Occlusal radiography and the bisecting angle technique Flashcards
Where is the image receptor in occlusal radiographs?
- Image receptor in occlusal plane
What are the dimensions of the image receptor used for occlusal radiographs?
- Image receptor 7x5cm (smaller in small mouths)
What is an oblique occlusal radiograph similar to?
- Similar to a large periapical
- Because it is a bigger end receptor there are more teeth on it than a periapical but in terms of the way it looks it is very similar
What kind of sensors are sued for occlusal radiographs?
- Film or digital sensors (PSP - photostimulable phosphor) available
What sensors are used in the dental hospital for occlusal radiographs?
- Phosphor plates
What is a cross-sectional occlusal radiograph?
- Called this because the view of the teeth you get is as if the x-ray beam is going right up through the long axis so have a cross sectional view
On which jaw would you take a cross-sectional occlusal radiograph?
Only do this on the lower jaw
Are PSP’s direct or indirect digital sensors?
Indirect
Why do we not use direct digital sensors for occlusal radiographs?
-They would be very expensive to make and would not be a market for that
In which types of radiographs do we use phosphor plates? (3)
- Occlusals
- Periapicals
- Bitewings
- Need to be very careful in how we handle them (phosphor plates)
What are the indications for taking an oblique occlusal radiograph? (4)
- Periapical type assessment where periapicals are not possible (e.g. if patient has trismus)
- Pathology too large to be seen on a single periapical (would likely use Cone Beam CT now though)
- Trauma - fractures to teeth and alveolus
- Localisation using parallax (+ panoramic, other occlusal or periapical) (useful when we are trying to work out where structures that we can’t actually see are in relation to each other or a structure that we can see)
What is the ideal projection geometry for a radiograph? (4)
- Image receptor and object in contact and parallel
- Parallel beam of x-rays
- X-ray beam perpendicular to object plane and image receptor
- Image size identical to object size
This does not happen
- Cannot have image receptor and object completely in contact and parallel
- Don’t have a parallel beam of x-rays
- We can decide how to direct our x-ray beam, what it is perpendicular to but we never get an image size that is identical to the object because of that divergent beam of x-rays (always get some magnification)
What are the problems with ideal projection geometry? (4)
- Image receptor and object NOT in contact
- Beam of x-rays NOT parallel
- X-ray beam central ray MAY OR MAY NOT BE perpendicular to object plane and image receptor
- Image size NOT identical to object size DUE to MAGNIFICATION - DIVERGENT BEAM
One solution to projection geometry problems is the BISECTING ANGLE TECHNIQUE. Explain the properties of this technique? (4)
- Image receptor and object partly in contact but not parallel
- Image receptor and object close together at crowns, but apart at apices
- Still use long x-ray focus-skin distance as requires for machines operating at 60kV and over (@ least 20cm)
- Can be done without image receptor holders
Can the bisecting angle technique be done without image receptor holders?
- Yes
In the bisecting angle technique, how far apart is the image receptor and object?
- Touching at one end but as you go further to the apex they get further apart
- How far apart they are is dependent on which part of the mouth you are looking at
- Place where they are least far apart is the lower molar region
In the bisecting angle technique the image receptor and tooth touch at the crown and are apart at the apex. If the x-ray beam is at 90 degrees to the long axis of the tooth what will the image be like?
- Elongated image
In the bisecting angle technique the image receptor and tooth touch at the crown and are apart at the apex. If the x-ray beam is at 90 degrees to the plane of the image receptor what will the image be like?
- Short image (foreshortened)
When we talk about the x-ray beam. What are we actually thinking about?
- We are thinking about the imaginary central ray, think of 1 ray and how we are directing it in relation to either the tooth or the image receptor
Because of the law of equal triangles, if we actually bisect the angle formed by the long axis of the tooth and the plane of the image receptor and draw a line in which bisects that and we direct our x-ray beam at right angles to that, apart from the inherent magnification we always get we will get an accurate image
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What position will a patient be in when taking a periapical or bitewing radiograph?
- Sitting up (but can do it lying down)
What position will a patient be in when taking an occlusal radiograph?
- Will definitely be sitting up
What is the correct vertical angle for the bisecting angle technique?
- X-ray beam at 90 degrees to line bisecting angle formed by long axis of tooth and plane of image receptor - correct sue to identical triangles
By hoe many mm is the image receptor positioned beyond the tooth edge for an occlusal radiograph?
- Image receptor positioned with 2-3mm beyond tooth edge
How is the vertical angle judged for an occlusal radiograph using the bisecting angle technique?
- Judged by eye
The vertical angle may need to be adjusted to adapt to incisor angulation. If the tooth is proclined. How will we adjust the angle?
Will increase the angle
The vertical angle may need to be adjusted to adapt to incisor angulation. If the tooth is retroclined (a bit more upright). How will we adjust the angle?
- We will decrease the angle
What do we want the head position to be like when taking an occlusal radiograph? (3)
- Oblique occlusals require occlusal plane (of jaw being examined) to be horizontal
- Altered by degree of mouth opening
- Required external soft tissue points to assess if correct
For oblique occlusals how do you want the maxilla to be positioned?
- Ala-tragus line horizontal (parallel to the floor)
- This is for a seater upright patient
What is the ala-tragus line?
- From fleshy bit on the side of the nose to the little cartilaginous bit at the front of your external auditory meatus
- Need to see this when positioning the head for an oblique occlusal so might need to ask patient to move their hair if you can’t see this
For oblique occlusals how do you want the mandible to be positioned?
- Corner of moth-tragus line horizontal (parallel to the floor)
- This is for a seated upright patient
- To get mandible horizontal need to slightly tip head back, need to support the head in the position you put the patient in
What do you want the head position to be like for maxillary occlusals?
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