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Final_Lec4 21-April-2013

Occlusal Radiography + Exposure & Technique Errors

Occlusal technique is considered a localizing technique that helps in localizing objects; if they
are buccaly or lingually located.

Occlusal radiograph is at right angle to peri-apical radiograph & bite-wing radiograph so if you
want to take the location of an object you take 2 radiographs at right angle to each other or a
3D radiograph if necessary. Taking 2 radiographs (2D) at right angle to each other will gives the
patient less dose of x-ray compared to 3D.

There are 2 types of localization techniques:

1) Buccal Object Technique/SLOB (Same

Lingual Opposite Buccal):

Governs the orientation of structures portrayed in

2 radiographs exposed at different angulations.
One Peri-apical/bite-weing film is exposed using
proper technique & angulation, and then a second
Peri-apical/Bite-Wing film is exposed after
changing the direction of the x-ray beam. The
angulation can be horizontal or vertical. Ex. A
different horizontal angulation is used when
you’re trying to locate vertically aligned images
like locating root canals. Also, a different vertical
angulation is used when trying to locate a
horizontally aligned image such as the mandibular
canal.

 Buccal object rule can be also applied vertically, when you take panoramic radiograph
the beam is directed near the occlusal plane, it is not exactly, there is a little vertical
angulation, however maxillary occlusal coming from inside of the nose, and the
mandibular occlusal from the side of the chin. So we can use SLOB rule vertically.
e.g. I moved the beam upward and the object appears to go downward then it is
buccally located.

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 2) Right Angle technique.
As discussed above. (Two dimensional radiographs are compared to locate an object in
three dimensions).

Now we are going to start a new topic which is Exposure &

Technique Errors Ch.20

 Exposure errors which include:

1) Unexposed Film: Film appears clear.
This is caused by failure to turn on the X-ray machine. Or you press
the exposure button without waiting to listen the audible sound.

2) Film exposed to light: Film appears Black (very dark film) & this is caused by accidentally
exposing the film to white light so the film gets burned. We have to protect the film & we
shouldn’t unwrap it in a room with white light.

3) Overexposed: Film also appears dark but NOT darker than

“Film exposed to light”↑. This is caused by increasing
exposure time, Kilo voltage, Milliampere or a combination
of these factors.

4) Underexposed: Film appear Light & this is caused by

inadequate exposure time, Kilo voltage, Milliampere or a
combination of these factors.
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Periapical Film Errors

 Technique Errors which include:
1) Peri-Apical Film errors: these include
a) Film Placement errors : Film should be placed parallel to
the teeth and it should be positioned 2 mm beyond the
apex & 1/8 inch (more than 2mm) beyond the
incisal/occlusal surface. A correct peri-apical film
placement demonstrates the entire tooth, including the
apex and surrounding structures.

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 Incorrect film placement:
 Absence of apical structures.
 Dropped film corner: when the occlusal plane is slanted/tilted due to the film not
placed parallel to incisal-occlusal surfaces of the teeth. To avoid this you have to
instruct your patient to hold the film firmly in place, and you have to be very quick
so that you won’t initiate gagging reflex for your patient.

b) Angulation errors which include:

Angulation: is a term used to describe the alignment of the central ray of the x-ray beam in
the horizontal and vertical planes.

 Incorrect Horizontal Angulation: overlapped contacts appear on the film.

This happens when the central ray is not directed through the
interproximal spaces so as a result, the proximal surfaces of adjacent teeth
appear overlapped in the peri-apical film. 

 Incorrect Vertical Angulation: this results in an image that is not the same length as the
tooth.
The image may be

1) Foreshortened (when vertical angulation is too

excessive or too steep the image of the tooth is
shorter than the actual tooth)
2) Elongated (when the vertical angulation is too flat
so the image of the tooth on the film is longer than
the actual tooth).
Both of these errors are rare nowadays since we use a film
holder now instead of using fingers to hold the film.

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c) Beam Alignment errors / PID alignment problems:

occur when the PID is misaligned & the x-ray beam is not centered over the film so the
resultant radiograph is a partial image only. The PID or “cone” is said to cut the image. A cone-
cut appears as a clear unexposed area on a dental radiograph & may occur with either a
rectangular or a round PID. This can happen in 2 ways:
1- Cone-cut WITH film holder => a clear, unexposed area appears on the film due to PID not
properly aligned with the peri-apical holder so the x-ray beam did not expose the entire film.
2- Cone-cut WITHOUT film holder => a clear unexposed area appears on the film due to PID
not directed at the center of the film so x-ray beam did not expose the entire film.

2) Bite-Wing Film errors: Include

a) Film Placement Problems
b) Angulation Problems
c) PID alignment Problems

a) Film Placement Problems:

Correct placement for bite-wing films shows equal areas of the maxilla & mandible, occlusal
plane exactly in the middle.
> Incorrect Film Placement may result in an absence of specific teeth or
tooth surfaces on a film, tipped occlusal plane, overlapped interproximal
contacts or a distorted image. Such errors may render a bite-wing film as
nondiagnostic.
> The most common error students make is that when they want to film a
premolar they put the film exactly on the first premolar so sometimes half of the 1st premolar
is not shown. To avoid this we should place the film in the middle of the canine. Same thing

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goes for the Molar bite-wing; we should place the film in the middle of second premolar.
Also in Molar bite wing; 3rd molars should be visible on the film. Even if the patient doesn’t
have 3rd molars that area should be visible on the film. This mistake is very common as well.

b) Angulation Problems:
Incorrect Horizontal Angulation which causes overlapping. (There is a pic above for
overlapping)
Incorrect Vertical Angulation causes distortion on the film. 

c) PID alignment Problems:

If PID is misaligned & the x-ray is not centered over the film,
a partial image is seen on the radiograph, this partial image
is called cone-cut. It appears as a clear area with a curved
outline. Again this happens in 2 ways:

1- Cone-cut WITH film holder => Due to PID not properly

aligned with the bite-wing film holder so the x-ray beam
did not expose the entire film. A clear, unexposed area on
the film is the result.
2- Cone-cut WITHOUT film holder => Due to PID not
directed at the center of the film so the x-ray beam did not
expose the entire film. A clear, unexposed area on the film
is the result.

Our last topic is Miscellaneous Technique Errors which include:

1) Film Bending = caused by excessive bending & this causes the image of the
film appear stretched, elongated & distorted. This is common when using
finger technique.

2) Film Creasing = Due to the film being creased and the film emulsion
cracked. As a result, a thin radiolucent line is on the resultant

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radiograph. (Permanent force on it or very excessive bending or long nails could cause this)

3) Phalangioma = Patients finger appears on the film.

4) Double Exposure = Film was exposed in the patients mouth twice. It

happens sometimes if the dentist takes the radiograph, puts it in his
pocket and forgets it. Then after a while he finds it & assumes he didn’t
use it so he uses it again & the result would be this pic shown on the right.

5) Movement = Blurred/hazy images appear on the film due to

movement of the patient during the exposure of the film.

6) Reversed Film = Film was placed in the mouth backward then exposed causing he lead foil
to appear in the image & it would be light with a tire-track/ herringbone pattern or a fish-
skeleton appearance.

Done By: Stephanie Na’was & Jad El Benni 

checked by: Sawsan Jwaied

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