WHEN? WHAT?? AND HOW???

OF
MODIFICATIONS IN
INTRAORAL PERIAPICAL
RADIOGRAPHIC TECHNIQUE .
PRESENTED BY: Dr. BIPIN R. UPADHYAY
(III rd year Post Graduate Student)
GUIDED BY: Dr. RAJEEV GADGIL
(Professor and PG Guide)
Dr. AJAY BHOOSREDDY
(Professor and Head)
FROM: Department of Oral Medicine and
Radiology
MGV’s KBH Dental College, Nashik
 INTRAORAL PERIAPICAL
RADIOGRAPHY
• Intraoral Periapical (IOPA) radiographs
form the backbone of dental
diagnosis.
•
 Two techniques for periapical
radiography have been developed:
Ø The paralleling • The bisecting angle
technique technique (most
• commonly used)
m
• X-
ray
bea b ea
- ray m
X
 BISECTING ANGLE TECHNIQUE 1 SCENE

PROS vs
CONS

ADVANTAGES AND DISADVANTAGES OF BISECTING ANGLE TECHNIQUE

ADVANTAGES DISADVANTAGES

§Film positioning relatively §Distortion (foreshortening,

comfortable to the patient.
§Simple and quick for the operator.
§Image is adequate but not ideal for
most diagnostic procedures.
elongation, magnification).
§Overlapping of structures due to
inaccurate vertical/horizontal
angulations.
§Non reproducible.

 û
Conclusion

Relatively easy technique and being comfortable to the patient makes the
Bisecting angle technique the most commonly used technique for intraoral
periapical radiography in General dental practice.
 WHY??
• The anatomy of the
oral cavity does not
always allow all the
ideal positioning
requirements to be
satisfied. HO W? ??
WH EN ? WH AT ?? AN D
• In an attempt to
overcome the
problems, some
modifications in the
Radiographic
technique are to be
 WHEN?
Ø Shadow of malar Ø Gagging
bone Ø Endodontics
Ø Bony growth Ø Edentulous
Ø Mandibular alveolar ridges
premolar region Ø Children
Ø Ankyloglossia Ø Handicapped
Ø Mandibular third patients
molar region Ø
Ø
 Shadow of malar bone
Le Master’s Technique


 A cotton roll is fastened to front side

of film, against palatal surface of
molars making mean plane of film
more parallel to plane of tooth
 Vertical angulation is decreased
 SHADOW OF MALAR BONE

LE MASTER’S TECHNIQUE FOR ESCAPING THE SHADOW OF MALAR BONE

MODIFICATIONS FOR PALATAL TORI

palatal torus
• Place film on the
opposite side of
palatal torus
(away from teeth
being
radiographed)
•
MODIFICATIONS FOR LINGUAL TORI

• Place film between

torus and tongue,
making sure it
doesn’t rest on
top of torus
mandibular torus
•
 Mandibular premolar region
• Reason
• Floor of mouth region is very
sensitive-Film causes
discomfort to patient
•
• Modification
• Film placement: under tongue
to avoid impinging on muscle
attachments and sensitive
lingual mucosa
• Film: Lower edge can be gently
MODIFICATIONS FOR MANDIBULAR
PREMOLAR REGION
Edge-Ease
tissue
protectors

Sponge tissue protector-

peel off backing that
exposes sticky surface to
adhere to film packet
F IC A T IO N S F O R A N K Y LO G LO S S IA ( T O N G U

Using the tongueblade

to support the film for
ankyloglossia

lingual frenum

portion of tongue
superimposed over roots
 Mandibular third molar region

Reason
• Placement of film more posteriorly
and to visualize the relationship of
the apex of the third molar with the
inferior alveolar nerve canal.
•
Modification

• Use of surgical needle holder

• Distal shift of the tube.
 IDEAL FILM POSITIONING FOR MANDIBULAR THIRD MOLAR: OCC

ITIONING FOR MANDIBULAR THIRD MOLAR: SIDE VIEW

USE OF NEEDLE HOLDER

EXTERNAL CENTERING POINT FOR MANDIBULAR THIR

 Problems of gagging

• Exposure factors, tube placement

should be ready
• One swift movement for palatal side-
No sliding
• Divert patient’s attention
• Asking patient to concentrate on
breathing deeply
• Ask patient to gargle with cold water
• Spraying palate with LA
• Prescribed Anxiolytics - tranquilisers
 Endodontics
Reason


 Film placement and stabilization with

endodontic instruments, rubber dam,
clamps
 Identification and separation of root
canals
 Assessing root canal length

Modification


 Taping film to one end of wooden

tongue spatula
 Using special endodontic film holders
Assessment of root canal length


• Actual length of root canal from

bisecting angle technique is
calculated mathematically with
diagnostic instrument within canal
at clinically assessed stop.


Measure -radiographic tooth length

 -radiographic instrument
length
 Formula-
Actual tooth length=
 (Radiographic tooth length x actual

instrument length)
 radiographic instrument length
 Edentulous patient
Reason
• Lack of height in palate / loss of
lingual sulcus depth contraindicates
paralleling technique
• Partially dentate patients
•
Modification

• Use of bisecting angle technique

• Placement of cotton roll in
edentulous area
 Children
Reason
• Size of mouth and difficulty in
placement of film
•
Modification

• Paralleling technique is not possible

in very small children, but
recommended in anterior region for
investigation of traumatized
permanent incisors
 Handicapped patients

Reason
• Patient’s cooperation
•
Modification

• Use of paralleling technique

• Trauma
• Neurologic deficit patients