Intraoral Imaging. Chapter 41. Copyright 2018, Elsevier Inc. All Rights Reserved. 1

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2 Learning Objectives Lesson 41.1: Projection Types and the Paralleling Technique 1. Pronounce, define, and spell the key terms. 2. Explain the reasons that the number of images in an FMX might vary. 3. Name the two primary types of projections used in an intraoral technique. 4. Discuss the paralleling technique, including the following: State the five basic rules of the paralleling technique. Describe how to prepare a patient for dental imaging. Explain why an image receptor holder is necessary with the paralleling technique. Describe the sequence of exposure for anterior and posterior teeth. Copyright 2018, Elsevier Inc. All Rights Reserved. 2

3 Introduction It is possible for every dental assistant to successfully produce quality dental images images that are free from distortion, with the correct density and contrast, that can be used for the detection of dental disease Create such images by carefully following the proper steps in image receptor placement, exposure, and processing Copyright 2018, Elsevier Inc. All Rights Reserved. 3

4 Introduction (Cont.) Your patients will come in a variety of sizes, physical and mental abilities, types of dentitions, and personalities You will have to modify your technique if your patient has a palate that is very high and narrow or if your patient has a sensitive gag reflex Copyright 2018, Elsevier Inc. All Rights Reserved. 4

6 Full-Mouth Survey (FMX) No dental examination is complete without dental images, and in almost all cases, the full-mouth survey is the most preferred technique An intraoral full-mouth survey (FMX) contains: Periapical images Bitewing images Copyright 2018, Elsevier Inc. All Rights Reserved. 6

7 The Bitewing Image The bitewing image shows the upper and lower teeth in occlusion Only the crowns and a small portion of the root of the teeth are seen This view is used for detecting interproximal decay, periodontal disease, and recurrent decay under restorations as well as the fit of metallic fillings or crowns Copyright 2018, Elsevier Inc. All Rights Reserved. 7

9 The Periapical Image The periapical image shows the entire tooth from the occlusal surface or incisal edge to about 2 to 3 mm beyond the apex to show the periapical bone This view is used to diagnose pathologic conditions of the tooth, root, and bone as well as tooth formation and eruption Periapical views are essential in endodontics and oral surgery procedures Copyright 2018, Elsevier Inc. All Rights Reserved. 9

11 Full-Mouth Survey (FMX) (Cont.) For the average adult, a full mouth series consists of 18 to 20 images Generally there are 14 periapical views and 4 to 6 bitewing views The number may vary depending on the dentist s preference and the number of teeth present The anterior region is where the number of images varies The variables include the size of the sensor, if you are using digital, and the technique used Copyright 2018, Elsevier Inc. All Rights Reserved. 11

13 Intraoral Imaging Techniques Whether using conventional film, digital sensors, or phosphor storage plates (PSPs), there are two basic techniques for obtaining periapical images: The paralleling technique The bisecting technique Copyright 2018, Elsevier Inc. All Rights Reserved. 13

14 Intraoral Imaging Techniques (Cont.) The American Academy of Oral and Maxillofacial Radiology and the American Association of Dental Schools recommend the use of the paralleling technique because it provides the most accurate image with the least amount of radiation exposure to the patient In some situations, however, such as a shallow mouth, a shallow palate, or tori, the operator may need to use the bisecting technique Copyright 2018, Elsevier Inc. All Rights Reserved. 14

16 The Paralleling Technique: Five Basic Rules Image receptor placement: Position the image receptor so that it will cover the correct teeth to be examined Image receptor position: The image receptor must be positioned parallel to the long axis of the tooth The image receptor, in the appropriate holder, must be placed away from the teeth and toward the middle of the mouth Copyright 2018, Elsevier Inc. All Rights Reserved. 16

17 The Paralleling Technique: Five Basic Rules (Cont.) Vertical angulation: The central ray of the x- ray beam must be directed perpendicular to the image receptor and the long axis of the tooth Horizontal angulation: The central ray of the x-ray beam must be directed through the contact areas between the teeth Central ray: The x-ray beam must be centered on the image receptor to ensure that all areas are exposed Copyright 2018, Elsevier Inc. All Rights Reserved. 17

18 Positions in the Paralleling Technique From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 5, St Louis, 2017, Elsevier. Copyright 2018, Elsevier Inc. All Rights Reserved. 18

Diagram of X-Rays From Iannucci J, Jansen

techniques, ed 4, St Louis, 2012, Saunders.

Cone Cut From Frommer HH, Stabulus JJ: Radiology for the dental professional,

21 Patient Preparation The patient who is having dental images taken should be seated after the room has been prepared and infection control procedures completed Copyright 2018, Elsevier Inc. All Rights Reserved. 21

22 Exposure Sequence for Image Receptor Placement You should plan an exposure sequence, or definite order, for periapical image receptor placement when you are exposing images When working with dental film without a planned exposure sequence, you are more likely to omit an area or expose the same area twice This does not occur as easily when using direct digital imaging because the image most recently exposed appears on the computer screen Copyright 2018, Elsevier Inc. All Rights Reserved. 22

23 Anterior Exposure Sequence When exposing periapical views with the paralleling technique, always start with the anterior teeth (canines and incisors) because: The size of the anterior image receptor (#1) is small and is easier for the patient to tolerate Patients more easily adapt to the anterior image receptor holder Patients are less likely to gag with anterior image receptor placement Copyright 2018, Elsevier Inc. All Rights Reserved. 23

24 Anterior Exposure Sequence (Cont.) The recommended sequence for the Rinn XCP instruments is as follows: Begin with the maxillary right canine (tooth 6) Expose all of the maxillary anterior teeth from right to left End with the maxillary left canine (tooth 11) Next, move to the mandibular arch Begin with the mandibular left canine (tooth 22) Expose all of the mandibular anterior teeth from left to right Finish with the mandibular right canine (tooth 27) Copyright 2018, Elsevier Inc. All Rights Reserved. 24

25 Anterior Periapical Film Placement From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 5, St Louis, 2017, Elsevier. Copyright 2018, Elsevier Inc. All Rights Reserved. 25

26 Posterior Exposure Sequence Always begin with the premolar view before the molar view, for the following reasons: Premolar image receptor placement is easier for the patient to tolerate than is molar placement Premolar exposure is less likely to bring on the gag reflex With the paralleling technique, eight posterior image receptor placements are used: four maxillary exposures and four mandibular exposures Copyright 2018, Elsevier Inc. All Rights Reserved. 26

27 Posterior Exposure Sequence (Cont.) Begin with the maxillary right quadrant Assemble the posterior XCP instrument for this area Expose the premolar view (teeth 4 and 5) first, then the molar view (teeth 1, 2, and 3) Without reassembling the XCP instrument, move to the mandibular left quadrant Expose the premolar view (teeth 20 and 21) first, then the molar view (teeth 17, 18, and 19) Copyright 2018, Elsevier Inc. All Rights Reserved. 27

28 Posterior Exposure Sequence (Cont.) Move to the maxillary left quadrant and reassemble the posterior XCP instrument for this area Expose the premolar film (teeth 12 and 13) first, then the molar film (teeth 14, 15, and 16) Finish with the mandibular right quadrant Expose the premolar film (teeth 28 and 29) first, then the molar film (teeth 30, 31, and 32) Copyright 2018, Elsevier Inc. All Rights Reserved. 28

29 Posterior Periapical Film Placement From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 5, St Louis, 2014, Elsevier. Copyright 2018, Elsevier Inc. All Rights Reserved. 29

30 Guidelines for Film Placement When using dental x-ray film: The white side of the film always faces the teeth Anterior films are always placed vertically Posterior films are always placed horizontally The identification dot on the film is always placed in the slot of the film holder ( dot in the slot ) Always position the film holder away from the teeth and toward the middle of the mouth Always center the film over the areas to be examined Always place the film parallel to the long axis of the teeth Copyright 2018, Elsevier Inc. All Rights Reserved. 30

31 Learning Objectives Lesson 41.2: Bisecting and Bitewing Techniques 5. Discuss the bisecting technique, including the following: Identify the types of image receptor holders that can be used with the bisecting technique. Describe the result of incorrect horizontal angulation. Describe the result of incorrect vertical angulation. Identify the image receptor size used in the bisecting technique. 6. Discuss the bitewing technique, including the following: Explain the basic rules for the bitewing technique. Name the recommended vertical angulation for all bitewing exposures. Copyright 2018, Elsevier Inc. All Rights Reserved. 31

32 Bisecting Technique The bisection of the angle technique is based on a geometric principle of equally dividing a triangle In contrast to the paralleling technique, in which you move the image receptor away from the teeth to make the film and the teeth parallel, the bisecting technique places the film directly against the teeth to be exposed Thus, the film/sensor and the teeth are not parallel, but are at an angle Copyright 2018, Elsevier Inc. All Rights Reserved. 32

33 Bisecting Technique (Cont.) With the bisecting technique, the angle formed by the long axes of the teeth and the image receptor is bisected into two equal parts, and the x-ray beam is directed perpendicular to the bisecting line Perpendicular means at a right angle to the film The major disadvantage of this technique is that the image is dimensionally distorted Copyright 2018, Elsevier Inc. All Rights Reserved. 33

35 Image Receptor Holders When the bisecting technique is being used, you may see operators asking the patient to hold the film with his or her fingers to stabilize the film in the mouth This practice is not recommended Holding the film/sensor exposes the patient s hand and finger to unnecessary radiation Copyright 2018, Elsevier Inc. All Rights Reserved. 35

36 Image Receptor Holders (Cont.) Available types of image receptor holders for the bisecting technique include: The BAI (bisecting-angle instrument; Dentsply Rinn) The Stabe bite-block (Dentsply Rinn) The EeZee-Grip holder (Dentsply Rinn), previously called the Snap-A-Ray Copyright 2018, Elsevier Inc. All Rights Reserved. 36

38 Angulation of Position Indicator Device In the bisecting technique, the angulation of the PID is critical Angulation is the term that is used to describe the alignment of the central ray of the x-ray beam in the horizontal and vertical planes Angulation can be changed by moving the PID in a horizontal or vertical direction BAI instruments with aiming rings dictate the proper PID angulation Copyright 2018, Elsevier Inc. All Rights Reserved. 38

39 Horizontal Angulation Horizontal angulation refers to the positioning of the tubehead and direction of the central ray in a horizontal, or side-to-side, plane Horizontal angulation remains the same whether you are using the paralleling or the bisecting technique Copyright 2018, Elsevier Inc. All Rights Reserved. 39

Correct Horizontal Angulation With correct horizontal angulation, the central ray is directed perpendicular to the curvature of the arch and through the contact areas of the

41 Correct Horizontal Angulation With correct horizontal angulation, the central ray is directed perpendicular to the curvature of the arch and through the contact areas of the teeth From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 5, St Louis, 2017, Elsevier. Copyright 2018, Elsevier Inc. All Rights Reserved. 41

42 Incorrect Horizontal Angulation Incorrect horizontal angulation results in overlapped (unopened) contact areas A view with overlapped contact areas cannot be used to examine the interproximal areas of the teeth Copyright 2018, Elsevier Inc. All Rights Reserved. 42

43 Incorrect Horizontal Angulation (Cont.) From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 5, St Louis, 2017, Elsevier. Copyright 2018, Elsevier Inc. All Rights Reserved. 43

45 Vertical Angulation Refers to the positioning of the PID in a vertical, or up-and-down, plane Differs according to the x-ray technique that is being used, as follows: With the paralleling technique, the vertical angulation of the central ray is directed perpendicular to the image receptor and the long axis of the tooth With the bisecting technique, the vertical angulation is determined by the imaginary bisector; the central ray is directed perpendicular to the imaginary bisector With the bitewing technique, the vertical angulation is predetermined; the central ray is directed at +10 degrees to the occlusal plane Copyright 2018, Elsevier Inc. All Rights Reserved. 45

Vertical Angulation of the PID Courtesy of Dr.

47 Correct Vertical Angulation Correct vertical angulation results in an image that is the same length as the tooth From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 4, St Louis, 2012, Saunders. Copyright 2018, Elsevier Inc. All Rights Reserved. 47

48 Incorrect Vertical Angulation Incorrect vertical angulation results in an image that is not the same length as the tooth being x-rayed The image appears longer or shorter Elongated or foreshortened images are not diagnostic Foreshortened images: Result from excessive vertical angulation Elongated images: Result from insufficient vertical angulation Copyright 2018, Elsevier Inc. All Rights Reserved. 48

Foreshortened Images From Iannucci J, Jansen Howerton L: Dental radiography: principles and

Elongated Images From Iannucci J, Jansen

techniques, ed 5, St Louis, 2017, Elsevier.

51 Image Receptor Size and Placement In the bisecting technique, the image receptor is placed close to the crowns of the teeth to be x-rayed and extends at an angle into the palate or the floor of the mouth The image receptor should extend beyond the incisal or occlusal aspect of the teeth by about ⅛ inch Film holders for the bisecting of the angle technique, including some with alignment indicators, are available commercially Copyright 2018, Elsevier Inc. All Rights Reserved. 51

52 Patient Positioning The patient s midsagittal plane should be perpendicular to the floor This means that the patient s head is upright for maxillary films and is tipped back slightly for the mandibular arch Size #2 image receptor is used in both the anterior (in a vertical position) and the posterior (in a horizontal position) regions Only three films are needed in the maxillary anterior region because all four maxillary incisors can be imaged on #2 film/sensor if the arch is wide If the arch is narrow, it may be necessary to use four #1 films/sensors Copyright 2018, Elsevier Inc. All Rights Reserved. 52

53 Beam Alignment X-ray beam is directed to pass between contacts of teeth being x-rayed in horizontal dimension, just as it is in paralleling technique The vertical angle, however, must be directed at a 90 degree angle to the imaginary bisecting line Too much vertical angulation produces images that are too short (foreshortened) Too little vertical angulation results in images that are too long (elongated) The beam must be centered to help prevent cone cutting Copyright 2018, Elsevier Inc. All Rights Reserved. 53

54 Bitewing Technique A bitewing view shows the crowns and interproximal areas of the maxillary and mandibular teeth and the areas of crestal bone on a single image Bitewing views are used to detect interproximal caries (tooth decay) and are particularly useful in detecting early carious lesions that are not clinically evident Bitewing views are also useful in examining crestal bone levels between the teeth Copyright 2018, Elsevier Inc. All Rights Reserved. 54

55 Bitewing Technique (Cont.) The basic principles of the bitewing technique are: The image receptor is placed in the mouth parallel to the crowns of both the upper and lower teeth The image receptor is stabilized when the patient bites on the bitewing tab or bitewing film holder The central ray of the x-ray beam is directed through the contacts of the teeth, using +10 degrees of vertical angulation Copyright 2018, Elsevier Inc. All Rights Reserved. 55

56 Bitewing Technique: Vertical Angulation From Iannucci J, Jansen Howerton L: Dental radiography: principles and techniques, ed 5, St Louis, 2017, Elsevier. Copyright 2018, Elsevier Inc. All Rights Reserved. 56

57 Image Receptor Holder and Bitewing Tab In the bitewing technique, a film holder or bitewing tab is used to stabilize the image receptor When using a Rinn type of image receptor, red is the universal color for bitewing holders Copyright 2018, Elsevier Inc. All Rights Reserved. 57

Bitewing Tab and Film Holder Courtesy Dentsply Rinn,

59 Angulation of Position Indicator Device The angulation of the PID is critical in the bitewing technique The film-holding instruments and aiming rings provide the proper angulation When a bitewing tab is used, however, the operator must determine both the horizontal and the vertical angulation Copyright 2018, Elsevier Inc. All Rights Reserved. 59

60 Exposure for Image Receptor Placement Bitewing images are always parallel views regardless of technique used for the periapical images The number of bitewing films necessary is based on the curvature of the arch and the number of teeth present in the posterior areas The curvature of the arch often differs in the premolar and molar areas If curvature of arch differs, it is impossible to open all the posterior contact areas on a single bitewing view Consequently, two bitewing views are usually exposed on each side of the arch Copyright 2018, Elsevier Inc. All Rights Reserved. 60

61 Exposure for Image Receptor Placement (Cont.) Because the curvature of the arch differs in most adult patients, a total of four bitewing films are exposed One right premolar One right molar One left premolar One left molar Copyright 2018, Elsevier Inc. All Rights Reserved. 61

62 Learning Objectives Lesson 41.3: Occlusal Technique, Special Dental Needs, and Mounting Radiographs 7. Explain the technique for exposing occlusal radiographs. 8. Describe techniques for managing patients with special medical needs. 9. Describe techniques for managing patients with special dental needs, including a hypersensitive gag reflex. 10. Describe the appearance of the most common dental image technique errors. 11. Explain the two methods of mounting dental radiographs. Copyright 2018, Elsevier Inc. All Rights Reserved. 62

63 Occlusal Technique The occlusal technique is used to examine large areas of the upper or lower jaw The technique is so named because the patient bites, or occludes, the entire film In adults, size #4 intraoral film is used, but #2 film is used in children Copyright 2018, Elsevier Inc. All Rights Reserved. 63

64 Occlusal Images Can be used for the following purposes: Locate retained roots of extracted teeth Locate supernumerary (extra) unerupted or impacted teeth Locate salivary stones in the duct of the submandibular gland Locate fractures of the maxilla and mandible Examine the area of the cleft palate Measure changes in the size and shape of the maxilla or mandible Copyright 2018, Elsevier Inc. All Rights Reserved. 64

65 Basic Principles of the Occlusal Technique The film is positioned with the white side facing the arch exposed The film is placed in the mouth between the occlusal surfaces of the maxillary and mandibular teeth The film is stabilized when the patient gently closes on the surface of the film Copyright 2018, Elsevier Inc. All Rights Reserved. 65

66 Patients with Special Medical Needs Radiographic examination techniques often must be modified to accommodate patients with special needs You must be prepared to alter your radiographic technique to meet the specific need of the individual patient Copyright 2018, Elsevier Inc. All Rights Reserved. 66

67 Physical Disabilities A person with a physical disability may have problems with vision, hearing, or mobility You must make every effort to meet the individual needs of such patients In many cases, a family member or caretaker accompanies the person with a physical disability to the dental office You can ask this person to assist you with communicating or with the physical needs of the patient Copyright 2018, Elsevier Inc. All Rights Reserved. 67

68 Vision Impairment If your patient is blind or visually impaired, you must communicate using clear verbal explanations You must keep your patient informed of what you are doing and explain each procedure before performing it You must never gesture to another person in the presence of a person who is blind Blind persons perceive that you are talking behind their backs Copyright 2018, Elsevier Inc. All Rights Reserved. 68

69 Hearing Impairment If your patient is deaf or hearing impaired, you have several options You may ask a caregiver to act as an interpreter, use gestures, or use written instructions If the patient can read lips, you will need to remove your mask, face the patient, and speak clearly and slowly Copyright 2018, Elsevier Inc. All Rights Reserved. 69

70 Mobility Impairment If your patient is in a wheelchair and does not have use of the lower limbs, you may need to expose the necessary views with the patient seated in the wheelchair If your patient does not have the use of the upper limbs, and a film holder cannot be used to stabilize the films in the mouth, you may ask the patient s caregiver to assist with holding the film This person must wear a lead apron and a thyroid collar during exposure of the films You must never hold a film for a patient during an exposure Copyright 2018, Elsevier Inc. All Rights Reserved. 70

72 Developmental Disabilities A substantial impairment of mental or physical functioning that occurs before adulthood and lasts indefinitely Examples include autism, cerebral palsy, epilepsy, and mental impairment A person with a developmental disability may have problems with coordination or comprehension of instructions You may have difficulties in obtaining intraoral views If coordination or comprehension is a problem, mild sedation may be useful Copyright 2018, Elsevier Inc. All Rights Reserved. 72

73 Developmental Disabilities (Cont.) It is important that you recognize situations in which the patient cannot tolerate intraoral film/sensor placement and exposure Intraoral views should not be attempted in these patients; such exposure results only in nondiagnostic images and needless radiation exposure of the patient Extraoral images such as lateral jaw and panoramic views may be used Copyright 2018, Elsevier Inc. All Rights Reserved. 73

74 Patients with Special Dental Needs Often, you may need to modify the basic imaging techniques to accommodate patients with special dental needs, including: Edentulous patients Endodontic patients Pediatric patients Copyright 2018, Elsevier Inc. All Rights Reserved. 74

75 Edentulous Patient Images on edentulous patients may be required for the following reasons: Detect retained root tips, impacted teeth, and lesions (cysts, tumors) Identify objects embedded in bone Observe the quantity and health of the bone Copyright 2018, Elsevier Inc. All Rights Reserved. 75

76 Exposure Techniques for the Edentulous Patient Radiographic examination of an edentulous patient may include a panoramic radiograph, periapical radiographs, or a combination of occlusal and periapical radiographs Radiographic images must be taken in all areas of the arches, whether or not teeth are present Because no teeth are present, the distortion inherent in the bisecting technique does not interfere with diagnostic intrabony conditions For partially edentulous patients, image receptorholding instruments can be used by placing a cotton roll on the bite-block where the crowns of the missing teeth would have been Copyright 2018, Elsevier Inc. All Rights Reserved. 76

78 Pediatric Patient In children, images are useful for: Detecting conditions of the teeth and bones Showing changes related to caries and trauma Evaluating growth and development Copyright 2018, Elsevier Inc. All Rights Reserved. 78

79 Images in the Pediatric Patient Explain the x-ray procedures you are about to perform in terms that the child can easily understand For example, you can refer to the tubehead as a camera, the lead apron as a coat, and the image as a picture Exposure factors (milliamperage, kilovoltage, time) must be reduced because of the smaller size of the pediatric patient The shorter exposure time will reduce the effect of blurring if the child should move Copyright 2018, Elsevier Inc. All Rights Reserved. 79

Extension-Cone Paralleling (XCP) Instruments

81 Endodontic Patient It often is difficult to obtain accurate images during endodontic (root canal) treatment because of the rubber dam clamp, endodontic instruments, or filling material extending from the tooth The EndoRay II film holder can be used to aid in positioning the film during this portion of the root canal procedure This holder fits around a rubber dam clamp and allows space for endodontic instruments and filling materials to protrude from the tooth Copyright 2018, Elsevier Inc. All Rights Reserved. 81

EndoRay II Film Holder Courtesy Dentsply Rinn, Elgin,

83 Radiographs for the Endodontic Patient A diagnostic quality endodontic film must have the following qualities: Tooth is centered on the film At least 2 mm of bone beyond the apex of the tooth is visible The image is as anatomically accurate as possible The preoperative diagnostic view and the postoperative view should be taken with the standard paralleling technique and with the use of a film-holding device Copyright 2018, Elsevier Inc. All Rights Reserved. 83

84 Gagging Patient To help prevent the gag reflex, you must convey a confident attitude If the patient senses nervousness, a psychogenic stimulus may result and cause the gag reflex Be patient, tolerant, and understanding As the patient becomes more tolerant with the procedure, the less likely the patient is to gag Copyright 2018, Elsevier Inc. All Rights Reserved. 84

85 Exposure Sequencing Exposure sequencing plays an important role in preventing the gag reflex Anterior films are easier for the patient to tolerate and are less likely to elicit the gag reflex With posterior film placements, you should always expose the premolar film before the molar film The maxillary molar film placement is the one most likely to cause the gag reflex For the patient with a hypersensitive gag reflex, you should expose the maxillary molars last Copyright 2018, Elsevier Inc. All Rights Reserved. 85

86 Image Receptor Placement Avoid the palate When you place films in the maxillary posterior, do not slide them along the palate Instead, position the film lingual to the teeth, and then firmly bring the film into contact with the palatal tissues in a single motion Demonstrate film placement In the areas that are most likely to elicit the gag reflex, rub a finger along the tissues near the intended area of film placement while telling the patient, This is where the film will be positioned Then quickly position the film Copyright 2018, Elsevier Inc. All Rights Reserved. 86

87 Extreme Cases At times, you may encounter a patient with an uncontrollable gag reflex In such patients, intraoral films are impossible to obtain You must use extraoral radiographs such as panoramic or lateral jaw films Copyright 2018, Elsevier Inc. All Rights Reserved. 87

88 Dental Imaging Technique Errors Diagnostic quality radiographs are those that have been properly placed, exposed, and processed Errors in any of these three areas may result in nondiagnostic films Nondiagnostic films must be retaken, which results in additional exposure of the patient to ionizing radiation Copyright 2018, Elsevier Inc. All Rights Reserved. 88

89 Mounting Dental Radiographs Recognizing anatomic landmarks To mount dental radiographs correctly, the dental assistant must be able to recognize the normal anatomic landmarks on intraoral radiographs Processed radiographs are arranged in anatomic order in holders, called mounts, to make it easier for the dentist to view the films The mount must always be labeled with the patient s name and the date that the radiographs were exposed The dentist s name and address should also be on the mount Copyright 2018, Elsevier Inc. All Rights Reserved. 89

90 Selecting the Mount Mounts are available in many sizes, with different numbers and sizes of windows (openings) to accommodate the number and sizes of views in the patient s radiographic survey The mounts most often used for radiographic surveys are available in black, gray, and clear plastic Copyright 2018, Elsevier Inc. All Rights Reserved. 90

91 Methods of Mounting Two methods used when mounting radiographs Both methods rely on identification of the raised (embossed) dot on the film Labial mounting method: The films are placed in the mount with the raised dots facing up (convex) The American Dental Association recommends this method of mounting radiographs Radiographs are viewed as if the viewer is looking directly at the patient The patient s left side is on the viewer s right, and the patient s right side is on the viewer s left Lingual mounting method: Radiographs are placed in the mount with the raised dots facing down (concave) Copyright 2018, Elsevier Inc. All Rights Reserved. 91

92 Lingual Mounting With this method, radiographs are viewed as if the viewer is inside the patient s mouth and is looking out The patient s left side is on the viewer s left, and the patient s right side is on the viewer s right Note: It is critical to know how the dentist prefers to have radiographs mounted Copyright 2018, Elsevier Inc. All Rights Reserved. 92

93 Guidelines for Mounting Radiographs Handle films only by the edges Label and date the film mount before mounting the films Include the patient s full name and date of exposure and the dentist s name Work with clean, dry hands Use a definite order for mounting films Use the smile line to mount bitewing radiographs Copyright 2018, Elsevier Inc. All Rights Reserved. 93

94 Portable Imaging FDA has approved a portable batterypowered machine that can be taken directly to the patient For operator safety, it has internal shielding materials Units are approved for use in many states, but not all Copyright 2018, Elsevier Inc. All Rights Reserved. 94

Intraoral radiographic techniques Introduction There are three main types of intraoral radiographs: Periapical radiograph Bitewing radiograph

Intraoral radiographic techniques Introduction There are three main types of intraoral radiographs: Periapical radiograph Bitewing radiograph Occlusal radiograph The anatomic area of interest and type