Intraoral Projections

Intraoral images can be divided into three

categories:

 Periapical projections, which show the entire length of the tooth

and the surrounding bone
 Bitewing projections, which show only the crowns of teeth and the
adjacent alveolar crests
 Occlusal projections, which show an area of teeth and bone larger
than periapical images
A full-mouth radiographic series consists of
periapical and bitewing projections
Projections for a Typical Full-Mouth
Radiographic Series

Anterior Periapical (Use No. 1 Receptor)

 • Maxillary central incisors: one projection
 • Maxillary lateral incisors: two projections
 • Maxillary canines: two projections
 • Mandibular central and lateral incisors: two projections
 • Mandibular canines: two projection
Projections for a Typical Full-Mouth
Radiographic Series

Posterior Periapical (Use No. 2 Receptor)

 • Maxillary premolars: two projections
 • Maxillary molars: two projections
 • Maxillary distomolar (as needed): two projections
 • Mandibular premolars: two projections
 • Mandibular molars: two projections
 • Mandibular distomolar (as needed): two projections
Projections for a Typical Full-Mouth
Radiographic Series

Bitewing (Use No. 2 Receptor)

 • Premolars: two projections
 • Molars: two projections
Criteria of Quality

 Radiographs should record the complete areas of interest on the

image
 Radiographs should have the least possible amount of distortion
 Images should have optimal density and contrast to facilitate
interpre​tation
complete areas of interest on the image

Periapical radiographs:
full length of the roots and at least 2 mm of periapical bone
 area of the entire abnormality plus some surrounding normal
bone
Bitewing examinations:
each posterior proximal surface at least once
 Overlap of adjacent proximal tooth surfaces should be less than
one third of the enamel thickness
the least possible amount of distortion

 Most distortion is caused by improper angulation of the x-ray

beam rather than by the curvature of the structures being
examined or inappropriate positioning of the receptor
optimal density and contrast

Radiographic exposure settings, including

 peak kilovoltage (kVp),
 the milliamperage (mA), and
 exposure time (s)
are crucial parameters that influence density and contrast for both
digital- and filmbased radiography
 Periapical Radiography

 • Asses extent of dental caries

 • Detect presence and assess extent of periapical inflammation
 • Evaluate consequences of traumatic injuries to the teeth and alveolar
bone
 • Assess periodontal bone loss
 • Evaluate root morphology
Periapical Radiography

 • Assess implant osseointegration and peri-implant bone loss

 • Evaluate unerupted and impacted teeth
 • Evaluate external and internal root resorption
 • Assess pulp morphology
 • Determine length of endodontic instrumentation during
treatment
Two intraoral projection techniques are
commonly used for periapical radiography:

(1) the paralleling technique

(2) the bisecting-angle technique.
Both techniques can be applied to digitaland film-based
imaging
receptor

any medium used to capture an image, including

 film,
 charge-coupled devices (CCDs),
 complementary metal oxide semiconductor (CMOS) sensors,
 or storage phosphor plates.
 The principles for making projection radiographs are the same for
each of these receptor type
Paralleling Technique


rightangle technique
long-cone technique
x-ray receptor

parallel to the long axis of the teeth and the central ray of
the x-ray beam is directed at right angles to the teeth and
receptor
minimizes geometric distortion and presents the teeth
and supporting bone in their true anatomic relationships
This increases the object-to-receptor distance and results
in higher image magnification and poor geometric
sharpness.
 To compensate for the resultant distortion and lack of
sharpness, the paralleling technique is used with a
relatively long source-to-object distance
Receptor-Holding Instruments
Receptor Placement

 parallel to the teeth

 deep into the lingual vestibule or palatal vault;
 For maxillary projections, the superior border of the receptor
generally rests at the height of the palatal vault in the midline.
 for mandibular projections, the receptor should be used to
displace the tongue posteriorly or toward the midline to allow the
inferior border of the receptor to rest on the floor of the mouth
away from the mucosa on the lingual surface of the mandible.
anatomic variations

a shallow palate
a shallow floor of the mouth,
tori.
 all the roots of a multirooted tooth may not be placed
parallel to the receptor, resulting indifferential distortion
of the roots
Angulation of the Tube Head

to align with the aiming ring.

The horizontal direction of the beam primarily influences
the degree of overlapping of the images of the crowns at
the interproximal space
Bisecting Angle Technique

Cieszynski's rule of isometry

that two triangles are equal when they share one
complete side and have two equal angles
Receptor-Holding Instruments


receptorholding bisecting angle instrument
 forefinger
Positioning of the Patient

Maxillary projections. The patient should be seated

upright in the dental chair with the sagittal plane vertical
and the occlusal plane horizontal.
 Mandibular projections. The patient should be seated
upright in the dental chair with the sagittal plane
vertical. The head is tilted back slightly to compensate for
the changed occlusal plane when the mouth is opened
Receptor Placement

 behind the area of interest, with the apical end against the
mucosa on the lingual or palatal surface
 The occlusal or incisal edge is oriented
 against the teeth with an edge of the receptor extending just
beyond the teeth
Angulation of the Tube Head

Horizontal angulation.
Vertical angulation.
 General Steps for Making Intraoral
Radiographs

 Prepare unit for exposure

 Greet and seat the patient
 Adjust the x-ray unit setting
 Wash your hands thoroughly and wear appropriate personal protective equipment
 Examine the oral cavity
 Position the x-ray tube head
 Position the receptor
 Position the x-ray tube
 Make the exposure
Paralleling Technique
Maxillary Central Incisor Projection
Maxillary Lateral Projection
Maxillary Canine Projection
Maxillary Premolar Projection
Maxillary Molar Projection
Mandibular Centrolateral Projection
Mandibular Canine Projection
Mandibular Premolar Projection
Mandibular Molar Projection
Individual Periapical Projections

A typical full-mouth radiographic series consists of 21

images
start with the anterior views because they cause less
discomfort for the patient.
Bitewing Radiography

 interproximal radiographs
 the crowns of the maxillary and mandibular teeth and the
alveolar crest on the same receptor.
Diagnostic Objectives of Bitewing Radiograph

 • Detect early interproximal caries before it becomes clinically

apparent
 • Detect secondary caries below restorations
 • Assess loss of the interdental and furcation bone
Receptor Holding Instrument
Positioning of the Patient

 upright in the dental chair with the sagittal plane vertical and the
occlusal plane horizontal
Angulation of the Tube Head

Horizontal angulation.
 To effectively image the interproximal tooth surface without
superimposition, the x-ray beam is directed through the contacts.
Vertical angulation.
 about +10 degrees to project the beam parallel with the occlusal
plan
Premolar Bitewing Projection
Molar Bitewing Projection
Occlusal Radiography

 An occlusal radiograph displays a relatively large segment of a

dental arch. It may include the palate or floor of the mouth and a
reasonable extent of the contiguous lateral structures
 Diagnostic Objectives of Occlusal Radiography

 • To locate supernumerary, unerupted, and impacted teeth

 • To localize foreign bodies in the jaws and floor of the mouth
 • To identify and determine the full extent of disease (e.g., cysts,
osteomyelitis, malignancies) in the jaws, palate, and floor of the mouth
 • To evaluate and monitor changes in the midpalatal suture during
orthodontic palatal expansion.To detect and locate sialoliths in the ducts
of sublingual and submandibular glands
 • To evaluate the integrity of the anterior, medial, and lateral
outlines of the maxillary sinus
• To aid in the examination of patients with trismus, who can
open their mouths only a few millimeters
 • To obtain information about the location, nature, extent,
and displacement of fractures of the mandible and maxilla
 Occlusal receptors are made of film or storage phosphor plates.
 CCD or CMOS sensors of this size are not manufactured
Anterior Maxillary Occlusal Projection
Lateral Maxillary Occlusal Projection
Anterior Mandibular Occlusal Projection
Lateral Mandibular Occlusal Projection
Object Localization

 An inherent limitation of plain radiography is the two-

dimensional nature of the image.
Approaches to Decipher ThreeDimensional
Relationships by Radiography

 • Examine two conventional images projected at right angles to

each other.
 • Use the tube-shift technique employing conventional periapical
views.
 • Image the anatomic region with a three-dimensional imaging
modality.
tube-shift technique

buccal-object rule and Clark's rule

 When an object lies lingual to the reference object, its image
appears to move in the direction of the tube shift.
 When the object lies buccal to the reference object, its image
appears to move in the direction of opposite to the tube shift.
 SLOB:

same lingual, opposite buccal.

 if the object in question appears to move in the same direction
with respect to the reference structures as does the x-ray tube, it is
on the lingual aspect of the reference object; if it appears to move
in the opposite direction as the x-ray tube, it is on the buccal
aspect