilized when the patient gently bit on the surface of the film

To minimize overlapping of the teeth on the x-ray is ? Horizontal elongated.

A black lines hsows across the radiograph is? the film was bent

Question 21

patients with special needs

Answer 21

Radiographs examination technique must often be modified to accommodate patient with special needs.

The dental radiographer must be competent altering radiographic technique to meet the specific diagnostic need of the individual patient.

A person with physical disability might have problem with vision, hearing, or mbility. You must make every effort to meet the individual needs od such patients. In many cases a family member or caretaker accompanies the person with physical disability to dental office. YOu van ask the caretake to assist you in communicating with regard to the physical needs of the patient.

Question 22

Endodontic (filling is not sufficient to protect the tooth.
root canal) patients

Answer 22

It is difficult to obtain accurate radiographs during endodontic (root canal). treatment because of rubber dam clamp, endodontic instruments, or filling material extending from the tooth.

The Endoray@ II film can be used to aid in positioning the film during this portion of the root canal procedure. This holder fits around a rubber dam clap and allows space or endodontic instruments and filling materials to protrude from the tooth.

Question 23

Edentulous patients

Answer 23

Radiographic examination are made of Edentulous (without teeth) patients.
these examination are used to detect the items listed here.

The radiographic examination of an edentulous patient might inculde a panoramic radiograph, periapical radiographs, or a combination of occlusal and periodical radiographs. Radiographic images must be made in all teeth bearing area of the mouth whether or not teeth are present.

In Edentulous patients, either bisection of the angle or the paralleling technique can be used. The absence of the teeth prevents the distortion inherent in the bisecting technique from interfering with the diagnostic intrabony conditions

Question 24

patients who gag

Answer 24

to help prvent the gag reflex, you must convey a confident attitude. In a patient with a hypersensitive gag reflex, you should expose the maxillary molars last. when you place film in the maxillary posterior, do not slide it long the palate.

There might be times when you will encounter a patient with an uncontrollable gag reflex. When this occurs, you must use extraoral radiographs such as panoramic or lateral jaw radiographs.

Question 25

P

Question 27

pediatric patients

Answer 27

In children, radiographs are used for detecting conditions of teeth and bones. in show cnages related to caries and trauma and in evaluation growth and in evaluating growth and development.

Exposure factors (milliamperage, kilovoltage, time) must be reduced because of the small size f the pediatric patient.

Expain the radiographic procedures you are about to perform n terms that the child can easily understand. For example, you can refer to the
tube head = camera, the lead apron =coat, radiograph = picture

Question 28

Mounting dental radiographs

Answer 28

normal anatomic landmarks on intraoral radiographs help the dental assistant to correctly mount dental radiographs.

• maxillary anterior:
• medial palatine suture
• incisive foramen
  -Anterior nasal spine
  nasal septum
  -nasal fossa

*Mandible landmarks:
- genial tubercles
- ligual foramen
- nutrient canals
- mandibular canal
-coronoid process
-mylohyoid ridge
-external oblique ridge
-mental ridge

Question 29

Tips for mounting radiographs

Answer 29

• Handle film only by the edges
• Before mounting the film, label film mount with the patient’s full name , date of exposure and the dentist’s name.
• work with clean, dry hands
• use a definite order for mounting film
• use the “smile” line to mount bit wing radiographs.