Occlusal & Localization Technique

2019/12/10‫) للفرقة الثالثة بتاريخ‬Radiology( 11 ‫املحاضرة الـ‬

Definition of Occlusal radiograph: radiograph designed to be placed between upper & lower teeth
with central beam directed by angle + 50o-90o to the plane of the film according to view needed.
digital or traditional‫ممكن تكون‬
- It doesn’t need neither a film holder nor a film positioning instrument,
‫وبالتالي سهل عل الدكتور مش محتاج مهارة ومش محتاج مجهود من المريض‬
upright for upper and his chin forward in lower. ‫فاهحتاجه‬floor ‫ ل‬parallel ‫يبق‬film ‫كل الل محتاجه انه‬
- Now, cone beam CT is used if we need more detailed film as it provides 3D films
‫ئ‬
occlusal + periapical‫تكاف التقاط الفيلم بكل من ال‬ ‫وبالتال ه لوحدها‬
- Dimensions captured in two dimension films as periapical films are MD and occluso-apical.
- BuLi, anteroposterior, transverse, axial captured in occlusal film.
-Occlusal film also 2D detect MD and BuLi, not occluso-apical.
 General indications: used in:
1. In conjunction with Periapical & bitewing image
2. When large area of maxilla or mandible must be visualized
3. When area of interest is larger than Periapical receptor may cover or when the placement of
inter oral receptors is too difficult for patient
4. To locate retained roots of extracted teeth.
5. To locate supernumerary, unerupted on impacted tooth.
6. To locate foreign bodies in maxilla on in mandible.
7. To locate salivary gland stone in submandibular gland duct. this is the most important point
when asking about the lower occlusal.‫ودي اول نقطه اكتبها ف الفك السفل‬
8. To locate & evaluate extent of lesion (e.g. Crypts, tumors, etc.)
9. To evaluate boundaries of maxillary sinus.
10. To evaluate fractures of maxilla or mandible.
11. To examine patients who had trismus.
12. To examine area of cleft palate.
13. To examine changes in size, shape of maxilla on mandible.
14. To determine the position of upper impacted canine. This is the most important point when
asking about the upper occlusal film‫ودى اول نقطه اكتبها ف الفك العلوى‬
15. It determines the anteroposterior dimensions of both jaws

 Size of film:
▪ In adult → #4
▪ In child → # 2

 Principles:
1. The film is positioned with the white side (non- tube side) facing the arch that being exposed.
2. The receptor is placed in mouth between occlusal surface of maxillary & mandibular tooth.
3. The receptor is stabilized when the patient bites on surface of receptors.

1|Page
 Step by step procedures:
1. Patient procedures: first, infection control procedures must be done then preparation of
treatment area supplies, after that the patient is seated.
After seating → preparation of pt. for exposure of receptors.
‫ بيكون الـ‬cross section‫ ما عدا نوع واحد وهو ال‬Floor ‫ بيبق الفك السفل بتاع المريض موازي للـ‬occlusal ‫يعي كل أنواع الـ‬
.90‫ وبينهم زاويه‬Floor ‫ عمودي عل الـ‬mandible
2. Equipment procedures: equipment must be prepared before exposure to any receptors.
‫اعدل الفيلم واعدل رأس المريض واعدل وضعيه االكس راي الل طالعه من الكون‬:‫يعي الخطوات من االخر‬
 Occlusal film projections:
1. Cross section
i. upper cross section.
ii. lower cross section.
2. Topographic
i. Anterior topograph (upper and lower).
ii. Lateral topograph.

1. Cross section
▪ The only intraoral films that is screen film because it passes through multiple anatomical
structures (to prevent overlap), And need high x-ray dose.
i. Upper cross section:
N. B - Screen magnify the effect
•
Vertical angulation = +90
of the x-ray
•
Tube side of the film facing upward.
 Disadvantages:
1. No longer use as xray passes along and expose the eye to radiation.
2. Super imposition of the anatomical structures.
3. Lack of details and poor resolution.
ii. Lower cross section:
• Vertical angulation = -90
• Tube side facing down ward
 Indications:
1. Salivary gland stone
2. Periapical film assessment of lower anterior teeth in uncooperative child or in case of
trismus.
3. Assessment of buccolingual position of impacted teeth, odontomas or any lesion
4. Localize fracture in mandible

2. Topographic:
i. Upper anterior topographic
• Vertical angulation in adults = +65
• In pediatric = +60
• Above nasion and don’t pass the eye.

2|Page
  Indications:
1. Periapical film assessment of upper anterior teeth in uncooperative child or in case of
trismus or fracture.
2. Impacted upper canine.
3. Assessment of fracture in anterior teeth or ant maxilla.
4. After oral trauma in children.
5. Lesion in anterior maxilla and palate.
6. Maxillary pediatric: it is used to examine anterior teeth of maxilla and is recommend for 5
years children or younger.
▪ Provide image of deciduous and their remaining roots.
▪ Indicate for extraction or delayed.
▪ Show developing permanent.

ii. Lower anterior topographic

• Vertical angulation in adult and pediatric = -55
• Tube side of the film facing downward.
• Indicate half of the jaw.
 Indications:
1. Salivary gland stone near the gland.
2. Lesion or cyst at retromolar area.
3. Mandibular (angle, body) fracture.

iii. Lateral topographic ‫ بالطول زى مابصور ال‬upper ant.

• Vertical angulation in adult and pediatric = 55
 Indications:
1. Lesions in palate posteriorly at the tuberosity.
2. Periapical film assessment of lower anterior teeth in uncooperative child or adults unable
to use periapical as trismus.
3. Lesion extends buccolingually.
4. Assessment of fracture in anterior teeth.
5. Posterior teeth as periapical.
6. Maxillary sinus.
- Mandibular Topographic: it is used to examine anterior teeth of mandible. All the anterior roots are seen. And also to detect
any bone expansion
- Mandibular cross sectional or true occlusal: it is used to examine buccal & lingual aspects of mandible so detect amount
of expansion with lesion also to locate foreign bodies or salivary stones in floor of the mouth.
▪ It also used in past for implant to determine buccolingual dimension while length and mesiodistal detected from
panorama
Lateral oblique occlusal film also for lower jaw ,it is an intra oral film ‫ ف نوع تان من االشعه‬-
1. To determine the position of impacted third molar
2. To detect the salivary stone
3. To detect the lingual surface of the teeth
‫بخل المريض يرفع راسه واجيب الكون من تحت ذقنه واوجهه من السطح الداخل الفك السفل‬

3|Page
A, The central ray (CR) is directed at +60 degrees vertical angulation to the plane of the receptor. B,
Relationship of the receptor and the position-indicating device (PID).
C, Maxillary lateral occlusal projection.

The central ray (CR) is directed at
−55 degrees vertical angulation to
the plane of the receptor. C, It
represents mandibular pediatric
occlusal projection
A, The central ray (CR) is directed at +60
degrees vertical angulation to the plane of the
receptor. B, Maxillary pediatric occlusal
projection.

4|Page
The central ray (CR) is directed at −55 degrees
vertical angulation to the plane of the receptor.
B, Relationship of the receptor and the position-
indicating device (PID). C, Mandibular
topographic occlusal projection.
, The central ray (CR) is perpendicular (90
degrees vertical angulation) to the plane of
the receptor. B, Relationship of receptor
and PID. C, Mandibular cross-sectional
occlusal projection.

Localization technique: is used to locate the position of tooth or an object in the jaws also step by
step procedures are required first
 Purpose: to locate:
1. Foreign bodies.
2. Impacted teeth.
3. odontoma
4. Unerupted teeth.
5. Any lesion buli.
6. Retained roots.
7. Roots positions.
8. Salivary stones.
9. Jaw fractures.
10. Broken needles in instruments.
11. Filling materials.
12. To determine the number, the position of the root canals in endodontic ttt

Types:
1. Buccal object rule.
2. Right – angle technique.
5|Page
1. Buccal object rule (tube shift tech-Clarks tech –SLOB tech):
Its principal of use of two periapical films with two different vertical angulations to distinguish buccal
canal from lingual one as in Bu&Li canals of upper 4 , MB and ML canals of mesial root of lower6.
‫ يبق الحاجه الل‬Distal ‫ بس من بعدين مختلفي فلو الصوره ف المره التانيه جت بعيده ناحيه الـ‬periapical ‫يعي باخد صورتي‬
.lingually ‫ تبق الحاجه الل بابحث عليها مكانها‬mesial ‫ اما لو الصوره التانيه كانت اقرب يعي‬Buccally ‫بابحث عليها مكانها‬
‫ عادي‬distal ‫ النه بس اسهل لكن انا عندي‬mesial shift ‫ االول كان ايه وغيته اليه انا باستخدم لفظ‬shift‫اهم حاجه احدد ال‬
- It governs orientation of structures portrayed
in two radiographs exposed at different
angulation.
- Different horizontal angulation is used when
trying to locate vertically aligned objects and
vice versa.
- SLOB “Same lingual opposite buccal” when
the object seen in the second image appears
to have moved in the same direction of PID.
- The object is positioned to the lingual →
lingual = same.
- Conversely when the object seen in the
second image appears to have moved in the
opposite direction of PID, the object is
positioned to buccal → buccal = opposite. Buccal and lingual objects shift positions when the direction of
the x-ray beam is changed. A, Buccal (cross-hatched circle) and
2. Right – angle technique (Mylar tech): lingual (black circle) objects are superimposed in the original
• In this technique radiograph. B, If the tubehead is shifted in a mesial direction, the
‫باخدصورتي مختلفي عن بعض بحيث االول تبق عموديه عل‬ buccal object moves distally, and the lingual object moves
mesially (same direction = lingual; opposite direction = buccal).
Occlusal ‫ والتانيه‬Panorama ‫التانيه يعي مثال واحده‬
- One Periapical receptor is exposed using the
proper technique and angulation to show the
position of the object in supra-inferior and
anteroposterior relationship.
- Next, an occlusal receptor is exposed
directing the central ray perpendicular to the
receptor.
- It shows the position of the object in
buccolingual & anteroposterior relationships
- After exposure & processing, the images are Right-angle technique. A, The object appears to be
compared with each other to locate object in 3- located in bone on the periapical radiograph. B, The
dimensions occlusal image reveals that the object is actually
located in soft tissue lingual to the mandible

- This technique is primarily used for locating objects in the mandible

- Not indicate for determine buccal canal from lingual one as in Bu&Li canals of upper 4 , MB and
ML canals of mesial root of lower6.
Source:
▪ Lecture
6|Page