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X-ray beam
Long axis of film
Bisecting Angle Technique
(Advantages)
When comparing the two periapical techniques, the
advantages of the bisecting angle technique are:
1. More comfortable: because the film is placed in
the mouth at an angle to the long axis of the teeth,
the film doesn’t impinge on the tissues as much.
2. A film holder, although available, is not needed.
Patients can hold the film in position using a finger.
• a shallow palate
• a large palatal torus
• a shallow or tender floor of the mouth
• a short lingual frenum (tongue-tie)
Bisecting Angle Technique
(Disadvantages)
When comparing the two periapical techniques, the
disadvantages of the bisecting angle technique are:
1. More distortion: because the film and teeth are
at an angle to each other (not parallel) the
images will be distorted (see next slide).
bisecting paralleling
Head Position
When using a bisecting instrument, head position is not
critical. However, when using finger retention, head
position is important. When radiographing the maxillary
arch, the head should be positioned so that the maxillary
arch is parallel to the floor. For mandibular films, the
head is tipped back slightly so that the mandible is
parallel to the floor when the mouth is open (The mouth
is always open when using finger retention). Make sure
head is supported by headrest.
Maxilla Mandible
headrest (head tipped back)
Head Position
When viewed from the front of the patient, the
Midsagittal Plane (which divides the head into
right and left halves) is perpendicular to the floor.
MSP
floor
Bisecting Angle Technique
Film Selection for Adults
The # 2 size film is routinely used for all periapical
films using the bisecting angle technique. The long
axis of the film is vertical for anterior films and
horizontal for posterior films.
#2 #2
anterior posterior
Bisecting Angle Technique
Film Selection for Children
For children with small mouths, the # 0 size film is
used for both anterior and posterior periapical
films. However, if the child’s mouth is large
enough to reasonably accommodate the larger
size films, and the child is cooperative, they
should be used.
#0 #0
anterior posterior
Anterior Periapical
The # 2 (or # 0) size film is positioned vertically with the
all-white side of the film facing the teeth. The identifying
dot is placed at the incisal edge of the teeth. The thumb or
finger is applied to the back (colored) side of the film at
approximately the junction of the tooth with the gingiva;
this provides good support for the film and avoids film
bending. The film should extend ¼” beyond the incisal
edges of the teeth.
Posterior Periapical
The # 2 (or # 0) size film is positioned horizontally with
the all-white side of the film facing the teeth. The
identifying dot is placed at the occlusal surface of the
teeth. The finger is applied to the back (colored) side of
the film at approximately the junction of the tooth with
the gingiva; this provides good support for the film and
avoids film bending. The film should extend ¼” beyond
the occlusal surface of the teeth.
Bisecting Instrument
The Bisecting Angle Instrument is shown below.
Notice that the biteblock support, against which the
film will be aligned, is not parallel with the ring; it is
slightly angled to accommodate the bisecting
technique. This slight tilt of the film does little to
make film placement more comfortable for the patient
over the paralleling technique; that is why finger
placement is recommended if the bisecting technique
is indicated.
Snap-A-Ray
Another instrument that may be used for posterior
periapical films is the Snap-A-Ray shown below. The
alligator jaws hold the film tightly and, since there is no
support behind the film, the film can flex as the patient
closes. This makes it more comfortable for the patient.
Finger Retention
Bisecting line
Long axis of tooth
X-ray beam
Long axis of film
Vertical Angulation 0
correct incorrect
Centering the Beam
For the anterior periapicals it is easy to see the sides of
the film and makes it easy to center the beam on the
film side-to-side. You then need to make sure the PID
extends ¼” below the visible (incisal) edge of the film
(maxillary arch) or above the visible edge (mandible).
In the posterior region, the front edge of the PID should
be ¼” anterior to the front edge of the film and the PID
should extend ¼” beyond the visible (occlusal) edge of
the film (above or below, depending on which arch is
being radiographed). These steps will help to insure
that the film is completely covered by the x-ray beam,
avoiding cone-cuts.
¼”
Maxillary Incisors
The film is held in place using the thumb of either hand.
The x-ray beam is directed perpendicular to the bisecting
line vertically and the horizontal angulation aligns the x-
ray beam perpendicular to the film. The x-ray beam is
centered on the film. The film shows both central
incisors and most of the lateral incisors.
Maxillary Canine
The film is held in place using the thumb or index finger
of the opposite hand. (Right hand for maxillary left
canine pictured below). The x-ray beam is directed
perpendicular to the bisecting line vertically and the
horizontal angulation should open the contact between
the canine and first premolar (see next slide). The x-ray
beam is centered on the film. The film shows tooth # 11.
Canine Horizontal Angulation
If you direct the beam perpendicular to the canine,
there will normally be overlap between the canine and
first premolar. In order to open this contact, the
horizontal angulation must be rotated posteriorly. Try
to imagine the mesial surface of the first premolar and
align the beam parallel with this surface. (see diagram
below right).
Incorrect Correct
Maxillary Canine 0
All # 2 films
R L
Anterior First
When taking films on a patient, you should always
start with the anterior films. If you are doing a full
series, start with the maxillary canine film and
then finish all the anterior films, both maxillary
and mandibular. Then complete the posterior
films, starting with the premolar, then molar, in
each quadrant. When doing only a few films on a
patient, start with the most anterior film and work
your way back in the mouth. This sequence of
taking films allows the patient to get used to the
procedure with a minimum of discomfort and
helps to avoid stimulation of the gag reflex.
Bisecting Angle Technique
Errors
x-ray beam
film
bisecting line
Foreshortening
If you have too much vertical angulation, as in the
diagram below, the image will be foreshortened or
reduced in length. The angle the x-ray beam forms
with the bisecting line is greater than 90°. The red lines
on the film represent the actual length of tooth # 9; the
black arrow points to the end of the “image” of the
tooth.
film
When using the bisecting angle technique with finger retention,
the incisal edge /occlusal surface will always be in contact with
the film. This part of the tooth will always appear at the same
spot on the film no matter what the angulation is. However, the
apex of the teeth, being farther away from the film, will be
imaged at different positions depending on the vertical
angulation. The arrows in the diagram below identify where the
apex of the tooth will be at different angulations; e. g., at >90°
the apex will be imaged lower on the film, shortening the overall
image. Remember, a 90° angle between the x-ray beam and the
bisecting line is the ideal alignment.
>90º = foreshortening
<90º = elongation image lengths
Improper Film Placement
As with the paralleling technique, improper film
placement is one of the most common errors
seen in the bisecting angle technique. In the
molar film below, the film was placed too far
forward, cutting off the distal root of the second
molar and failing to image the third molar region.
AP
Mandibular molar periapical
Film Placement 0
Canine periapical
Reversed film 0
Underexposure or
processing error
(e.g., developer
solution too cold)
Cone-cutting
If the x-ray tubehead is not positioned properly, the x-ray
beam may not cover the entire film. This is known as
conecutting, which results in a clear (white) area on the
film where the silver halide crystals were not exposed to
x-rays (see film below). In the diagram below left, the
dotted circle represents where the x-ray beam should
have been positioned; the solid circle shows the actual
position of the x-ray beam (too posterior).
Overlap (incorrect horizontal angulation)
Overlap is the superimposition of part of one tooth
with part of the adjacent tooth (dotted circles below
left). The red arrow represents the direction of the x-
ray beam; the x-ray beam should be perpendicular to
the dotted line below. (See discussion of horizontal
angulation on earlier slide).
Film “Softening”
If you try to make the film more comfortable for the
patient by “softening” the corners or edges, the
emulsion of the film will be affected, resulting in
black lines (see film below). With finger retention,
film placement is usually not very uncomfortable;
therefore, film softening is not needed.
Double exposure
When taking films, you should always place each film in
a container or paper bag immediately after it is exposed.
Exposed films should never be placed in the same area
where unexposed films are located. If you inadvertently
pick up an exposed film and use it for another exposure,
the result is a double exposure. Two different areas of
the mouth are superimposed, making the images
worthless. This is the worst error because two films have
to be retaken.
The film at left shows
images of mandibular
posterior teeth , both
upright and inverted. The
film was used for both the
premolar and molar films
on the same side.
Patient Movement 0
PI D
Incorrect Exposure Factors
The standard exposure settings on your x-ray machine
will be acceptable for the majority of your patients.
However, if you are taking radiographs on a child you
would need to decrease the settings. If your patient is
very large, you would need to increase the settings.
Underexposure results when the exposure factors are
set too low for the patient size. Overexposure results
when the exposure factors are set too high.
65 degrees
True Maxillary Occlusal
The True Maxillary Occlusal film is not often used
because of the much higher exposure time needed to
properly expose the film. (Because the vertical
angulation is 90 degrees, the x-ray beam passes
through the very dense frontal bone; this is the reason
for the increased exposure). Structures located farther
back in the mouth are more likely to be imaged on this
film.
90 degrees
Mandibular Occlusal
With the head tipped back as much as possible,
the x-ray beam is directed at a 90 degree angle to
the film. Bony expansions of the mandible as well
as abnormalities or pathology in the floor of the
mouth can be imaged with this film.
90 degrees
Occlusal Technique
Exposure Settings