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Final_Lec4

21-April-2013

Occlusal Radiography + Exposure & Technique Errors

Occlusal technique is considered a localizing technique that helps in localizing objects; if they are buccaly or lingually located. Occlusal radiograph is at right angle to peri-apical radiograph & bite-wing radiograph so if you want to take the location of an object you take 2 radiographs at right angle to each other or a 3D radiograph if necessary. Taking 2 radiographs (2D) at right angle to each other will gives the patient less dose of x-ray compared to 3D. There are 2 types of localization techniques: 1) Buccal Object Technique/SLOB (Same Lingual Opposite Buccal): Governs the orientation of structures portrayed in 2 radiographs exposed at different angulations. One Peri-apical/bite-weing film is exposed using proper technique & angulation, and then a second Peri-apical/Bite-Wing film is exposed after changing the direction of the x-ray beam. The angulation can be horizontal or vertical. Ex. A different horizontal angulation is used when youre trying to locate vertically aligned images like locating root canals. Also, a different vertical angulation is used when trying to locate a horizontally aligned image such as the mandibular canal. Buccal object rule can be also applied vertically, when you take panoramic radiograph the beam is directed near the occlusal plane, it is not exactly, there is a little vertical angulation, however maxillary occlusal coming from inside of the nose, and the mandibular occlusal from the side of the chin. So we can use SLOB rule vertically. e.g. I moved the beam upward and the object appears to go downward then it is buccally located.

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2) Right Angle technique. As discussed above. (Two dimensional radiographs are compared to locate an object in three dimensions).

Now we are going to start a new topic which is Exposure & Technique Errors Ch.20

Exposure errors which include:

1) Unexposed Film: Film appears clear. This is caused by failure to turn on the X-ray machine. Or you press the exposure button without waiting to listen the audible sound. 2) Film exposed to light: Film appears Black (very dark film) & this is caused by accidentally exposing the film to white light so the film gets burned. We have to protect the film & we shouldnt unwrap it in a room with white light. 3) Overexposed: Film also appears dark but NOT darker than Film exposed to light. This is caused by increasing exposure time, Kilo voltage, Milliampere or a combination of these factors. 4) Underexposed: Film appear Light & this is caused by inadequate exposure time, Kilo voltage, Milliampere or a combination of these factors.
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Periapical Film Errors

Technique Errors which include:
1) Peri-Apical Film errors: these include a) Film Placement errors : Film should be placed parallel to the teeth and it should be positioned 2 mm beyond the apex & 1/8 inch (more than 2mm) beyond the incisal/occlusal surface. A correct peri-apical film placement demonstrates the entire tooth, including the apex and surrounding structures.

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Incorrect film placement: Absence of apical structures. Dropped film corner: when the occlusal plane is slanted/tilted due to the film not placed parallel to incisal-occlusal surfaces of the teeth. To avoid this you have to instruct your patient to hold the film firmly in place, and you have to be very quick so that you wont initiate gagging reflex for your patient.

b) Angulation errors which include:

Angulation: is a term used to describe the alignment of the central ray of the x-ray beam in the horizontal and vertical planes.

Incorrect Horizontal Angulation: overlapped contacts appear on the film. This happens when the central ray is not directed through the interproximal spaces so as a result, the proximal surfaces of adjacent teeth appear overlapped in the peri-apical film.

Incorrect Vertical Angulation: this results in an image that is not the same length as the tooth. The image may be 1) Foreshortened (when vertical angulation is too excessive or too steep the image of the tooth is shorter than the actual tooth) 2) Elongated (when the vertical angulation is too flat so the image of the tooth on the film is longer than the actual tooth).
Both of these errors are rare nowadays since we use a film holder now instead of using fingers to hold the film.

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c) Beam Alignment errors / PID alignment problems: occur when the PID is misaligned & the x-ray beam is not centered over the film so the resultant radiograph is a partial image only. The PID or cone is said to cut the image. A conecut appears as a clear unexposed area on a dental radiograph & may occur with either a rectangular or a round PID. This can happen in 2 ways: 1- Cone-cut WITH film holder => a clear, unexposed area appears on the film due to PID not properly aligned with the peri-apical holder so the x-ray beam did not expose the entire film. 2- Cone-cut WITHOUT film holder => a clear unexposed area appears on the film due to PID not directed at the center of the film so x-ray beam did not expose the entire film.

2) Bite-Wing Film errors: Include

a) Film Placement Problems b) Angulation Problems c) PID alignment Problems

a) Film Placement Problems:

Correct placement for bite-wing films shows equal areas of the maxilla & mandible, occlusal plane exactly in the middle. > Incorrect Film Placement may result in an absence of specific teeth or tooth surfaces on a film, tipped occlusal plane, overlapped interproximal contacts or a distorted image. Such errors may render a bite-wing film as nondiagnostic. > The most common error students make is that when they want to film a premolar they put the film exactly on the first premolar so sometimes half of the 1st premolar is not shown. To avoid this we should place the film in the middle of the canine. Same thing
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goes for the Molar bite-wing; we should place the film in the middle of second premolar. Also in Molar bite wing; 3rd molars should be visible on the film. Even if the patient doesnt have 3rd molars that area should be visible on the film. This mistake is very common as well.

b) Angulation Problems:
Incorrect Horizontal Angulation which causes overlapping. (There is a pic above for overlapping) Incorrect Vertical Angulation causes distortion on the film.

c) PID alignment Problems:

If PID is misaligned & the x-ray is not centered over the film, a partial image is seen on the radiograph, this partial image is called cone-cut. It appears as a clear area with a curved outline. Again this happens in 2 ways: 1- Cone-cut WITH film holder => Due to PID not properly aligned with the bite-wing film holder so the x-ray beam did not expose the entire film. A clear, unexposed area on the film is the result. 2- Cone-cut WITHOUT film holder => Due to PID not directed at the center of the film so the x-ray beam did not expose the entire film. A clear, unexposed area on the film is the result.

Our last topic is Miscellaneous Technique Errors which include: 1) Film Bending = caused by excessive bending & this causes the image of the film appear stretched, elongated & distorted. This is common when using finger technique.

2) Film Creasing = Due to the film being creased and the film emulsion cracked. As a result, a thin radiolucent line is on the resultant

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radiograph. (Permanent force on it or very excessive bending or long nails could cause this) 3) Phalangioma = Patients finger appears on the film.

4) Double Exposure = Film was exposed in the patients mouth twice. It happens sometimes if the dentist takes the radiograph, puts it in his pocket and forgets it. Then after a while he finds it & assumes he didnt use it so he uses it again & the result would be this pic shown on the right.

5) Movement = Blurred/hazy images appear on the film due to movement of the patient during the exposure of the film.

6) Reversed Film = Film was placed in the mouth backward then exposed causing he lead foil to appear in the image & it would be light with a tire-track/ herringbone pattern or a fishskeleton appearance.

Done By: Stephanie Nawas & Jad El Benni checked by: Sawsan Jwaied

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