L a m in a g ra p h y is a te c h n ic used to

m in im iz e s u p e rim p o s itio n o f tissue

s tru c tu re s in a d ia g n o s tic ra d io g ra p h .
T h e a u th o r gives a b r ie f review o f the
h is to ry o f la m in a g ra p h y , e x p la in s its
a p p lic a tio n in th e d ia g n o sis o f
c o n d itio n s o f th e te m p o ro m a n d ib u la r
jo in t, a nd describes its p o te n tia l as
a d ia g n o s tic tool.
LAMINAGRAPHY:

Dentistry exists as a profession to maintain and

methods and application preserve oral health. The technics o f examination,

diagnosis, and therapy must be used to accomplish
this task.
Contemporary dental literature reveals that the
task o f maintaining oral health is becoming more

in oral diagnosis complex, and that improved technics and proce­

dures are demanded. A danger exists in over­
concentration on technics in the absence of knowl­
edge basic to the solution of clinical problems.
Few diagnostic tools are generally useful to den­
tists. Radiography is important in recording physi­
ological phenomena.
Superimposition o f tissue structures is one of

Henry M. Rosenberg, D D S, C h ica g o

Fig. 1 ■ Diagram of principles of laminagraphy

88
 LEVEL C R ESULTAN T (ABC)
ZONAGRAM
Fig. 2 ■ Diagram of visual resolution in laminagraph.
Box A represents tissue section at level A, or plane A;
box B represents tissue section at level B, or plane B,
and box C represents tissue section a t level C, or plane
C. Each plane appears in sharp focus when examined
separately. In laminagraphy, if plane o f interest were at
level B, composite, as viewed in box D, would be re­
corded with level B in sharp focus. Planes A and C would
be blurred, as explained in theory of laminagraphy
the greatest handicaps in obtaining a diagnostic
radiograph. Laminagraphy is one o f the more
specialized technics used to minimize superimpo­
sition of tissue structures.
This paper explains the technic o f laminagraphy
and describes its potential as a diagnostic tool.
T h e o ry o f la m in a g ra p h y
Laminagraphy is a method that permits radio-
graphic projection o f plane sections o f solid ob­
jects. The fundamental principle may be described
as follows (Fig. 1 ):
■ The point o f emission of roentgen rays moves
in one direction, while the film or recording me­
dium moves in the opposite direction. Tube and
film move simultaneously in a constant relation­
ship that is maintained by a connecting system
that rotates about an axis lying in the plane of
the section to be projected.
■ Planes, other than the plane of the section to
be projected, experience relative displacements on
the film and are blurred. The degree o f blurring
depends on the distance o f the other planes from
the projected plane. This blurring results in a
correct image o f the plane o f the section to be
projected, while the images o f other planes are
blurred.
Rosenberg: LAMINAGRAPHY IN ORAL DIAGNOSIS ■ 89
Fig. 3 ■ Ordograph
Figure 2 is a schematic representation of the
visual resolution obtained in laminagraphy.
H is to ry o f la m in a g ra p h y
Literature refers to the principle and technic of
body-section radiography by several terms. A
brief review of the history and development of
body-section radiography affords clarification of
its terminology and technic. Body-section radiog­
raphy had been fundamentally developed to aid
in chest evaluation in medical diagnosis.
The history o f body-sectioning radiography has
been reviewed by Andrews1 and Kieffer.2 The in­
formation that follows is taken, in part, from their
reviews.
Bocage* described the principle o f body-section
radiography in a French patent application. He
referred to thi technic as “ planigraphy.” He pro­
posed three methods for the achievement o f
planigraphic projections. Ott3 described these
methods in a paper, “ The Present Day A cco m ­
plishment of Body Section Visualization.” Four
months after the description o f the principles of
body-section radiography by Bocage, Portes and
Chaussef suggested a method o f applying its use
in deep roentgen therapy for concentration of
depth dose. Pohlt described the principles o f this
method in a patent application.
Vallebona4 was first to put the method to prac­
tical use in making body-section radiographs. He
termed these projections “ stratigrams.” His meth-

Fig. 4 ■ Skull with lines of cuts and laminagraphic
sections
od differed from those o f other authors in that
the object was rotated during the exposure, and
the point o f emission and the recording medium
were held in a rigid position. Vallebona was able
to make planigrams o f skulls, and these repro­
Fig. 5 ■ Laminagraph (le ft) and radiograph (rig h t) of midsagittal plane
90 ■ JADA, Vol. 74, Jan. 1967
ductions were published in his first paper on
body-sectioning radiography. Practical difficulties
prevented further development of this technic.
Vallebona5 described a new improvement and
published studies on his method. His method was
termed “ stratigraphy.”
Ziedses des Plantes’ doctoral thesis6 was the
most elaborated work o f the few works on body-
sectioning radiography. He made a study o f the
normal and pathological anatomy o f the skull and
its contents. After Ziedses des Plantes’ first pub­
lication,7 Bartelink8 demonstrated the results that
he obtained by use of a similar method on N o­
vember 2, 1931, for the Dutch Association of
Electrologj' and Roentgenology in Amsterdam,
The Netherlands. In January, 1934, Siemens and
Reiniger1 constructed a research model of a plani-
graphic instrument.
Grossmann9 described a slightly different plani-
graphic method and named the apparatus used
the “ tomograph.” This device was the simplest
and seemingly, most practical planigraphic in­
strument that had been developed to date. It was
manufactured in Germany under the trade name,
Tomograph.
Kieffer,2 in the United States, said that he
discovered the principles o f body-section radiog­
raphy and designed a practical machine one year
later while unaware o f previous work. Kieffer
met Sherwood M oore in September, 1936. When
shown the design o f the instrument, M oore real­
 Hg. 6 • .Laminagraph (le ft) and radiograph (rig h t) 1 cm. from midsagittal plane

ized its clinical value and obtained permission
from the authorities of Washington University to
finance its construction at the Edward Mallinc­
krodt Institute of Radiology, Washington Univer­
sity School o f Medicine, St. Louis. The instrument
was constructed there with the cooperation of the
institute’s director, Sherwood M oore. M oore
named the unit “ laminagraph” (lamina— a thin
layer) and presented the clinical results.
The instrument used in the University o f Illi­
nois College of Dentistry, department of radiology
in the Temporomandibular Joint Center, is called

Fig. 7 ■ Laminagraph (le ft) and radiograph (rig ht) 2 cm. from midsagittal plane

Rosenberg: LAMINAGRAPHY IN ORAL DIAGNOSIS ■ 91

Fig. 8 ■ Laminagraph (top) and radiograph (bottom )
3 cm. from midsagittal plane
the ordograph. This unit, with its tilting table and
connected accessories, allows laminagraphs to be
taken in several positions (Fig. 3 ). The ordograph
table and adapting parts are manufactured by
General Electric Company (m odel no. 11G E 3).
C o n v e n tio n a l c e p h a lo m e tric
la m in a g ra p h y
Body-sectioning radiography (laminagraphy), with
the use of head-positioning accessories (cephalo-
92 ■ JADA, Vol. 74, Jon. 1967
Fig. 9 ■ Laminagraph (top) and radiograph (bottom)
4 cm. from midsagittal plane
m etric), permits the viewing o f separate predeter­
mined layers of the skull.
T o demonstrate the potentials o f cephalometric
laminagraphy, a dry skull of relatively symmetri­
cal configuration was selected. Laminagraphic
exposures were made at the midsagittal plane and
at intervals o f 1 cm. laterally to the right for a
total o f six exposures at six levels. The skull was
embedded in Slectron plastic and sectioned with a
band saw to duplicate cuts made in the plane of
laminagraph exposures (Fig. 4 ).
Skull sections were photographed, radio­
graphed, and then evaluated for structures visible
with laminagraphy and with conventional radiog­
raphy.
When the laminagraphic projections are com ­
pared with the radiographs of the anatomical
sections o f the skull, some superimposition of
structures is seen in the laminagraphic projec­
tions that reduce definition in the plane of inter­
est. Nevertheless, the film produced with the
laminagraph reveals the structures in the plane of
interest more clearly than the conventional head-
plate (Fig. 5 -1 0 ).

T e c h n ic used in e x a m in a tio n
o f te m p o ro m a n d ib u la r jo in t

A report by Yale and others10 in 1961 described

variations in mandibular condyle morphology in
dry skull material, and a technic o f mediolateral
cephalometric laminagraphy was developed. This
technic reveals the variations in condylar shapes
and minimizes distortion in the vertical and hori­
zontal angulation since the central ray follows
the long axis o f the condyle.
The University of Illinois College of Dentistry,
department of radiology, used laminagraphy as a
technic for examination o f the temporomandibu­
lar joint (Fig. 10, top ).
The routine procedure includes the following
extraoral radiographs made for diagnostic evalua­
tion: anteroposterior cephalometric laminagraph;
subzygomatic view, conventional radiograph; cor­
rected lateral cephalometric laminagraphs o f each
condyle.
T o produce the anteroposterior cephalometric
laminagraph, the patient’s head is positioned with
Camper’s line§ parallel to the floor (Fig. 11,
left). The anteroposterior laminagraph (Fig. 11,
top, right) is evaluated according to the contour Fig. 10 ■ Laminagraph (top) and radiograph (bottom )
5 cm. from midsagittal plane
of the superior surface o f the condyles and the
relationship of the superior border o f the condyles
to the fossae outline.
The transmeatal line is scribed by connecting
the ear post markers. The long axis o f each con­ beam is directed at an angle o f 40 degrees to
dyle is determined, and this line is extended to Camper’s line, which is parallel to the floor, or
cross the transmeatal line. The resulting angle is the central beam may be parallel to the floor and
the vertical angle. This angle may be positive or Camper’ s line oriented at an angle o f 40 degrees
negative. It is positive when the medial pole of to the floor (Fig. 1 2 ). The patient’s jaws are in
the condyle is directed superiorly and negative centric occlusion.
when the medial pole is directed inferiorly (Fig, The subzygomatic projection (Fig. 12, top,
11, bottom, right). right; bottom, right) presents a view o f the con­
T o produce the subzygomatic projection, which dyle from the anteroposterior position. This pro­
is a conventional extraoral radiograph, the central jection provides a visualization of the posterior

Rosenberg: LAMINAGRAPHY IN ORAL DIAGNOSIS ■ 93,

Fig. 1 1 ■ Le ft: Patient positioned for anteroposterior laminagraph.
Top, rig ht: Anteroposterior laminagraph. Transmeatal line and long
axes of condyles inscribed. Bottom, rig ht: Tracing of transmeatal line
and establishing positive vertical angle (posterior view)

Fig. 12 ■ Le ft: Patient positioned for subzygomatic projection. Top,

rig h t: Subzygomatic radiograph. Bottom rig h t: Diagram of posterior
slope of articular eminence and anteroposterior view of condyle

slope of the articular eminence and is taken with
the patient’s mouth closed.
T o produce the submental vertical (inferosu-
perior) conventional extraoral radiograph, the
patient’s head is positioned with the posterior
border of each condyle, the contour o f the me­
dial and lateral borders of each condyle, and the
length o f the condyles.
The transmeatal line is scribed by connecting
the ear post markers. The long axis o f the con-

94 ■ JADA, Vol. 74, Jan. 1967

Fig. 13 ■ Le ft: Patient positioned for submental vertical (infero-
superior) projection. Top, rig ht: Submental vertical ( inferosuperior)
radiograph. Transmeatal line and orientation of long axes of condyles
inscribed. Bottom, rig h t: Tracing of transmeatal line and establishing
horizontal angle (superior view)

Fig. 14 ■ Left: Patient positioned for corrected lateral cephalometric laminagraph. Right: Corrected lateral cephalo-
metric laminagraph with patient's mouth closed. Head positioned a t predetermined condylar horizontal and vertical angles

dyle is determined in this projection, and a line
passing through the long axis is extended to cross
the transmeatal line which determines the hori­
zontal angle o f each condyle (Fig. 13, bottom,
right).
T o produce the final laminagraphs for diag­
nosis, the patient’s head is positioned according
to the predetermined condylar horizontal angle
established by the submental vertical (inferosu­
perior) projection and condylar vertical angle
established by the anteroposterior laminagraph
(Fig. 14, left).

Rosenberg: LAMINAGRAPHY IN ORAL DIAGNOSIS ■ 95

 sociazione cranio. Radiology Sept., 1930. Abstract.
5. Vallebona, A. A method of taking roentgenograms
which makes it possible to elim inate shadows. Fortschr
Roentgenstr 48 :599, 1933.
6. Ziedses des Plantes, B. G. Planigraphy, a roent-
genographic differentiation method. PhD thesis, Kenink
and Son., N.V., Utrecht, Netherlands, 1934.
7. Ziedses des Plantes, B. G. Special method of m ak­
ing roentgenograms of cranium and spinal column.
Nederl T Geneesk 75 :521 8 Oct. 17, 1931.
8. Bartelink, D. L. Roentgen section. Nederl T Ge­
neesk 76 :23, 1932.
9. Grossmann, G. Tomographie. Fortschr Roentgenstr
51 :61 Jan., 1935.
10. Yale, S. H., and others. Laminagraphic cephal-
ometry in the analysis of m andibular condyle morphology.
A prelim inary report. Oral Surg 14:793 July, 1961.

Fig. 15 ■ Corrected lateral cephalometric laminagraph

with patient's mouth open. Head positioned at predeter­
mined condylar horizontal and vertical angles

By use of a cephalometric device and by posi­

tioning the head by the preceding method, the
final laminagraphs are termed “ corrected lateral
cephalometric laminagraphs,” and they produce
a true cross-section image o f the condyle along
its long axis. These laminagraphs are made with
the patient’s mouth open and closed (Fig. 14,
right; 15).

The author thanks O. A. McCloud, Jr., senior dental

student at the University of Illinois College of Dentistry,
for his assistance in the performance of many technical
services for the study.

This investigation was supported in part by USPHS

grant D E -01849-02.
Doctor Rosenberg is an associate professor and acting
head, department o f radiology, the University of Illinois
College of Dentistry, 808 S. Wood, Chicago. Doctor
Rosenberg is also a member of the academic research
staff of Temporomandibular Joint Center, University of
Illinois College o f Dentistry a t the Medical Center.
Life

*Bocage, A. E. M. French patent no. 536464 (1 9 2 2 ).
tPortes, F., and Chausse, M. French patent no.
541941 (1 9 2 2 ).
iPohl, E. Imperial German patent no. 544200 (19 27 -
1 9 32 ), and Switzerland, no. 155613 (1 9 3 0 -1 9 3 2 ).
§An imaginary line from the inferior border of the
ala nasi to the superior border of the tragus of the ear.
1. Andrews, J. R. Planigraphy: introduction and his­
tory. Amer J Roentgen 36:575 Nov., 1936.
2. Kieffer, J. Laminagraph and its variations; ap pli­
cations and implications of the planigraphic principles.
Amer J Roentgen 39 :497 A pril, 1938.
3. O tt, Paul. Die gegenwärtige Leistungsfähigkeit der
Köaperschichtdarstellungen. Fortschr Roentgenstr 52:40,
1935.
4. Vallebona, A. Una modalita di tecnica per la dis-
"A n empty pageant, a stage play; flocks of
sheep; herds of cattle; a tussle of spearmen;
a bone flung among a pack of curs; a
crumb tossed into a pond of fish; ants,
loaded and labouring; mice, scared and
scampering; puppets, jerking on their strings
— that is life. In the midst of it all you
must take your stand, good-temperedly and
without disdain, yet always aware that a
man's worth is no greater than the
worth of his am bitions."
Marcus Aurelius Meditations, translated by
Maxwell Staniforth, Baltimore, Penguin
Books, Inc., 1964.

96 ■ JADA, Vol. 74, Jan. 1967