Intra-Oral Radiography.pptx

INTRA ORAL RADIOGRAPGY BY DR. SHILPA RT

1. Navodaya Dental College Department of Oral Medicine & Radiology Dr Shilpa R T Professor III Year

2. Intra-Oral Radiography

3. Objectives of the presentation A step towards Evidence based Dentistry . Intra-Oral Radiographic techniques Film holders to make techniques easy. Modifications in difficult situations Highlights on Digital Radiography. Emphasis on Interpretation of Periapical Lesions Introduction

4. Intra-oral Radiography Periapical Bitewing Occlusal Divided into three categories:

5. Indications of periapical Radiography • Apical infection/inflammation • Assessment of the periodontal status • After trauma to the teeth and associated alveolar bone • Presence and position of unerupted teeth • Assessment of root morphology before extractions • During endodontics • Pre and post operative appraisal of apical surgery • Evaluation of apical cysts and other lesions • Evaluation of implants postoperatively.

6. Two fundamental rules of radiography: The lowest level of distortion and the highest level of image clarity will always be found in the region of the central ray projection. The image receptor should be as perpendicular as possible to the central ray and as parallel as possible to the tooth long axis in order to guarantee optimum radiographic interpretability.

7. GENERAL STEPS FOR MAKING AN EXPOSURE Greet and seat the patient Adjust the x-ray unit setting Position the tube head Wash hands thoroughly Examine the oral cavity Position the film Position the x-ray tube Make the exposure

8. Intra-oral Periapical Projection ‘Bisecting - the angle’ Technique (Short cone technique) (Long cone technique) ‘Paralleling Cone’ Technique Two Techniques

9. Paralleling Cone Technique of Intra-oral Periapical Radiography Patient Position: Patient can be either sitting upright or reclined in the dental chair provided that the head is not tilted to the side. First described by Edmund C. Kells in 1896 Revived by Donald McCormack in 1937 Perfected by Gordon Fitzgerald in 1947 Vertical Horizontal

10. Long spacer cone or beam-indicating device (BID)

11. Is It Easy ?

12. Film holder XCP (extension cone paralleling) Instruments

13. Bisecting - the Angle Technique of Intra-oral Periapical Radiography First described by Weston Price in 1904 Independently described by Cieszynski in 1907 Also called as technique based on Principle of Isometric Triangulation

14. Image size < Object size Foreshortening Image size > Object size Elongation Image size = Object size

15. Film Holding Instruments Snap-A-Ray Instrument

16. PID Angulations: Bisecting Technique Vertical angulation

17. Horizontal Angulation

18. Angulation in the vertical plane: Teeth Angulation Maxillary Mandibular Incisors + 40 -15 Canines + 45 - 20 Premolars + 30 - 10 Molars + 25 - 05 Direction of the Central Ray: Central ray is directed perpendicular to the teeth in the horizontal plane.

19. 11 12 13 16 17 18 14, 15 Maxilla : Imaginary ala-tragus line Point of Entry of X Ray Central Beam

20. 4 1 4 2 4 3 47 48 44 46 45 Point of Entry of X Ray Central Beam Mandible : Imaginary line 1 cm above the inferior border of mandible.

21. Comparison of Parallel cone and Bisected angle Techniques

22. Bisecting Angle Technique Paralleling cone Technique

23. Paralleling cone Technique Periodontal bone Status

24. Accurate images with little magnification No Superimposition Well represented periodontal bone levels Enable early detection of proximal caries Angulations automatically determined by the film holder No cone cutting Reproducible radiographs positions of the film maintained irrespective of the position of the patient's head Advantages of the paralleling cone technique

25. Anatomy of the mouth makes uncomfortable for the patient may cause gagging. Difficult to practice in Endodontics . Lower third molar regions difficult. Needs Long Cone. Disadvantages of the paralleling technique

26. Advantages of Bisecting Angled Technique Easy to master comfortable for the patient Easy to practice in endodontics If all angulations are correct , the image will be adequate (but not ideal)

27. Disadvantages of the Bisected angle technique image distortion - foreshortening or elongation Incorrect horizontal angulation - overlapping Poor detection of proximal caries and the periodontal bone levels. superimposition of the zygomatic buttress Cone cutting

28. Special Considerations Object localization techniques Mandibular third molars Gagging Endodontics Edentulous alveolar ridges Children

29. Object localization techniques

30. Mandibular third molars

31. Possible solutions: REASSURANCE local anaesthetic lozenge Placing the film packet flat in the mouth (in the occlusal plane) so it does not touch the palate. Gagging

32. Endodontics

33. Edentulous Ridges Partially Edentulous Ridges

34. Pediatric Patients Exposure factors ( milliamperage , kilovoltage , time) must be reduced because of the smaller size of the pediatric patient. Euphenisms

35. Digital Radiography

36. The digital radiograph: A digital image actually corresponds to the reduction of a conventional image into a prepared grid work of image points, the so-called pixel (picture element).

37. High image quality L ess radiation dose compared to film radiography Image Enhancement possible Tele radiology Why should we go Digital ?

38. Automated measurement Inversion Magnification

39. Alteration in contrast Pseudocolourization

40. Embossing or pseudo 3-D

41. Limitations: Very high initial cost. Sensor is bulkier compared to an x-ray film making it difficult to place in some parts of the mouth and in children.

42. Thank You