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Dental X Ray

Techniques and Errors

Dr Jasmine Kueh
KP Kota Samarahan
Common types of dental
radiographs
Intraoral Radiographs
Bitewing Xray
Periapical Xray (IOPA)
Occlusal Xray
Extraoral Radiographs
Panaromic Xray
Cephalometric projection
Cone-beam computed tomography (CT)
Why IOPA?
Detection of apical infection / inflammation
Assessment of periodontal status
After trauma to the teeth and associated alveolar bone
Assessment of the presence and position of
unerrupted teeth
Assessment of root morphology before extraction
During endodontics
Preoperative assessment of apical surgery
Detailed evaluation of apical cysts and other lesions
within the alveolar bone
Evaluation of implant postoperatively
Dental caries

Periapical abcess
Periodontal disease

Retained root
Minor oral surgery

Implant
Endodontics

Unerrupted teeth
Alveolar bone or tooth
fracture
Xray Components
Techniques
Paralleling
Technique

Bisecting Angle
Technique
Paralelling technique
Theory: Film is
positioned parallel
to the long axis of
the tooth and beam
is directed
perpendicularly
Bisecting Angle Technique
Based on principal
of aiming x-ray
beam at 90
degrees to an
imaginary line
which bisects the
angle between the
longitudinal axis of
the tooth and the
film.
Bisecting Angle Technique
Patients position
Vertical angulation
Horizontal angulation
Advantages
Paralleling Bisecting Angle

Vertical and horizontal


angulation
automatically
Positioning of the film
determined.
in simple
Reproducible
Simple and quick
radiographs when
placed in holder.
Disadvantages
Paralelling Bisecting Angle

Positioning of the Non reproducible


image receptor can be views
uncomfortable and Cone cutting may
cause gagging. result if beam not aim
Anatomy of the mouth at centre.
makes technique Incorrect horizontal
impossible eg: curved angulation causes
palate overlapping
Special Considerations
Gag Reflex

To overcome this, operator should make an effort to


relax and reassure the patient.
Describe and explain the procedures.
Tongue should be very relaxed and positioned well to
the floor of the mouth. This can be accomplished by
asking pt to swallow deeply just before opening the
mouth for the placement of the film.
Advise pt to breathe rapidly through the nose as
mouth breathing usually aggravates the condition.
Minimise tissue irritation (posterior dorsum of the
tongue and soft palate)
Mandibular 3 molar rd

Main difficulty: To record the entire third mandibular molar and the
surrounding tissues, incl inferior dental canal
Possible solutions:
Using specially designed or adapted holders to hold and position the
film packet in the mouth, as follows:
1. The holder is clipped securely on to the top edge of the film packet .
2. With the mouth open, the film packet is positioned gently in the
lingual sulcus as far as posteriorly as possible.
3. The patient is asked to close the mouth (to relax the tissues of the
floor of the mouth) and is eased further back until the front edge is
opposite the mesial surface of the mandibular first molar.
4. Pt is asked to bite on the holder and to support it in position.
5. The xray tubehead is positioned at right angles to the third molar
and centred 1cm up frm the lower border of mandible , on a vertical
line dropped from the outer corner of the eye.
Common
causes of faulty
radiographs
Peratus X-Ray Reject (<10%)
25

20

15 Peratus X-Ray Reject


(<10%)

10

0
Jan Feb Mac Apr Mei Jun Jul Aug Sep
Films with errors should be avoided
due to the following reasons:
Retake will lead to:
expose the patient to unnecessary
radiation
Waste film (money) & time
Interfere with accurate interpretation
and diagnosis
Film too dark
Possible causes
Overexposure due to:
o Faulty xray equipment, eg. Timer
o Incorrect exposure time setting by the operator
Overdelopment due to:
o Excessive time in developer solution
Fogging due to:
o Old film stock i.e. fims used after expiry date
Thin patient tissues
Film too pale
Possible causes
Underexposure due to:
o Faulty xray equipment, e.g. timer
o Incorrect exposure time setting by operator
o Failure to keep timer switch depressed throughout the
exposure
Underdevelopment due to:
o Inadequate time in the developer solution
o Developer solution too cold, too dilute
Excessive thickness of patients tissues
Film packet back to front
Image unsharp and blurred
Possible causes
Movement of the patient during the
exposure
Excessive bending of the film packet
during the exposure
Film marked
Possible causes
Film packet bent by the operator
Careless handling of the film
resulting in marks caused by:
o Fingerprints, fingernails, bending, static
discharge
Processing errors due to:
o Chemical spots
o Insufficient chemicals to immerse films
fully
Patient biting too hard on the film
packet
Operator Positioning Errors
Incorrect
placement of the
Xray tubehead
producing:
Elongation
Foreshortening
Superimposition /
overlapping
Coning off or cone
cutting
Incorrect
placement of the
film packet:
Back to front, image
of the lead foil
evident (film also
too pale)
Inadvertently used
twice, double
exposure ( film also
too dark)
Not covering the
area of interest
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