“Image receptor is

placed inside the Intra-oral

mouth and x-rays are
directed from outside
Radiography
the mouth”

Extra-oral “Image receptor is placed outside

the mouth and x-rays, too, are
Radiography directed from outside the mouth”

Dr rupam sinha
 Intra-oral Radiography

Periapical Bitewing

Occlusal

Dr rupamsinha
 Description of
a Radiographic Technique

# Patient Position
# Placement of Image Receptor
# Direction of the Central Ray
# Point of Entry / Centering Point
# Exposure Parameters:
Tube voltage (kVp), Tube current (mA), Exposure time
(S), Target to image receptor distance (TID / TFD),
Size and type of image receptor
 General Considerations in Intra-oral Radiography

 Follow the Infection Control protocol.

 Follow the methods of Radiation Protection.
Provide a leaded apron to every patient
irrespective of age and sex.
 Prior and careful explanation of the procedure
will make the patient relaxed, comfortable,
confident of your ability, and therefore, co-
operative.
 Eyeglasses, nose ornaments and removable
dentures should be removed prior to
exposure.
 Immobilize the patient to avoid repeat exposure.
General Considerations in Intra-oral Radiography
 Carry out the easier and more comfortable
techniques first.
 Film should remain flat as far as possible.
Gentle bending (not ‘folding’) of the corners
may avoid tissue injury and gagging.
 Process under standardized conditions to
achieve consistent good quality.
 Interpret under ideal viewing conditions to
obtain maximum useful information.
Remember! Radiographs are to be made only
when benefits from them far outweigh the
damages from radiation exposure.
 Intra-oral Periapical Projection
“To record images of teeth; periapical and
periodontal alveolar bone”

Two Techniques

‘Paralleling Cone’ ‘Bisecting - the

Technique angle’
(Long cone Technique
(Short cone
technique) technique)
 Paralleling Cone Technique of
Intra-oral Periapical Radiography

1. Patient•First
Position:
described Patient can C.beKells
by Edmund either sitting
in 1896
upright or •Revived
reclinedbyinDonald
the dental chair inprovided
McCormack 1937 that
the head is•Perfected
not tiltedbytoGordon Fitzgerald in 1947
the side.

2. Placement of Image Receptor: Image receptor is

placed parallel to the long axis of the tooth to be
radiographed. Special devices are used to achieve
and maintain the correct receptor position.
OMR, CODS, DVG
Requirements for Receptor Holders:
~ Should be rigid
~ Should be autoclavable
~ Should be small and lightweight
~ Should maintain parallelism between
tooth and receptor
~ Should align the central ray
perpendicular to the receptor

Types of Receptor Holders:

~ Artery forceps with a bite
block
~ ‘Snap-a ray’ instrument
~ ‘XCP’ device
Snap-A-Ray Instrument
XCP (extension cone paralleling) Instruments
Artery forceps
or
needle holder
3. Direction of the Central Ray: The central
ray should be perpendicular to both- the
image receptor and the long axis of the tooth
in both -vertical and horizontal planes.

Horizontal

Vertical
4. Point of Entry / Centering Point:
Maxillary teeth > Along the ala-tragus line
Mandibular teeth > Along a line 3 cms above
the inferior border of mandible
5. Exposure Parameters: kVp = 80 / 65 mA = 10

Exposure time (in seconds) 80 kVp 65 kVp

maxillary anterior teeth 1/4 1/2
maxillary posterior teeth 1/3 3/4

mandibular anterior teeth 1/6 2/5

mandibular posterior teeth 1/4 1/2

TID = 40 cms Type & size of image receptor : ‘E’ speed non-
screen film; No. 1 for anterior teeth, No. 2 for posterior teeth
 Advantages: related to image quality
 Better image quality i.e. sharper image with least
image size and shape distortion.
 Detection of early caries at the D-E junction and at
the proximal surfaces possible due to perfect
superimposition of buccal cusps over the lingual
cusps.
 Detection of early periodontal disease possible due to
perfect superimposition of buccal alveolar crest
over the lingual alveolar crest.
 Avoids superimposition of zygomatic process of
maxilla over the periapical region of maxillary
molars.
OMR, CODS, DVG
 Advantages: related to patient protection
Less radiation due to:
~ higher kVp
~ more TID
~ less vertical angulation
~ patient in reclining position.

Advantages: general
~ Technique can be executed in any patient position.
 Limitations:

 Difficult to master.
 Difficult to practice in endodontics.
 Needs special receptor holders.
 More number of exposures needed for a FMRS.

OMR, CODS, DVG

 Bisecting - the Angle Technique of
Intra-oral Periapical Radiography
1. Patient Position: Patient is made to sit upright in
the dental chair with sagittal plane perpendicular to
•First
the floor. For maxillary
described teeth, Price
by Weston the in
ala-tragus
1904 line is
•Independently
kept parallel to floor. For mandibular
described by Cieszynskiteeth,
in 1907lower
•Also
border of called asistechnique
mandible basedtoonfloor.
kept parallel Principle of
2. PlacementIsometric
of Image Triangulation
Receptor: Image receptor is
placed close to the teeth making an angle at the
occlusal level with the long axis of the tooth to be
radiographed. The receptor extends beyond the
occlusal plane by 5 mm. Receptor position is
maintained either with patient’s finger or with a holder.
Image size>
Image size <=Object
Objectsize
size
3. Direction of the Central Ray: Central ray is directed
perpendicular to the teeth in the horizontal plane.

Angulation in the vertical plane:

Teeth Angulation
Maxillary Mandibular

Incisors + 40 -15
Canines + 45 - 20
Premolars + 30 - 10
Molars + 25 - 05
 4. Point of Entry / Centering
Point:
¶ Maxillary ‘line of
concentration’ (MYLOC) is
the imaginary ala-tragus line.
Hi!
¶ Mandibular ‘line of
concentration’ (MRLOC) is an
imaginary line 1 cm above
the inferior border of
mandible.
Centering Points for Maxillary Teeth

11

18
12

16, 17
13
14, 15
Centering Points for Mandibular Teeth

44, 45

Bye!
41

48 43 42

46, 47
5. Exposure Parameters: kVp = 65, mA = 10,
Exposure time in Seconds:
Mandibular anteriors : 0.1
Mandibular posteriors
and
Maxillary anteriors : 0.2
Maxillary posteriors : 0.3

TID = 20 cms Type & size of image receptor: ‘E’ speed

non-screen film; No. 1 for anteriors, No. 2 for posteriors
Bisecting-the Angle Technique of Intra-oral Periapical Radiography

Limitations: related to image quality

 Poorer image quality with size and shape distortion.
 Detection of early caries and of early periodontal
disease not possible.
 Zygomatic process of maxilla superimposes over the
periapical region of maxillary molars.
Limitations: related to patient protection
More patient exposure due to
lower kVp
shorter TID
more vertical angulation
patient in upright position.
Bisecting-the Angle Technique of Intra-oral Periapical Radiography

Limitations: general
 technique must be executed with patient in
upright position.

Advantages:
Easy to master.
Easy to practice in endodontics.
Does not need special receptor holders.
Less number of exposures needed for a FMRS.
T
H
E
Paralleling cone technique is the
R technique
E
F Bisecting-the
of choice forangle technique
periapical is to be used
radiography.
O only when the paralleling cone technique is not
R
E feasible.
Full Mouth Radiographic Survey (‘FMRS’)
A ‘FMRS’ is a radiographic examination of the
entire dentition and its supporting structures or
of the edentulous alveolar processes.
‘FMRS’ consists of
EITHER
10 to 16 periapical radiographs with 2 to 5 bitewing
radiographs,
OR
6 topographic occlusal radiographs with 2 bitewing
radiographs,
OR
A panoramic radiograph with 2 to 5 bitewings
radiographs.