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 Object Localization

The following slides describe

Object Localization, including the
Right Angle Technique and the
Tube Shift Technique.
 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 two-
dimensional. 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, Clark’s 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
distal 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.
distal mesial
 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
distal
(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.
distal mesial
 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 distal

(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 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).
Richard’s Method of Object Localization

This method of determining the buccolingual

location of objects was first suggested by
Richards. It utilizes similar ideas to Clark’s
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 1 incisor film

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

The
The arrow
arrow in the canine
identifies film iscanal.
the lingual pointing
Thetotubehead
the guttamoves
percha from
mesially in which canal of the
the premolar filmmaxillary first premolar?
to the canine film (beam
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.
premolar film 3 molar film

TheIstubehead movessecond
the maxillary distally from
the premolar
premolar film to the molar film.
(arrows)
Thedisplaced
second premolar also moves
to the buccal
distally,
or theoverlapping
lingual? the first molar
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
premolar bitewing lingual.
 incisor film 4 canine film

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

premolar film

Lingual. The tubehead moves mesially from the premolar

film to the canine film. The object also moves mesially,
starting out distal object
Is the radiopaque to the first molarby
identified onthe
thearrows
premolar film and
located
ending up mesial
on the buccal to the
or the first molar on the canine film. This
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
 incisor film
premolar film 6

Thetubehead
The maxillarymoves
right lateral incisor
mesially from(arrow) is tiltedfilm
the premolar outtoofthe
position.
incisor InThe
film. which direction
lateral (buccal
incisor or lingual)
also moves is it
mesially,
tipped?out overlying the canine on the premolar film and
starting
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 7 canine film

The
Thetubehead
maxillarymoves distally
left canine fromis
(arrow) the incisor film
impacted. Is ittolocated
the
canine
more tofilm.
theThe impacted
buccal or the canine
lingual?also moves distally,
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
8
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
premolar bitewing film
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

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

10
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
molar periapical film
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.
 11
premolar film molar film

The
Doestubehead moves
the arrow pointdistally from the premolar
to the mesiobuccal film to the
or mesiolingual
molar
canal?film. The canal indicated by the arrow also moves
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
12

The tubehead moves down

The the
from amalgam particle
bitewing film to the
indicated by
mandibular the arrows
periapical film.
is located
The amalgam bucally or moves
particle
lingually?
upward (opposite direction),
indicating that it is located
molar periapical film buccally.
 13 premolar bitewing film
The tubehead moves distally from the
canine
Is thefilm to the premolar
restoration periapical.
indicated by
The
therestoration moveson
arrows located mesially.
the From
the bitewing
buccal to the mandibular
or lingual of the first
premolar
premolar?periapical, the tubehead
moves down and the restoration
moves up. The restoration is located
on the buccal of # 21.
canine periapical film
premolar periapical film
 14

premolar film

incisor film canine film

The
In gutta from
moving percha
theroot canal
incisor filling
film identified
to the by the
canine film, arrows
and then
is located
from in which
the canine filmcanal?
to the 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 the Buccal
Object Rule. If you have any questions, you
may e-mail me at jaynes.1@osu.edu.