Intraoral Radiography 牙科放射線學(1) Intraoral Radiography 口內攝影術 陳玉昆副教授: 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw

學 習 目 標 知道口內片攝影術的名稱 了解口內片攝影術的適應症 明白口內片攝影術的方法 References: 1. Eric Whaites: Essentials of dental radiography & radiology 3rd edition, Chapter 8-10, p. 75-116 2. Eric Whaites: Essentials of dental radiography & radiology 1st edition, Chapter 8, p. 59-77 3. Newman ME & Friedman S: Extraoral radiographic technique: An alternative approach. J Endod 2003;29:419-21 4. Kaohsiung Medical University, Oral Pathology Department

Periapical Radiography Paralleling technique Bisecting angle technique Positioning difficulties Film & tooth parallel & in contact Ideal positioning Parallel X-ray beam meeting both the tooth & film at right angles Ref. 1

Paralleling technique Film & tooth parallel & in contact Ideal positioning Parallel X-ray beam meeting both the tooth & film at right angles For film & tooth to be parallel they must placed some distance apart Ref. 1

Paralleling technique Film & tooth parallel & in contact Ideal positioning Parallel X-ray beam meeting both the tooth & film at right angles Paralleling technique Long spacer cone Near parallel X-ray beam Minimal magnification of the image Short spacer cone Diverging X-ray beam Magnification of the image Ref. 1

Paralleling technique Anterior Posterior Metal supporting indicator rod White locator ring Bite block Positioning Maxillary incisor Patient positioning Maxillary incisor Ref. 2

Paralleling technique Anterior Posterior Metal supporting indicator rod White locator ring Bite block Maxillary canine Positioning Maxillary canine Patient positioning Ref. 2

Paralleling technique Anterior Posterior Metal supporting indicator rod White locator ring Bite block Positioning Maxillary premolar Maxillary premolar Patient positioning Ref. 2

Paralleling technique Anterior Posterior Metal supporting indicator rod White locator ring Bite block Maxillary molar Positioning Maxillary molar Patient positioning Ref. 2

Paralleling technique Anterior Posterior Metal supporting indicator rod White locator ring Bite block Mandibular incisor Patient positioning Mandibular incisor Patient positioning Ref. 2

Paralleling technique Anterior Posterior Metal supporting indicator rod White locator ring Bite block Mandibular canine Positioning Patient positioning Mandibular canine Ref. 2

Paralleling technique Anterior Posterior Metal supporting indicator rod White locator ring Bite block Mandibular premolar Positioning Mandibular premolar Patient positioning Ref. 2

Paralleling technique Anterior Posterior Metal supporting indicator rod White locator ring Bite block Positioning Mandibular molar Patient positioning Mandibular molar Ref. 2

Paralleling technique Anterior tooth 直 放 upper lower Posterior tooth 橫 放 左上、右下 象限 右上、左下 象限 Ref. 4

Paralleling technique 高雄市牙醫師公會資料

Full mouth X-ray films Left Right Upper Lower Premolars Molars Bitewing Upper Lower Incisors Canine Ref. 4

Periapical Radiography Paralleling technique Bisecting angle technique Positioning difficulties Vertical angulation too small Alveolar bone level is not accurate Ref. 1

Bisecting angle technique Horizontal angle Anterior teeth 2 - 3mm beyond the incisal edge Long axis of the film packet vertical Long axis of the film packet horizontal Posterior teeth the occlusal edge 正 照 想 要 照 的 牙 齒 Upper arch Lower arch Ref. 1

Bisecting angle technique Maxillary incisor Patient positioning Vertical angle Maxillary canine Patient positioning Vertical angle Ref. 2

Bisecting angle technique Maxillary premolar Maxillary molar Ref. 2

Bisecting angle technique Mandibular incisor Mandibular canine Ref. 2

Bisecting angle technique Mandibular premolars Mandibular molars Ref. 2

Bisecting angle technique Posterior tooth Anterior tooth Bite fork 鱷 魚 夾 Ref. 4

Bisecting angle technique Posterior tooth 右 上 象 限 Tube head Posterior tooth 右 上 象 限 Tube head 顯示片子 最外緣 橫竿顯示片子最低處 Tube head垂直 bitefork橫竿 得到正確之水平角 Ref. 4

Periapical Radiography Paralleling technique Bisecting angle technique Positioning difficulties Mandibular third molar Gagging Endodontics Edentulous alveolar ridge Children Patients with disabilities

Mandibular third molar – Solution (1) 止血鉗(mosquito) Vertical line dropped from the outer corner of the eye 1cm above the lower mandibular border External centering point Ref. 2

Mandibular third molar - Solution (2) Apex of 8 too far distally to be recorded X-ray tubehead to record the second/ third molar crown relationship to record the apex of third molar tubehead X-ray Distal shift Ref. 1

Endodontics – Solution (1) Anterior teeth Reamer/ file Front view – film attached to a wooden spatula Side view – film & the wooden spatula are held parallel To the long axis of the tooth Reamer/file Ref. 1

Endodontics – Solution (2) Packet holder Reamer/file Posterior tooth Rubber dam Ref. 2

Endodontics – Solution (2) 左 上 右 下 右 上 左 下 Catalogue of manufacturer, Dentsply

Endodontics – Solution (2) Catalogue of manufacturer, Dentsply

Endodontics – Solution (2) 左 上 右 下 左 下 右 上 Catalogue of manufacturer, Dentsply

Gagging - Solution Steep downward angulation of the X – ray beam Film horizontal (in the occlusal plane) Surround structure will be distorted Ref. 1

Edentulous alveolar ridge - Solution Film packet position Maxilla Mandible Bite block unsupported -- film rotates Bite block supported -- film stable Cotton wool rolls Ref. 1

Children - Solution Patients with disabilities - Solution Maxillary incisors Ref. 1

Extraoral Radiographic Technique: An Alternative Approach Maxillary technique Film or sensor -55 -35 建議使用digital sensor 因kVP較低 建議使用 digital sensor Mandibular technique Ref. 3

Extraoral Radiographic Technique Endodontic treatment Children Ref. 3

Extraoral Radiographic Technique B C D Ref. 4

Extraoral Radiographic Technique 自 製 工 具 底片 Ref. 4

S Extraoral Radiographic Technique Ref. 4

Extraoral Radiographic Technique Ref. 4

Bitewing Radiography Horizontal bitewing Vertical bitewing Adult Children Vertical Horizontal Child Adult Downward vertical angulation Ref. 2

Bitewing Radiography Vertical bitewing Horizontal bitewing Refs. 2, 4

Occlusal Radiography Maxillary occlusal projections Upper standard occlusal (standard occlusal) Upper oblique occlusal (oblique occlusal) Vertex occlusal (vertex occlusal)

Maxillary Occlusal Projections Upper Standard Occlusal 片 子 橫 放 突 點 朝 上 Ref. 2

Maxillary Occlusal Projections Upper Oblique Occlusal 片 子 直 放 突 點 朝 上 盡量靠近所要照之牙弓 65-70 degree Ref. 2

Maxillary Occlusal Projections Vertex Occlusal 突 點 朝 上 片 子 直 放 已不建議使用 因kVP過高 Ref. 2

Occlusal Radiography Mandibular Occlusal Projections Lower 90 degree occlusal (true occlusal) Lower 45 degree occlusal (standard occlusal) Lower oblique occlusal (oblique occlusal)

Mandibular Occlusal Projections Lower 90 Degree Occlusal 片 子 橫 放 突 點 朝 下 Mouth floor Ref. 2

Mandibular Occlusal Projections Lower 45 Degree Occlusal 片 子 直 放 突 點 朝 下 Symphysis Ref. 2

Mandibular Occlusal Projections Lower Oblique Occlusal 片 子直 放 突 點 朝 下 盡量靠近所要照之牙弓 Ref. 2

Summaries Periapical film Extent of alveolar bone loss (牙周病) (Parallel method) Periapical film The whole length of teeth, (Bisection method) Periapical area Bitewing film Proximal area of teeth, Extent of alveolar bone loss (牙周病) Occlusal film A section of maxilla or mandible

Do you have any queries?