DENTAL
RADIOGRAPHY
Adiba Fathima
Bsc Radiology
• Dental Radiography, is a Radiographic procedure that is used or
employed to take images of the teeth, bones, and soft tissues around
them, in order to identify, diagnose, plan treatments and monitor
both treatments and lesion development.
• Humans have 20 deciduous teeth and 32 permanent teeth. These
are classified into incisors, canines, premolars, and molars.
STRUCTURE OF TOOTH
DENTAL FORMULAE AND NOTATIONS
• There are several internationally recognized methods of
identifying the teeth that require radiography. The two most
commonly used methods of notation are:
• Palmer notation and
• Fédération Dentaire International (FDI) notation.
• The Palmer notation is depicted schematically, with a vertical
line between the central maxillary and mandibular incisors and
a horizontal line between the maxilla and mandible, dividing the
oral cavity into quadrants.
• The clinician requesting intraoral radiography uses these vertical
and horizontal lines to denote the quadrant to which the
tooth/teeth to be radiographed belong.
• to avoid confusion between
the permanent and
deciduous dentition. The
following conventions is
used.
• For the deciduous
dentition: five teeth in each
quadrant are assigned the
letters A-E, from the central
deciduous incisor to the
second deciduous molar,
respectively.
• For the permanent
dentition: eight teeth in each
quadrant are assigned the
numbers 1-8, from the
• A request card for dental radiography using the
palmer notation must contain the following.
• The number of tooth to be radiographed
• The letter of the tooth to be radiographed
• This is added to complete the notation, and will
give the Radiographer more information in
carrying out the examination. For Example -
• In the FDI, The dentition is again divided into four quadrants. These are
assigned the numbers 1-4 for the permanent teeth and the numbers 5-8 for
the deciduous dentition.
• In both dentitions, the quadrants follow on numerically, starting from the
upper right, to the upper left, to the lower left and, finally, to the lower right.
• The number of the quadrant precedes the number of the tooth to be
radiographed.
• Examples of requests for dental examinations
using this formula are:
• 53 - upper right deciduous canine.
• 37, 38 - lower left second and third molars.
EQUIPMENT
❖X ray tube potential:-Not lower than 50kVp
and recommended is 60-70kVp
❖X-ray tube filtration: - 1.5mm aluminum
equivalent for up to 70kVp and 2.5mm for more
than 70kVp.
❖X-ray beam dimensions:- Beam diameter at
the patient's skin not greater than 60mm.
❖Minimum focus-to-skin distance:-200mm
for 60kVp or, greater and 100mm for less
than 60kVp.
• The dental x ray machine consists of 3 parts-
• 1.The Control Panel
• 2.The Extension Arm: it connects the tube head with the control panel. It moves 360 degreees
horizontally.
• 3.The Tube Head: houses the x ray tube. It has an angle indicator and counters balanced arm
mechanism. It can swing 290 degrees in vertical plane.
DENTAL RADIOGRAPHIC FILM TYPES
• There are two main type of dental xrays- intraoral and
extraoral.
• Intra-oral radiography:
• -direct or non-screen film
• -digital receptors.
• Extra-oral radiography:
• -film-screen
• -digital receptors: (storage phosphor and solid-state).
INTRA ORAL DENTAL FILM
Direct or non screen film: it is used in intraoral radiography.it provides fine details and high
resolution images. The film is made up of following:
• Outer plastic envelope: it protects the film from light and saliva. It has two sides white side
and outer flap side. The smooth white side is known as the tube side, and the outer side has a
flap to open the film during the processing.
• Black paper : it protects from light ingress and damage during handling.
• Lead foil: it is placed back to the film to absorb the scattered radiation and prevent film
fogging .
• The Embossed dot: It indicates the front side of the film ( it should be towards the crown of the
tooth)
• THE DENTAL FILM:
• 1. Film base: transparent sheet of cellulose acetate .
• 2. Adhesive: connects the emulsion to thebase.
• 3. Emulsion: made upof silver bromide(AgBr)
and gelatin.it can be single or double
coated .
INTRA ORAL FILM SIZES-
• Size 0- 22*35mm: for paralleling technique in the children.
• Size 1- 24*40mm: for bitewings technique in the children.
• Size 3 -31*41mm: standard size –most commonly used in the adults.
• Size 4 -57*76mm: used for occlusal projections of the maxilla and mandible.
DENTAL FILM HOLDERS-
• They are used to avoid exposure of a patient's finger and are necessary for
parallelling and bisecting technique.
FILM SPEED-
• It is the amount of radiation required to produce a standard density on the film.
• It is directly proportional to the size of silver halide crystals and thickness of
emulsion.
• The speed is expressed in A,B,C,D,E & F.
• A&B are slow films.
• C is medium speed. D&E are called high speed films.
TYPES OF DENTAL RADIOGRAPHY
Dental radiography is classified in to two types :-
1. Bitewing
2. Periapical
BITEWING TECHNIQUE
• Bitewing radiography requires that the beam, in the horizontal plane, meets the teeth and the film
at right-angles and passes through all the contact areas.
• There are 3 methods used to position the film intraorally:
1.bitewing tab
2.film holding instrument
3.film holding beam alignment instrument
• Patient Position:
• The correct film size is chosen and the bitewing tab is attached. Place the film in
the lingual sulcus.
• The anterior edge of the film should be located opposite to the distal aspect of the lower canine.
• The tab rests on the occlusal surface of the lower teeth.
• The patient is told to bite gently on the tab and, when the teeth are almost in contact, the
operator pulls the tab laterally to ensure that there is good contact between the film and the
teeth.
• BEAM DIRECTION:- The beam
direction is horizontal, with a 5-8
degree caudal angulation.
• CENTRING POINT:- Centre to the
middle of the image receptor, over
the occlusal pane
• INCLUDE:- Crowns of the teeth
under examination and alveolar
crests.
PERIAPICAL RADIOGRAPHY
Periapical radiography provides an image of the teeth, the surrounding periodontal tissues and
the alveolar bone.from the crown to the root.
For periapical radiography two techniques have been developed
1.BISECTING TECHNIQUE
It requires the central ray of the X-ray beam to pass through the root of the tooth at right-angles
to a plane that is the bisector of the angle formed by the long axis of the tooth and the plane of
the film.
The convention for intra-oral film placement is as
follows:-
• Anterior teeth (incisors and canines): long axis of
film vertical.
• Posterior teeth (premolars and molars): long axis of
film horizontal.
Position of patient and film
• The patient's head must be supported adequately
with the medial plane vertical and the occlusal
plane horizontal i.e. upper occlusal plane and lower
occlusal plane for maxillary and mandibular
radiography, respectively.
Direction and centering of the X-ray beam
• The X-ray beam should be centered vertically on
the midpoint of the tooth to be examined.
• It is important to remember that proclined teeth
will require more angulation, whilst retroclined
teeth will need less angulation.
• The X-ray tube must be positioned so that the beam
is at right-angles to the labial or buccal surfaces of
the teeth to prevent horizontal overlap
THE PARALLELING TECHNIQUE
• The paralleling technique requires that the X-ray film is positioned parallel with the long axes
of the teeth. The central ray of the X-ray beam passes at right-angles, i.e. perpendicular, to the
tooth.
• In order to minimize magnification of the image and subsequent loss of image sharpness, the
technique uses an increased focal spot-to-object distance, ensuring that a more parallel X-ray
beam is incident to the object and image receptor.
Position of patient and film
• The appropriate film holder and periapical film are selected and assembled.
• Place the bite block in contact with the edge of the tooth to be imaged. Ensure that the film
covers the particular tooth/teeth to be examined.
❖ Maxilla:
• For the incisor, canine, premolar and molar regions, the film holder must be positioned some
distance from the tooth to achieve parallelism. This requires using the entire horizontal length
of the bite block with the film holder occupying the highest part of the palate.
❖Mandible:
• For the lower incisor teeth, position the film holder in the plane of an imaginary line
intersecting the first mandibular premolars or as posterior as anatomy will allow. For the
mandibular premolars and molars, position the film holder in the lingual sulcus adjacent to the
teeth selected for imaging.
Occlusal plane :it means the biting surface of premolar and molar teeth. during intraoral
radiography, the upper occlusal plane or lower occlusal plane should be horizontal, and the
median plane is vertical position.
OCCLUSAL TECHNIQUE
It shows the roof or floor of the mouth and entire arch of teeth of the upper and lower jaw to
evaluate tooth development abnormalities. the occlusal film is placed into the mouth.
Upper jaw occlusal technique
• The patient is seated with the neck slightly flex, so the occlusal plane is parallel to the floor.
• The film is placed inside the mouth.
• The patient is asked to bite gently to maintain the position.
• The central ray is angled at 65 degrees towards the bridge of the nose
Lower jaw occlusal technique
• The patient is seated with the head tilting slightly back, so the occlusal plane is parallel to
the floor.
• The film is placed inside the mouth.
• The patient is asked to bite gently to maintain the position.
• The central ray is angled at 55 degrees towards the film.
FILM PROCESSING
Films may be processed both manually and automatically.
RADIATION PROTECTION
The operator should
pay particular attention • • Radiographers must never position themselves in the
to careful handling of the direction of the primary beam.
film and should ensure that • Controlled areas are determined in consultation with the
the processing and Radiation Protection Adviser.
darkroom techniques • The radiographer must never support a film inside the
employed result in: patient's mouth.
• Film holders should be used routinely for intra-oral
• no pressure marks on the film
and no emulsion scratches; radiography.
• Quality assurance procedures must be adopted.
• no roller marks (automatic
processing only); • The use of rectangular collimation for intra-oral
dental radiography has been shown to reduce patient dose by
• no evidence of film fog;
up to 50% compared with a 6-cm round beam.
• no
chemical streaks/splashes/con • A protective lead thyroid collar should be placed.
tamination;
• no evidence
of inadequate fixation/washing.
EXTRA ORAL RADIOGRAPHY
The extra oral film is placed outside of the mouth. Extraoral radiography is used to examine large
areas of the head or jaws. Commonly screen film and rare earth intensifying screens are used. The
extra oral films are large and double-emulsion films, so the extra oral radiographic projections
should be performed using screen film. The extra oral film is placed between two intensifying
screens. The intensifying screen absorb the X-rays and emits visible light that exposes the screen
film.
(a) Panoramic X-ray:- A panoramic film shows a panoramic (wide) view of the upper and
lower jaws on a single radiograph. Panoramic X-ray is performed to detect impacted teeth, bone
abnormalities, cysts, tumors, infections, and fractures of the upper and lower jaws. This is a
curvilinear variation of conventional tomography in which the X-ray source and an image
receptor move around a central point where the object of interest is located.
(b) Cephalometric Projections:- A cephalometric film shows the bony and soft tissue
areas of the facial bones. Cephalometry is used to measure dimensions of bone, teeth, and facial
bones. The Dentists and maxillofacial surgeons perform Cephalometric analysis of the dental and
skeletal relationships by the Cephalometric projections for further treatment planning. Intra-Oral
Dental Film:- The non-screen film is used in Intra-oral radiography. It provides fine details and
high-resolution images.
