PRESENTED BY: Dr. BIPIN R. UPADHYAY (III r d 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

WHEN? WHAT?? AND HOW??? OF

MODIFICATIONS IN INTRAORAL PERIAPICAL

RADIOGRAPHIC TECHNIQUE.

INTRAORAL PERIAPICAL RADIOGRAPHY

• Intraoral Periapical (IOPA) radiographs form the backbone of dental diagnosis.

Two techniques for periapical radiography have been developed:

The paralleling technique

• The bisecting angle technique (most commonly used)

X-ray beamX-ray beam

DISADVANTAGESDISADVANTAGESADVANTAGESADVANTAGES

Distortion (foreshortening, elongation, magnification).

Overlapping of structures due to inaccurate vertical/horizontal angulations.

Non reproducible.

Distortion (foreshortening, elongation, magnification).

Overlapping of structures due to inaccurate vertical/horizontal angulations.

Non reproducible.

Film positioning relatively comfortable to the patient.

Simple and quick for the operator.

Image is adequate but not ideal for most diagnostic procedures.

Film positioning relatively comfortable to the patient.

Simple and quick for the operator.

Image is adequate but not ideal for most diagnostic procedures.

BISECTING ANGLE TECHNIQUE

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.

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ADVANTAGES AND DISADVANTAGES OF BISECTING ANGLE TECHNIQUE

1SCENE

PROS vs CONS

WHEN? WHAT?? AND

HOW???

WHY??• The anatomy of the oral

cavity does not always allow all the ideal positioning requirements to be satisfied.

• In an attempt to overcome the problems, some modifications in the Radiographic technique are to be made to obtain an optimum radiograph.

WHEN?

Shadow of malar bone Bony growth Mandibular premolar

region Ankyloglossia Mandibular third molar

region

Gagging Endodontics Edentulous alveolar

ridges Children Handicapped patients

Shadow of malar boneLe Master’s TechniqueA cotton roll is fastened to front side of film, against palatal surface of molars making mean plane of film more parallel to plane of toothVertical angulation is decreased

SHADOW OF MALAR BONE

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

palatal torus

MODIFICATIONS FOR PALATAL TORI

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

mandibular torus

• Place film between torus and tongue, making sure it doesn’t rest on top of torus

MODIFICATIONS FOR LINGUAL TORI

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 curved / softened.

MODIFICATIONS FOR MANDIBULAR PREMOLAR REGION

Edge-Ease tissue

protectors

Sponge tissue protector-peel off backing that exposes sticky surface to adhere to film packet

Using the tongueblade to support the film for ankyloglossia

lingual frenum

portion of tongue superimposed over roots

MODIFICATIONS FOR ANKYLOGLOSSIA (TONGUE TIE)

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: OCCLUSAL VIEW

IDEAL FILM POSITIONING FOR MANDIBULAR THIRD

MOLAR: SIDE VIEW

USE OF NEEDLE HOLDER

EXTERNAL CENTERING POINT FOR MANDIBULAR

THIRD MOLARS

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 -diazepam

Endodontics

ReasonFilm placement and stabilization with endodontic instruments, rubber dam, clampsIdentification and separation of root canalsAssessing root canal length

ModificationTaping film to one end of wooden tongue spatulaUsing 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 -actual instrument length

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

Edentulous patientReason•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