RADIOLOGY: BISECTING TECHNIQUE

Supervised by: Lusi Epsilawati., drg

By KPBI GROUP 2:
Yong Ker Loon Nirossha.S Suganya.M Uthaiya Githa .S - 160110083006 - 160110083008 - 160110083009 - 160110083011
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Introduction:
Other name: bisecting angle technique, bisection-of-the-angle technique and short cone technique. Used to expose periapical films.

Terminology:
Angle: a figure formed by two lines diverging from a common point. Bisect: to divide into two equal parts. Isometry : equality of measurement. Long axis of the tooth: an imaginary line that divides the tooth longitudinally into two equal halves. Central ray: the central portion of the primary beam of x-radiation.
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Principles:
Based on a geometric principle of bisecting a triangle or the RULE OF ISOMETRY. The rule of isometry states that two triangles are equal if they have two equals angles and share a common side.
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 The film must be placed along the lingual surface of the tooth. When the film contacts the tooth, the plane of the film and the long axis of the tooth form an angle. Visualize a plane that divides in half or bisect, the angle formed by the film and the long axis of the tooth: imaginary bisector. The imaginary bisector creates two equal angles and provides a common side for the two imaginary equal triangles.
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 The dental radiographer must then direct the central ray of the x ray beam perpendicular to the imaginary bisector. The hypotenuse of one imaginary triangle is represented by the long axis of the tooth, the other hypotenuse is represented by the plane of the film.

Film Stabilization:
There are two methods: using film holder and finger holding method. Used to position an intraoral film in the mouth and retain the film in position during exposure. Film holders are recommended: reduces the patients exposure to radiation.
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Film Holder:
Examples of intraoral film holders: a) Rinn Bisecting Angle Instruments (BAI) b) EEZEE-Grip film holder or Snap-A-Ray c) Stabe bite block

Finger Holding:
Known as the digital method: patients thumb or finger is used to stabilize the periapical film and always placed at lingual side of the teeth. Always use the hand opposite to the side of the mouth being radiographed.
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 The DISADVANTAGES in this method is: a) Patients hand is in the path of the primary beam, resulting in UNNECESSARY RADIATION. b) Patients may use excessive force to stabilize the film, causing the film to bend and resulting in IMAGE DISTORTION. c) Patient may allow the film to slip from its position, resulting in INADEQUATE EXPOSURE of the prescribed area. d) Without the film holder with aiming ring, the dental radiographer may align incorrectly, causing a PARTIAL IMAGE OR CONE CUT.
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Film Placement:
Usually, size 2 intraoral film is used. Anterior region: film is always placed in the vertical or upright direction. Posterior region: film is always placed in the horizontal or sideways direction.
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Angulation:
Angulation: alignment of the central ray of the x-ray beam in the horizontal and vertical planes. Angulation can be changed by moving the position indicating device (PID) in either a horizontal or vertical direction.

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Angulation:
MAXILLA VERTICAL ANGULATION INCISORS CANINE PREMOLARS MOLARS

55 0
INCISORS

50 45
CANINE

40 75
PREMOLARS

35 90
MOLARS

HORIZONTAL ANGULATION
MANDIBULA VERTICAL ANGULATION HORIZONTAL ANGULATION

-25 0

-20 45

-15 75

-5 90
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Horizontal Angulation:
Positioning of the tubehead and direction of the central ray in a horizontal or side-toside plane. Remains the same in both paralleling or bisecting technique.
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Horizontal Angulation:
CORRECT horizontal angulation: the central ray is directed perpendicular to the curvature of the arch and through the contact areas of the teeth. INCORRECT horizontal angulation results in overlapped (unopened) contact areas cannot be used to examine the interproximal areas of the teeth.
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Vertical Angulation:
Positioning of the tubehead and direction of the central ray in a vertical or up-and-down plane. Differs according to the radiographic technique being used.
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Vertical Angulation:
With the paralleling technique, the VA of the central ray is directed perpendicular to the film and the long axis of the tooth. With the bisecting technique, the vertical angulation of the central ray is directed perpendicular to the imaginary bisector.
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Vertical Angulation:
CORRECT vertical angulation results in a radiographic image that is the same length as the tooth. INCORRECT vertical angulation results in an image that is not the same length as the tooth being radiographed. The image appears either elongated or foreshortened.
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FORESHORTENED

ELONGATED

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BASIC RULES
Film placement Film position Vertical angulation Horizontal angulation Film exposure
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1. Patient should be seated 2. Briefly explain the radiograph procedure 3. Position the patient upright in the chair. The level of chair must be adjusted to a comfortable working height for the dental radiograph 4. Adjust the headrest to support the patients head. 5. Place and secure the lead apron with thyroid collar over the patient 6. Remove all objects from the patients mouth (dentures, retainers, chewing gum) that may interfere with film exposure. Eyeglasses must also be removed

1. Set the exposures factors (kilovoltage, milliamperage & time) on the x-ray unit 2. Either a short (8-inch) or long (16-inch) cone may be used. Typically the short cone is preferred.

Exposure sequence for film placements

1. When exposing periapical films always START with the anterior teeth (canines and incisors) 2. The reason; anterior placements are less likely to cause the patient to gag 3. With size 2 film, a total of 6 anterior film placement are used in this bisecting technique

Sequence;
1. Begin with the maxillary right canine 2. Expose all the maxillary anterior teeth from right to left 3. End with the maxillary left canine 4. Next, mandibular arch. Begin with mandibular left canine 5. Expose all the mandibular anterior teeth from left to right 6. Finish with the mandibular right canine

Posterior;
In each quadrant, always expose the premolar film first and then molar film 8 posterior film placement are used in the bisecting technique (4 maxillary and 4 mandibular exposures)

Sequence;
1. Begin with maxillary right quadrant 2. Expose the premolar film first then the molar film 3. Move to mandibular right quadrant 4. Expose the premolar film first then the molar film 5. Move to maxillary left quadrant 6. Expose the premolar film first then the molar film 7. Finish with the mandibular left quadrant 8. Expose the premolar film first then the molar film

Maxillary Canine Exposure

1.Center the film packet on the canine

3. Instruct the patient to slowly close on the bite block

2. Position the lower edge of the film parallel to the occlusal plane so that 1/8 inch extends below the incisal edge of the canine

4. Vertical angulation=50, horizontal angulation=45 5. Expose the film

THE ENTIRE CROWN AND ROOT OF THE CANINE MUST BE SEEN. THE INTERPROXIMAL ALVEOLAR BONE AND MESIAL CONTACT OF THE CANINE MUST ALSO BE VISIBLE.

Maxillary Incisors Exposure

1.Center the film packet on the contact between the 2 central incisors

3. Instruct the patient to slowly close on the bite block

2. Position the lower edge of the film parallel t the occlusal plane so that 1/8 inch extends below the incisal edge of the canine

4. Vertical angulation=55, horizontal angulation=0 5. Expose the film

ENTIRE CROWN AND ROOTS OF ALL FOUR MAXILLARY INCISIORS MUST BE SEEN. THE INTERPROXIMAL ALVEOLAR BONE BETWEEN CENTRAL.I AND C.I AND L.I MUST ALSO BE VISIBLE

Mandibular Canine Exposure

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Central film

Upper edge of film parallel to occlusal plane 2 1/8 inch extends above the incisal edge of canine. Central ray is perpendicular to the imaginary bisector. X ray 4 vertical angulation (-20) horizontal angulation (45)

Instruct patient to slowly close on to a bite block or film holder. 3

RESULTS
Clearly seen crown, root, periodontal membrane, lamina dura, periapical, alveolar bone

Mandibular Incisor Exposure

Central film

Upper edge of film parallel to occlusal plane 2 1/8 inch extends above the incisal edge of canine.

Central ray is perpendicular to the imaginary bisector. X ray vertical angulation (-25) horizontal angulation (0) 4

RESULTS
Instruct patient to slowly close 3 on to a bite block or film holder.
Clearly seen crown, root, periodontal membrane, lamina dura, periapical, alveolar bone

Maxillary Premolar Exposure

Central film 1

Lower edge of film parallel to occlusal plane 1/8 inch extends above the incisal edge of canine.

Central ray is perpendicular to the imaginary bisector. X ray vertical angulation (40) 4 horizontal angulation (75)

RESULTS
Instruct patient to slowly close 3 on to a bite block or film holder. Clearly seen crown, root, periodontal membrane, lamina dura, periapical, alveolar bone

Maxillary Molar Exposure

Central film 1

Lower edge of film parallel to occlusal plane 1/8 inch extends above the incisal edge of canine.

Central ray is perpendicular to the imaginary bisector. X ray vertical angulation (35) 4 horizontal angulation (90)

RESULTS
Instruct patient to slowly close 3 on to a bite block or film holder. Clearly seen crown, root, periodontal membrane, lamina dura, periapical, alveolar bone

Mandibular Premolar Exposure: Bisecting Technique

Center the film holder and film packet on the 2nd premolar

Position the upper edge of the film to the occlusal 1/8 inch extending.

Correct vertical angulation

Slowly close on the film holding device

Correct horizontal angulation

Position the PID

Mandibular Molar Exposure: Bisecting Technique

Center the film holder and film packet on the 2nd molar

Position the upper edge of the film to the occlusal 1/8 extending.

Slowly close on the film holding device

Position the PID

Correct horizontal angulation

Correct vertical angulation

Expose the film

Mandibular Incisor Exposure: Finger Holding Method

Center the film packet btwn 2 central incisor

Position the upper edge of the film to the occlusal 1/8 extending.

Instruct patienthold the film using the index finger of either hand.

Correct horizontal angulation

Correct vertical angulation

Exert light but firm pressure in the area whr the teeth meet gingival tissue

Position the PID

Expose the film

Maxillary Premolar Exposure: Finger Holding Technique

Center the film packet on the 2nd premolar.

Position the upper edge of the film to the occlusal 1/8 extending.

Instruct patient- hold the film using the thumb opposite the side the film is placed.

Correct horizontal angulation

Correct vertical angulation

Exert light but firm pressure in the area whr the teeth meet gingival tissue

Position the PID

Expose the film

Advantages of Bisecting Technique

It can be used without a film holder when the anatomy of the patient precludes the use of a film-holding device. Decreased exposure time.

Disadvantages of Bisecting Technique

Image distortion Angulation problems Unnecessary exposure