Object Localization

The following slides describe Object Localization, including the Right Angle Technique and the Tube Shift Technique. In navigating through the slides, you should click on the left mouse button when you see the mouse holding an x-ray tubehead or you are done reading a slide. Hitting Enter or Page Down will also work. To go back to the previous slide, hit backspace or page up.

Object Localization
A periapical film will identify the location of an object vertically and in a horizontal (mesiodistal) direction. However, we cannot tell where the object is located buccolingually, since the periapical film is twodimensional. Therefore we need another method for locating objects in a buccolingual direction. The two primary methods of determining the buccolingual location of objects are: Right-Angle Technique (Occlusal projection) Primarily identifies buccolingual location, but may also confirm mesiodistal location seen on periapical Tube-shift Technique (SLOB rule, Clarks rule) Utilizes two films with different horizontal or vertical angulations

Right Angle Technique

Once you have identified an object on the periapical film, you can take an occlusal film with the beam at a right angle (perpendicular) to the direction of the beam for the periapical. The beam may also be perpendicular to the film, especially in the mandible. The occlusal film below shows that the impacted canine is lingually positioned.

Right Angle (Occlusal) technique

Tube-Shift Localization (Clark) SLOB Rule Same Lingual Opposite Buccal

The SLOB rule is used to identify the buccal or lingual location of objects (impacted teeth, root canals, etc.) in relation to a reference object (usually a tooth). If the image of an object moves mesially when the tubehead is moved mesially (same direction), the object is located on the lingual. If the image of the object moves distally when the tubehead moves mesially (opposite direction), the object is located on the buccal.

For the SLOB rule to work, there must be a change in the horizontal or vertical angulation of the x-ray beam as the tubehead is moved. This change in angulation will alter the relationship between the object of interest and the reference object, allowing you to determine the buccal or lingual location.

The closer the object to be localized is to the reference object, the less the amount of movement of the image of the object in relation to the reference object.

In the diagram at right, the tubehead is moved, but there is no change in direction of the x-ray beam, which results in no change in location of the object of interest in relation to reference object (see below). Moving the tubehead without changing the beam direction would often result in a cone cut , depending on how far the tubehead is moved (see below right).

When using the SLOB rule, the direction of the beam must be opposite to the way the tubehead is moved. Horizontal Tube Shift: When the tubehead is moved mesially, the beam must be directed more distally (from the mesial). If the tubehead is moved distally, the direction of the beam must be more towards the mesial (from the distal). Vertical Tube Shift: The SLOB rule also works for movement of the tubehead in a vertical direction. Downward movement of the tubehead requires that the beam be directed upward and when the tubehead is moved upward, the beam must be directed downward.

Moving the tubehead mesially or distally and changing the direction of the x-ray beam (as described in the previous slide) will result in the movement of the object of interest on the film in relation to the reference object. In the diagram below, the tubehead is moved distally with the x-ray beam directed more mesially (from the distal). The object of interest, located lingual to the first molar, moves distally, in the same direction as the tubehead movement. (Objects closer to the film move less distance than objects farther from the film; in the example shown below, both the tooth and object move forward on the film, but the lingual object , being closer to the film, moves less and appears to move distally in relation to the tooth).

Horizontal movement of the tubehead and x-ray beam

incisors canine premolar molar

In moving from the incisor film to the canine film, the canine film to the premolar film and the premolar film to the molar film, the tubehead moves distally and the beam is directed more mesially. There is not much change in angulation from the premolar to the molar film; the normal situation would be that the beam is directed slightly more from the distal (or to the mesial) as the tubehead is moved distally for the molar projection.

mesial

Horizontal movement
In the diagram at left, the buccal (yellow) and lingual (red) objects of interest are superimposed on each other because the beam is directed perpendicular to both of them and they are in the same relative position mesiodistally and vertically. Both images are located above the second molar.
mesial

distal

distal

mesial

Horizontal movement
In the diagram at left, the tubehead is moved distally and the beam is directed mesially. On the radiograph, the buccal object of interest (yellow) moves mesially (opposite to tubehead movement) in relation to the second molar and the lingual object of interest (red) moves distally (same direction as tubehead) in relation to the second molar.
mesial

distal

distal

mesial

Horizontal movement
In the diagram at right, the tubehead is moved mesially and the beam is directed distally. On the radiograph, the buccal object of interest (yellow) moves distally (opposite to tubehead movement) in relation to the second molar and the lingual object of interest (red) moves mesially (same direction as tubehead) in relation to the second molar.

distal

distal

mesial

Vertical movement of the tubehead and x-ray beam

Maxillary PA

BW Mandibular PA
In moving from the maxillary periapical to the bitewing and from the bitewing to the mandibular periapical, the tubehead moves down and the beam is redirected upward (opposite direction; decreased vertical angulation).

Vertical movement
In the diagram at left, the buccal (yellow) and lingual (red) objects of interest are superimposed on each other because the beam is directed perpendicular to both of them and they are in the same relative position mesiodistally and vertically. Both images are superimposed over the mandibular second premolar.

Vertical movement
In the diagram at left, the tubehead is moved upward and the beam is directed downward. On the radiograph, the buccal object of interest (yellow) moves down (opposite to tubehead movement) in relation to the second premolar and the lingual object of interest (red) moves up (same direction as tubehead) in relation to the second premolar.

Vertical movement
In the diagram at left, the tubehead is moved downward and the beam is directed upward. On the radiograph, the buccal object of interest (yellow) moves up (opposite to tubehead movement) in relation to the second premolar and the lingual object of interest (red) moves down (same direction as tubehead) in relation to the second premolar.

Usually when using the tube-shift method of localization, two films are taken of the same area using different beam angulations. However, this localization technique will also work when comparing films taken as part of a complete series of radiographs. The only difficulty is determining which way the beam was directed when comparing the molar and premolar films. Usually this can be done by comparing the relative positions of anatomical structures (e.g., zygomatic process in maxilla or mental foramen in mandible) or the angulation of the roots of the teeth. (See following two slides).

premolar

molar

For the films above, we know that the tubehead was moved distally from the premolar to the molar film. The zygomatic process (red arrows) is located at the distal aspect of the 2nd molar on the premolar film and it is located over the distal aspect of the 1st molar on the molar film. This indicates that it moved mesially as the tubehead moved distally. We know that the zygomatic process is buccal to the teeth and, using the SLOB rule, it follows that the x-ray beam was directed more mesially on the molar film (Buccal object moved opposite to tubehead movement).

premolar

molar

Another way of determining the change in the direction of the beam is to look at the angulation of the teeth. In the premolar film, the roots of the teeth are angled distally, indicating that the beam was directed distally (from the mesial). In the molar film, the roots are more upright or angled slightly mesially, indicating the beam was directed more mesially (from the distal). Therefore, the tubehead shifted distally and the beam was angled in the opposite direction, allowing the use of the SLOB rule (These films were taken from Slide 3 in the review films to follow).

Richards Method of Object Localization

This method of determining the buccolingual location of objects was first suggested by Richards. It utilizes similar ideas to Clarks method, but it emphasizes beam direction instead of tubehead movement. If the beam is directed distally, buccal objects will move distally in relation to the reference object; lingual objects move mesially, or opposite to beam direction. Although this method certainly works, I feel it is easier to use tubehead movement (SLOB) for object localization.

On the following slides, identify the buccal or lingual location of the selected objects. When you click the mouse, the correct response and a brief explanation will appear.

canine film

incisor film

The restoration isrestoration on tooth # 8The tubehead Is the composite located on the buccal. (arrows) moves mesiallybuccal or canine film to the incisor film located on the from the lingual? (x-ray beam projected more distally) and the composite moves distally, which is the opposite direction.

2
premolar film

canine film

The arrow in the canine film is pointing to the gutta The arrow identifies the lingual canal. The tubehead moves percha in which canal of film to the canine film (beam mesially from the premolarthe maxillary first premolar? directed more distally) and the gutta percha indicated by the arrow also moves mesially. (See following slide).

lingual buccal

PID

When the tubehead is moved mesially, with the beam directed distally, the two canals, which are initially superimposed (premolar periapical above) will separate. The lingual canal (red arrow) will follow the tubehead movement and the buccal canal (blue arrow) will move in the opposite direction, as seen on the canine film.

Thispinkarrow is pointing to the gutta percha in The is theis located in the lingual canal. As which The red arrow points to The tubehead goesthe The post buccal canal. a threaded post. In distallycanal maxillary left from the premolar is the which this the canine film to the premolar film canal offrom of this maxillary left first premolar? tubehead moves distally second canine film to and the gutta percha movesalso moves distally post premolar film, the post mesially to be the located? positioned over thethat hascanal which has the to cover the canal lingual all gutta percha. threaded post.

premolar film

molar film

premolar bitewing

TheIs the maxillary second from tubehead moves distally the premolar film to the molar film. premolar (arrows) Thedisplaced to the buccal second premolar also moves distally, overlapping the first molar or the lingual? more in the molar film. In moving from the premolar periapical to the bitewing, the tubehead moves down and the premolar also moves down. The displacement is to the lingual.

incisor film

canine film

The lateral incisor is displaced to the lingual. The Is the displaced incisor (arrows) located on the buccal tubehead moves or the lingual? distally from the incisor film to the canine film. The lateral incisor also moves distally, covering half the canine on the canine film.

6
premolar film

canine film

Lingual. The tubehead moves mesially from the premolar film to the canine film. The object also moves mesially, starting out distal object first molarby the arrows locatedand Is the radiopaque to the identified on the premolar film ending buccal or the the first molar on the canine film. This on the up mesial to lingual? object represents the tip of the palatal root of the second molar and is located distal to the first molar and in a lingual relationship (See following slide).

root tip

film placement for canine film

film placement for premolar film

premolar film

incisor film

The maxillary right mesially from the premolar film to the The tubehead moveslateral incisor (arrow) is tilted out of position. In which direction (buccal or lingual) is it incisor film. The lateral incisor also moves mesially, tipped? starting out overlying the canine on the premolar film and ending up over the central incisor on the incisor film. Since the lateral moves the same direction as the tubehead, it is tipped lingually.

incisor film

canine film

The tubehead moves distally fromis impacted.film it located The maxillary left canine (arrow) the incisor Is to the canine to theThe impacted canine also moves distally, more film. buccal or the lingual? starting out overlying # 9 on the incisor film and ending up over the lateral incisor on the canine film. The impacted tooth is located on the lingual (palatal).

premolar periapical film

9
The tubehead moves down from the premolar periapical film to the bitewing film. The The amalgam restoration restoration also moves indicated by the arrow is down, starting out above located on the buccal or the two occlusal the lingual? restorations on the periapical film and ending up overlapping the occlusal restorations on the bitewing film. The restoration is located on the lingual.

premolar bitewing film

premolar bitewing film

10
The mandibular second The tubehead moves premolar the premolar down fromis tilted out of position. In which bitewing film to the direction film. The periapical (buccal or lingual) is it tipped? second premolar also moves down, indicating that it is lingually tipped.

premolar periapical film

molar bitewing film

11
The tubehead moves down from the molar bitewing film The arrows point to a to the periapical film. The retention pin. Is the pin identified by the arrows pin located in the also moves downward. Since buccal or lingual the movement of the pin portion of the tooth? follows the direction the tubehead was moved, it is located toward the lingual aspect of the tooth. The other pin is located toward the buccal, since it moved upward as the tubehead moved down.

molar periapical film

12
premolar film molar film

The tubehead moves distally mesiobuccal or mesiolingual Does the arrow point to the from the premolar film to the molar film. The canal indicated by the arrow also moves canal? distally to align with the other canal, which moves mesially (The canals have to move in opposite directions in order to be superimposed on each other). The indicated canal (arrow) is located mesiolingually.

molar bitewing film

13
The tubehead moves down The amalgam particle from the bitewing film to the indicated periapical film. mandibularby the arrows is amalgam particle Thelocated bucally or moves lingually? upward (opposite direction), indicating that it is located buccally.

molar periapical film

14
The tubehead moves distally from the canine film to the premolar periapical. Is the restoration indicated by The restoration moves mesially. From the arrows located on the the bitewinglingualmandibular buccal or to the of the first premolar periapical, the tubehead premolar? moves down and the restoration moves up. The restoration is located on the buccal of # 21.
canine periapical film

premolar bitewing film

premolar periapical film

15

premolar film incisor film canine film

The gutta percha root canal filling identified by the arrows In moving from the incisor film to the canine film, and then is located in which to the from the canine filmcanal? premolar film, the tubehead moves distally. The gutta percha (arrows) also moves distally in each case. Therefore, it is in the lingual canal.

This concludes the section on Object Localization.

Additional self-study modules are available at: http://dent.osu.edu/radiology/resources.php If you have any questions, you may e-mail me at jaynes.1@osu.edu. Robert M. Jaynes, DDS, MS Director, Radiology Group College of Dentistry Ohio State University