Intraoral Projection (Periapical, Bitewing, Occlusal)

 

Intraoral Projection

Periapical

• Indication

  ● Detection of apical infection/inflammation

  ● Assessment of the periodontal status

  ● After trauma to the teeth and associated alveolar bone

  ● Assessment of the presence and position of unerupted teeth

  ● Assessment of root morphology before extractions

  ● During endodontics

  ● Preoperative assessment and postoperative appraisal of apical surgery

  ● Detailed evaluation of apical cysts and other lesions within the alveolar bone

  ● Evaluation of implants postoperatively.

• Technique

  • Paralleling technique

    • Theory

      1. The image receptor is placed in a holder and positioned in the mouth parallel to the long axis of the tooth under investigation.

      2. The X-ray tubehead is then aimed at right angles (vertically and horizontally) to both the tooth and the image receptor.

      3. By using a film/sensor holder with fixed image receptor and X-ray tubehead positions, the technique is reproducible.

    • Positioning technique

      The radiographic techniques for the permanent dentition can be summarized as follows:

      1. The patient is positioned with the head sup ported and with the occlusal plane horizontal.

      2. The holder and image receptor are placed in the mouth as follows:

      • Maxillary incisors and canines –

        the image receptor is positioned sufficiently posteriorly to enable its height to be accommodated in the vault of the palate

        

        

      • Mandibular incisors and canines –

        the image receptor is positioned in the floor of the mouth, approximately in line with the lower canines or first premolars

        

        

      • Maxillary premolars and molars –

        the image receptor is placed in the midline of the palate, again to accommodate its height in the vault of the palate

        

        

      • Mandibular premolars and molars –

        the image receptor is placed in the lingual sulcus next to the appropriate teeth.

        The holder is rotated so that the teeth under investigation are touching the bite block.

        

        

      4. A cottonwool roll is placed on the reverse side of the bite block. This often helps to keep the tooth and image receptor parallel and may make the holder less uncomfortable.

      5. The patient is requested to bite gently together, to stabilize the holder in position.

      6. The locator ring is moved down the indicator rod until it is just in contact with the patient’s face. This ensures the correct focal spot to film distance (fsd).

      7. The spacer cone is aligned with the locator ring. This automatically sets the vertical and hori zontal angles and centres the X-ray beam on the image receptor

      8. The exposure is made

    • Image

      

  • Bisecting technique

    • Theory

      1. The image receptor is placed as close to the tooth under investigation as possible without bending the packet.
      2. The angle formed between the long axis of the tooth and the long axis of the image receptor is assessed and mentally bisected.
      3. The X-ray tubehead is positioned at right angles to this bisecting line with the central ray of the X-ray beam aimed through the tooth apex.

      4. Using the geometrical principle of similar triangles, the actual length of the tooth in the mouth will be equal to the length of the tooth on the image.

    • Position technique

      The bisected angle technique can be performed

      • using an image receptor holder to support the image receptor in the patient’s mouth

        1. The image receptor is pushed securely into the chosen holder. Either a large or small size of image receptor is used so that the particular tooth being examined is in the middle of the receptor, as shown in Fig. 9.21. When using a film packet the white surface faces the X-ray tubehead and the film orientation dot is oppo site the crown.

        2. The X-ray tubehead is positioned using the beam-aiming device if available OR the opera tor has to assess the vertical and horizontal angu lations by observation and then position the tubehead without a guide.

        3. The exposure is made.

      • asking the patient to support the image receptor gently using either an index finger or thumb

        1. The appropriate sized image receptor is posi tioned and orientated in the mouth as shown in Fig. 9.18 with about 2 mm extending beyond the incisal or occlusal edges, to ensure that all of the tooth will appear on the image. The patient is then asked to gently support the image receptor using either an index finger or thumb.

        2. The operator then assesses the vertical and hori zontal angulations by observation and positions the tubehead without a guide. The effects of incorrect tubehead position are shown in Fig. 9.22.

        3. The exposure is made.

        

    • Image

      

• Error

  

  

• Ideal Quality

  Ideal quality criteria

  Irrespective of the type of image receptor or tech

  nique being used, typical quality criteria for a

  periapical radiograph should include:

  ● The image should have acceptable definition

  with no distortion or blurring.

  ● The image should include the correct anatomi

  cal area together with the apices of the tooth/

  teeth under investigation with at least 3–4 mm

  of surrounding bone.

  ● There should be no overlap of the approximal

  surfaces of the teeth.

  The desired density and contrast for film

  captured images will depend on the clinical

  reasons for taking the radiograph, e.g.

  – to assess caries, restorations and the periapical

  tissues films should be well exposed and

  show good contrast to allow differentiation

  between enamel and dentine and between

  the periodontal ligament space, the lamina

  dura and trabecular bone.

  – to assess the periodontal status films should be

  underexposed to avoid burnout of the thin

  alveolar crestal bone. (see Ch. 22)

  ● The images should be free of coning off or cone

  cutting and other film handling errors.

  ● The images should be comparable with previ

  ous periapical images, both geometrically and

  in density and contrast.

• Angle

  

  

  

  

  CR=central ray

  

Bitewing

• Theory

  • Merupakan Suatu teknik foto Intra oral dimana pasien menggigit sayap kecil yang direkatkan di film
  • Hasil foto menunjukkan mahkota Premolar dan Molar

• Indication

  • Detection of lesions of caries
  • Monitoring the progression of dental caries
  • Assessment of existing restorations
  • Assessment of the periodontal status.

• Technique

  • Komunikasi dan Prosedur Awal
  • Mempersiapkan posisi penderita
  • Pasang film
  • Procedure
  • Central Ray
  • Exposure
  • Finishing
  • Positioning

• Image

  

• Ideal Quality

  Ideal quality criteria

  Irrespective of the type of image receptor being

  used, typical quality criteria for a bitewing radio

  graph should include:

  ● The image should have acceptable definition

  with no distortion or blurring.

  ● The image should include from the mesial

  surface of the first premolar to the distal surface

  of the second molar – if the third molars

  are erupted then the 7/8 contact should be

  included.

  ● The occlusal plane/bite-platform should be in

  the middle of the image so that the crowns and

  coronal parts of the roots of the maxillary teeth

  are shown in the upper half of the image and

  the crowns and coronal parts of the roots of the

  mandibular teeth are shown in the lower half of

  the image, and the buccal and lingual cusps

  should be superimposed.

  ● The maxillary and mandibular alveolar crests

  should be shown.

  ● There should be no overlap of the approximal

  surfaces of the teeth.

  ● The desired density and contrast for film

  captured images will depend on the clinical

• Failure

  

  • Match Band Effect

    Ernest Mach-1865:

    • notes: Described what we now call Mach bands = optical illusion: two different densities next to each other. In radiology, we have 3 densities/colors: white, gray, or black. Say we have enamel or metal restoration both completely white and then dentin that's grey, sometimes u have effect between these two elements that looks like a radiolucent line - > this radiolucent line is what we call Mach bands.
    • Not a property of film, it is a property of observer's eyes.
    • Edge enhancement effect
    • A light shade that becomes even lighter, a darker shade that becomes even darker.
    • Differentiate caries from Mach bands

    

    

  • Cervical Burn Out

    1 - Thin cervical root surface between dense crown and alveolar bone crest allows more x-rays to pass and reach the image receptor, producing an increased radiolucency

    

    1 -proximal caries = CONTACT2 - proximal caries3 - proximal caries4 - cervical burnout = Located in cervical region.5 - cervical burnout6 - proximal caries(cervical burnout doesn't touch the enamel)

    

• Lembar Interpretasi

  

• TOPIK 3. PSA

  Evaluasi mutu Kualitas RO Bitewing

  1. Menentukan apakah kontras, detil dan ketajaman radiograf baik : Kontras : Terdapat perbedaan antar daerah radioopak dan radiolusen. Daerah yang tidak terdapat obyek harus tampak sangat hitam/radiolusen, dan daerah dengan kepadatan tinggi (contoh : email) harus tampak sangat putih/radioopak. Detail : Struktur anatomis objek terlihat jelas Ketajaman : Outline/ batas tepi dari setiap struktur anatomis terlihat jelas.
  2. Menentukan apakah daerah interdental terlihat jelas: • Tujuan dari melihat daerah interdental ialah melihat ada tidaknya distorsi horizontal. Jika distorsi horizontal minimal maka daerah interdental terlihat jelas.
  3. Menentukan apakah cusp bukal dan palatal/ lingual terletak sebidang : Tujuannya untuk melihat ada/ tidaknya distorsi vertikal. Untuk gigi anterior yang menjadi indikator ialah singulum. • Jika sudut vertikal terlalu besar maka gigi tampak memendek sehingga singulum berhimpit dengan 1/3 servikal mahkota dan tampak gambaran radiopak tegas, jika sudut vertikal terlalu kecil maka gigi tampak elongasi sehingga jarak singulum menjauhi servikal line dan tampak gambaran radiopak difus.
  4. Menentukan apakah distorsi yang terjadi minimal : • Amati distorsi vertikal dan distorsi horizontal yang terjadi kemudian tentukan besarnya. Jika distorsi tidak minimal/ besar, maka radiograf tidak dapat diinterpretasi.
  5. Menyimpulkan apakah radiograf dapat diinterpretasi : Radiograf dapat diinterpretasi apabila masuk kriteria 1 atau 2 pada tingkatan kualitas secara subyektif pada radiograf

Occlusal

• Classification

  • Maxillary occlusal projections

    • Upper standard (or anterior) occlusal (standard occlusal) /Topografi RA

      • Menghasilkan gambaran radiografik bagian anterior / gigi-gigi anterior rahang atas sampai dengan daerah apikalnya.

      • Sinar-X diarahkan ke bawah, kearah batang hidung, dengan sudut 65° – 70° terhadap film.

      • Image

        

      • Indication

        • Periapical assessment of the upper anterior teeth, especially in children but also in adults unable to tolerate periapical holders

        ● Detecting the presence of unerupted canines, supernumeraries and odontomes

        ● As the midline view, when using the parallax method for determining the bucco/palatal position of unerupted canines (see Ch. 24)

        ● Evaluation of the size and extent of lesions such as cysts or tumours in the anterior maxilla

        ● Assessment of fractures of the anterior teeth and alveolar bone.

    • Upper oblique occlusal (oblique occlusal) / Oklusal Oblik RA

      • Memperlihatkan gambaran radiografik satu sisi rahang atas / gigi gigi daerah posterior.

      • Sinar-X diarahkan ke bawah, kearah pipi dengan sudut 65° – 70° terhadap film, di pertengahan regio yang diperiksa.

      • Indication

        ● Periapical assessment of the upper posterior teeth, especially in adults unable to tolerate periapical image receptor holders

        ● Evaluation of the size and extent of lesions such as cysts, tumours or other bone lesions affecting the posterior maxilla

        ● Assessment of the condition of the antral floor

        ● As an aid to determining the position of roots displaced inadvertently into the antrum during attempted extraction of upper posterior teeth

        ● Assessment of fractures of the posterior teeth and associated alveolar bone including the tuberosity

      • Image

        

    • Vertex occlusal (vertex occlusal) – no longer used/ Crosssection RA

      • Memperlihatkan gambaran radiografik potongan melintang rahang atas.

      • dengan memodifikasi teknik Topografi Rahang Alas, yaitu dengan memperbesar sudut sinar-X terhadap film, menjadi + 80° dan di arahkan ke dahi pasien

      • Teknik :

        1. Film diletakkan antara gigi RA dan RB
        2. Pasien diinstruksikan menggigit film
        3. Tube diletakkan pada atap tengkorak pada bagian depan
        4. Arah sinar sentral sejajar dengan sumbu/ panjang gigi incisivus anterior
        5. Teknik ini digunakan untuk menentukan letak gigi impaksi pada hubungan buccopalatinal dalam lengkung gigi.

      • Image

        

  • Mandibular occlusal projections

    • Lower 90° occlusal (true occlusal/vertex oclusal)/ Crossection RB

      • Memperlihatkan potongan melintang rahang bawah / gigi gigi dan dasar mulut.

      • Sinar-X diarahkan ke atas di pertengahan rahang bawah, mengarah ke daerah Molar, dengan sudut 90° terhadap film.

      • Indication

        ● Detection of the presence and position of radiopaque calculi in the submandibular salivary ducts

        ● Assessment of the bucco-lingual position of unerupted mandibular teeth

        ● Evaluation of the bucco-lingual expansion of the body of the mandible by cysts/tumours

        ● Assessment of fracture displacement of the anterior mandible in the horizontal plane

        ● Assessment of mandibular width prior to implant placement.

      • Image

        

    • Lower 45° (or anterior) occlusal (standart occlusal)/ Topografi RB

      • Memperlihatkan rahang bawah/gigi anterior rahang bawah. Gambaran radiografiknya mirip teknik biseksi, tapi mencakup daerah yang lebih luas.

      • Sinar-X diarahkan ke atas di pertengahan rahang bawah, mengarah ke dagu penderita dengan sudut 45° terhadap film.

      • Indication

        • Periapical assessment of the lower incisor teeth, especially useful in adults and children unable to tolerate periapical image receptor holders

        ● Evaluation of the size and extent of lesions such as cysts or tumours affecting the anterior part of the mandible

      • Image

        

    • Lower oblique occlusal (oblique occlusal)./Oklusal Oblik RB

      Menghasilkan gambaran radiografik satu sisi rahang bawah, terutama daerah kelenjar submandibula. Akan tetapi karena sinar-X arahnya oblik, maka gambaran anatomis RB yangterproyeksi mengalami distorsi.  Sinar-X diarahkan ke atas dan ke depan, dari arah belakang, di bawah angulus mandibula

      • Indication

        ● Periapical assessment of the lower incisor teeth,

        especially useful in adults and children unable

        to tolerate periapical image receptor holders

        ● Evaluation of the size and extent of lesions such

        as cysts or tumours affecting the anterior part

        of the mandible

        ● Assessment of fracture displacement of the

        anterior mandible in the vertical plane.

      • Image

        

• Lembar Interpretasi

  

• BNSL

  • Komunikasi dan Prosedur Awal
    1. Menyapa pasien dengan menyebut nama dan senyum
    2. Mempersilahkan masuk
    3. Mempersilahkan duduk pada dental chair
    4. Memperkenalkan diri kepada pasien
    5. Meminta ijin untuk melakukan foto dan beritahu pasien untuk tenang
    6. Dipersilahkan melepas peralatan yang dipakai (Denture, kacamata, jepit rambut dll)
    7. Memasang apron (baju pelindung)
  • Mempersiapkan posisi penderita
    1. Menentukan bidang oklusal // (sejejar) lantai
    2. Penderita Tegak (bid sagital tegak lurus lantai)
  • Pasang film
    1. Asepsis, menggunakan masker kemudian handscoon
    2. Memasukkan film pada daerah oklusal dengan dot di bagian luar rahang
    3. Memberi instruksi penderita untuk diam/tidak bergerak
  • Central Ray
    • Atur sudut sinar x terhadap film/bidang oklusi
    • Atur Posisi Cone/tube (CP)
    • Topografi RA: Sinar-X diarahkan ke bawah, kearah batang hidung, dengan sudut 65° – 70° terhadap film.
    • Oklusal Oblik RA= Memperlihatkan gambaran radiografik satu sisi rahang atas / gigi gigi daerah posterior.
    • Crosssection RA/Vertex=+ 80° dan di arahkan ke dahi pasien
    • Topografi RB= Sinar-X diarahkan ke atas di pertengahan rahang bawah, mengarah ke dagu penderita dengan sudut 45° terhadap film.
    • Oklusal Oblik RB=Sinar-X diarahkan ke atas dan ke depan, dari arah belakang, di bawah angulus mandibula
    • Crossection RB= Sinar-X diarahkan ke atas di pertengahan rahang bawah, mengarah ke daerah Molar, dengan sudut 90° terhadap film.
  • Exposure
    1. Menetapkan waktu exposure
    2. Exposure
  • Finishing
    1. Menyisihkan tube/cone kesamping
    2. Mengambil film dari mulut penderita
    3. Mengambil apron
    4. Mengucap terimakasih
    5. Mempersilahkan menunggu di luar
    6. Hasil foto akan tampak gigi RA dan RB dalam keadaan hampir oklusi (mahkota terihat seluruhnya dan bagian akar hanya terlihat sebagian)

• Interpretation

  • Lesion

    

  • Outline

    

  • Effect on adjacent surrounding structure

    • The teeth

      There may be evidence of:

      ● Resorption, which is a feature of long-standing,

      benign but locally aggressive lesions, chronic

      inflammatory lesions, and malignancy

      ● Displacement

      ● Delayed eruption

      ● Disrupted development, resulting in abnormal

      shape and/or density

      ● Loss of associated lamina dura

      ● Increase in the width of the periodontal liga

      ment space

      ● Alteration in the size of the pulp chamber

      ● Hypercementosis.

    • Surrounding bone

      There may be evidence of:

      • Expansion:

        – Buccal

        – Lingual

        – In other directions

      • Displacement or involvement of surrounding

        structures, including the:

        – Cortex of the inferior dental canal

        – Mental foramen

        – Lower border cortex of the mandible

        – Floor of the antrum

        – Floor of the nasal cavity

        – Orbits

      ● Ragged destruction

      ● Increased density (sclerosis)

      ● Subperiosteal new bone formation

      ● An increase in the normal width of the inferior

      dental canal

      ● Irregular bone remodelling, resulting in an

      abnormal shape or unusual overall bone

      pattern.

    

Image Receptor

• Digital image receptors
  • direct → rigid sensors (CCD)
    • charge-coupled device (CCD)
    • complementary metal oxide semiconductor (CMOS
  • indirect phosphor plate receptors. (PSP)
    • storage phosphor plates (SPP)
    • photostimulable phosphor plates (PSP)

https://res.cloudinary.com/mtree/image/upload/f_auto,q_auto,f_png,fl_attachment:img01 png/dentalcare/%2F-%2Fmedia%2Fdentalcareus%2Fprofessional-education%2Fce-courses%2Fcourse0501-0600%2Fce559%2Fimages%2Fimg01 png.png%3Fh%3D187%26la%3Den-us%26w%3D780%26v%3D1-201802161336?h=187&la=en-US&w=780

Untitled