CLASSIFICATION

OF
RADIOGRAPHIC
TECHNIQUES
 Intra-Oral Radiography

• Classification of Intra-Oral Radiographic

Techniques:
• According to the uses or types of the films, we
have 3 techniques:
– Periapical techniques.
– Bite wing techniques.
– Occlusal techniques.
 Periapical Radiography

• Periapical radiography describes intra-oral

techniques designed to show individual teeth
and the tissues around the apices. Each film
usually shows two to four teeth and provides
detailed information about the teeth and the
surrounding alveolar bone.
 Main Indications
• Detection of apical infections and pathoses.
• Assessment of the periodontal status; state of periodontal
membrane space and lamina dura.
• After trauma to the teeth and associated alveolar bone.
• Assessment of the presence and position of unerupted
teeth.
• Assessment of root morphology before extractions.
• During endodontics.
• Preoperative assessment and postoperative appraisal of
apical surgery.
• Detailed evaluation of apical cysts and other lesions within
the alveolar bone.
• Assessment of the position and prognosis of implants.
• For periodic check-up.
 Basic Principles of Periapical
Radiographic Techniques:
Anatomic consideration is essential to overcome
the anatomy of the oral cavity, which does not
always allow the ideal positioning requirements
for the periapical technique.
The x-ray beam is limited to two movements:

• Vertical to control the length of the image

(occluso-gingivaly).
• Horizontal: to control the antero-posterior
dimension (Mesio-distally).

– Film packet placement in relation to the

tooth.

– Point of central ray (CR) entry.

 Types of periapical
radiographic techniques:
• The paralleling technique.
• The bisecting angle technique.
Paralleling
Technique
 The Paralleling Technique:
Three different names are used for this technique:

a. Paralleling technique:
• It is called so because the film is positioned parallel to the long axis of the
tooth.

b. Right angle technique:

• It is called so because the central ray is directed perpendicular on both the
film and tooth.

c. Long cone technique:

• It is called so because a 16 inch long cone is used during radiography to
obtain almost parallel rays.
 PARALLELING TECHNIQUE:

• Theory:
– The film packet is placed in the mouth parallel to the long axis of the
tooth under investigation.
– The x-ray tube head (CR) is then aimed at right angles (vertically and
horizontally) to both long axes of the tooth and the film packet.
– Due to the curved anatomy of the palate and the shape of the arches,
the tooth and the film packet cannot be both parallel and in contact. So
the film packet has to be positioned some distance from the tooth
using a film holder.
– For the film to cover the entire tooth, this will require the movement of
the film towards the mid line, leading to the increase of the film object
distance
– To prevent the magnification of the image and the
loss of sharpness of the film due to increasing the
film-object distance we need:

• A parallel non-diverging, x-ray beam is required, this is

achieved by having a large focal spot to skin distance
(increase target film distance) by using a long cone (16
inch) on the x-ray set, and parallel rays will be obtained
providing a sharper and clearer image.
• A smaller source of x-ray beam is required; this is
achieved by using a collimator with a smaller aperture.
• By using a film holder with fixed film - tube head
positioning device, the technique is reproducible and
thus any geometric variations during exposure are
avoided.
 Holders of Intra-Oral Films
During Paralleling Technique:
• It is a device used to hold the film in place in order to achieve
parallelism between the film and the tooth.

• A variety of holders have been developed for this technique..

The different holders vary in cost and design.
 Types of Film Holders

• Cotton rolls: Le master technique. The film is

inserted between two cotton rolls.

• Haemostat: With rubber tubing on the shank

to avoid biting on metal.
 Types of Film Holders:

ANTERIOR
POSTERIOR

•Beam aligning holders:

Rinn X.C.P. with their centring aids attached to
the cone.
Rinn XCP instruments are color-coded for easier assembly. Red

,
instruments are for bite-wing placement yellow for posterior
placement, and blue for anterior
 Rinn XCP Film Holders
Extension Cone Paralleling (XCP)

Bitewing

Anterior

Root Canal
Treatment
(RCT)
Posterior

Color coded
 Rinn XCP Notes
• Make sure that you see
the whole radiographic
film through the ring.
• The white side should
always be towards the
x-ray tube.
• Pay attention to the dot
position (towards the
occlusal plane).

Images
Image by
by the
the author
author, Wisam Al-Rawi
Look through the ring!
 Accurate Cone Alignment

Images
Image by
by the
the author
author, Wisam Al-Rawi
 Film Holders:

• Advantages: Avoid exposure of patient's finger

and are essential in the paralleling technique.
• Disadvantages: the film sometimes cannot
extend far enough beyond the apical region to
allow examination of periapical tissues.
 Requirements of the Technique:

•The use of a long cone 16 inch to increase target-

film distance and thus decrease magnification

•One or a combination of the following must be

used: faster film, high K v and high exposure time in
order to compensate the fact that the intensity of the
beam is less at greater target-film object.
Diagrams showing film packet
positions for upper teeth
Bisecting Angle
Technique

X-ray beam
 BISECTED ANGLE TECHNIQUE

• Theory:
• The theoretical basis of the bisected angle technique
can be summarized as follows:
• The film packet is placed as close to the tooth under
investigation as possible without bending the packet.
• The angle formed between the long axis of the tooth
and the long axis of the film packet is imaginary
bisected by an imaginary line called the "bisector"
• The x-ray tube head is positioned at right angles to this
bisecting line with the central ray of the x-ray beam aimed
through the apex of the tooth.
• Using the geometrical principle of similar triangles, (rule of
isometry) the actual length of the tooth in the mouth will be
equal to the length of the image of the tooth on the film. This is
explained by the fact that 2 triangles are formed with the
bisector dividing them. In these triangles, there are 2 equal
angles, thus these triangles are equilateral and have equal
sides. Therefore, the image formed is equal to the radiographed
long axis tooth .Thus we recorded an image with the same size
of the tooth.
 Positioning Techniques

• A. Patient Position:
• The patient should sit upright in the chair:
• The median sagittal plane should be perpendicular to the
plane of the floor.
• The occlusal plane of the teeth being examined should be
parallel to the floor:
– For the maxilla: the ala-tragus line should be parallel to the floor.
– For the mandible: a line from the tragus to the corner of the mouth
should be parallel to the floor i.e. the patient tilts his head backwards in
such position the occlusal plane of the mandibular teeth is parallel to
the floor when the patient opens his mouth.
• Any metallic appliance in patient's mouth should be removed;
eye glasses, earrings, hairpins.
 Film Position and Placement:

• The pebbled surface of the film packet should be towards the

tube.
• Avoid excessive bending of the film otherwise distortion of the
image may occur. Slight bending of the corner of the packet
may be allowed in some areas e.g. mandibular premolar region
to relief patient discomfort.
• The teeth being examined should be in the centre of the film.
• In the molar and premolar regions the film is placed with it is
long dimension parallel to the occlusal surface while in anterior
teeth the short dimension is parallel to the occlusal surface
• About 2 to 3 mm (1/8 inch) of the film packet should be
left visible beyond the occlusal plane.
• The patient holds the film with the finger of the hand of the
opposite side, the thumb for maxillary and the index finger
for mandibular teeth.
• Avoid movement of the film, patient or cone (not to obtain
a blurred image).
• The printed dot should be incisally to avoid its
superimposition on the apices.
• N.B.: The film will never be parallel to the long axis of the
tooth at a certain point due to curvature of the bone.
 Cone Position:

• Use the short cone.

• The (CR) is directed perpendicular on the bisector forming
two angles:
– Vertical angulation.
– Horizontal angulation.
• There are specific points of entry for each tooth.
The Snap-A-Ray film holder
Angulations during Bisected
Angle Technique:
• The x-ray tube has two direction positions that
have to be adjusted during an exposure:
• 1- The vertical angulation:
• Determines the accurate length of the tooth.
• It is the angle made between (CR) and occlusal
plane.
• It is determined by the movement of the tube
head up and down.
• a. Vertical angle +ve
• When the CR is directed from above the occlusal
plane downwards; as for all maxillary teeth.
• b. Vertical angle -ve:
• When the cone is directed from below the
occlusal plane upwards as for mandibular teeth.
• c. Zero degree (0) or zero plane:
• The cone (CR) would be parallel to the floor.
 Average vertical angulations:
It is the angle between the CR and occlusal plane.
Teeth ( +ve) maxilla (-ve) mandible
Incisors 55-60 ° 25-15 °
Canine 45-50 ° 15-20°
Premolar 35-40° 5-10°
Molar 25-30° 0-5 °

• Average vertical angulation for each region in both jaws.

• N.B.: Vertical angulation may be slightly changed depending on anatomical variety.
• The Angle is increased by 5 in cases of:
• Flat palate vault.
• Flat ridge in edentulous mouths.
• Shallow floor of the mouth.
• Children with arches not fully developed.
• Buccally inclined teeth.
• The Angle is decreased by 5 in cases of:
• High vault.
• Deep floor of the mouth.
• Horizontal angulation
film equidistant from lingual
surface of teeth (red arrows)
– The horizontal position of the tube is perpendicular
to the mean tangent of the teeth and parallel to
interproximal surface of the teeth and the C.R
pass precisely through the contact area of the
teeth.
– It is responsible for mesiodistal dimension of the
teeth such that there is no superimposition or
overlapping of teeth on each other horizontally
 Horizontal Angulation
The horizontal angulation is adjusted so that a line
connecting the front and back edge of the PID (yellow line
below) is parallel with a line connecting the buccal surfaces
of the premolars and molars (green line below). The x-rays
will then be perpendicular to the film.

correct incorrect
 • Incorrect Vertical Angulations:
• Image foreshortened:
If the vertical angulation is too large or the
C.R. is perpendicular on the film

long axis of tooth

bisecting line

film
 •Incorrect Vertical Angulations:
Image elongated:
long axis of tooth
bisecting line

x-ray beam

film
bisecting line

• If the vertical angulation is too small or

the CR is perpendicular on tooth plane
 – Points for Entry of the Central Rays
• The cone should be placed so that the
central rays are directed to the apices of
teeth.
 Maxillary teeth
• The line of orientation upon which are located the
points of entry of the CR is the ala-tragus line (it is
the line where the apices of maxillary teeth are
positioned).

• Incisors: Tip of the nose.

• Canine: 5 mm distal to the ala of the nose.

 Maxillary teeth

• Premolars: Vertical line down from the middle of the eye to the
ala tragus line.

• Molars: For the first molar a vertical line drown from the outer
canthus of the eye to the ala-tragus line. For the second molar
one cm. distal to the canthus of eye to the ala-tragus and for
the third molar 2 cm distal to canthus of eye to the ala-tragus.
 Mandibular teeth

The same landmarks used for

maxillary teeth are used for the lower
jaw but the line of orientation is 0.5
cm above the lower border of the
mandible.
Adult full-mouth series,
BisectingTechnique
 Exposure time
There is no definite time of exposure
as it differs according to the
kilovoltage, milliampere used and the
tooth being radiographed.
 Comparison of the Paralleling and
Bisected Angle Technique
Advantages of the paralleling technique:
– Geometrically accurate images are
produced with little magnification and
maximum sharpness of the image.
– The shadow of the zygomatic bone (molar
bone) does not appear above the apices of
the molar teeth (no superimposition of
normal anatomical landmarks over the
molar roots).
 Comparison of the Paralleling
and Bisected Angle Technique
Advantages of the paralleling technique:
– The horizontal and vertical angulations of the
(x-ray tube head) are automatically
determined by the positioning devices.
– Reproducible radiographs are possible at
different visits and with different operators.
– This technique is more standardized, so it
can be used in research work.
– There is no exposure of the patient's fingers
during radiography
Comparison of the Paralleling and
Bisected Angle Technique
Disadvantages:

– The anatomy of the mouth sometimes

makes the technique difficult in all parts of
the mouth.
– Since target-film distance is increased,
according to the inverse square law, the
time of exposure is increased as intensity
of rays is decreased.
– Needs a long cone and also needs special
equipment as the film holders.
 Main differences between bisecting
angle and paralleling technique:
Bisecting angle Paralleling

Cone used Short cone Long cone

Film position It is in contact with the It is parallel to the tooth

crown of the tooth 2 mm and not in contact with
below incisal edges or crown by using film
occlusal surfaces. holder

It is held by finger of pt. It is held by film holder

Vertical angulation Different angulation

Zero angulation
according to the position.

C.R. Perpendicular on bisector Perpendicular on film &tooth

Beam Of Divergent rays Of almost parallel rays.

Reproducibility Not reproducible Standardized

Time and simplicity Quick and simple Needs time and is complicated