1. Supplemental Radiographic Technique Chapter 28

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson O BJECTIVES Define the key words. Demonstrate the ability to adapt standard techniques when necessary. Demonstrate appropriate adaptations in image receptor placement to avoid overlap. Explain the need to alter vertical angulation in the presence of a shallow palatal vault.

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson O BJECTIVES Demonstrate knowledge of setting the exposure time based on patient characteristics. Demonstrate the ability to place the intraoral image receptor in the presence of large maxillary or mandibular tori. Discuss the procedures for image receptor placement in patients with edentulous areas.

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson O BJECTIVES Discuss the procedures for image receptor placement during endodontic procedures. List three methods of localization. Use the buccal-object rule to identify the location of a foreign object. Describe the difference between a standard molar periapical radiograph and a disto-oblique periapical radiograph.

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson O BJECTIVES List four reasons to duplicate radiographs. Demonstrate the step-by-step procedures for duplicating radiographs.

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson I NTRODUCTION Each patient presents with unique characteristics, some of which may require that the dental radiographer have the knowledge and skills to adapt procedures to best suit the circumstances. What sets the skilled radiographer apart from the average is the ability to alter techniques and yet still produce diagnostic images.

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson A CCEPTABLE V ARIATIONS IN T ECHNIQUE Avoiding overlap Malaligned or crowded teeth Altering vertical angulation Exposure factors

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-1 I NDICATOR RING NOT A DICTATOR. T HE RADIOGRAPHER HAS CHOSEN TO INCREASE THE VERTICAL ANGULATION TO INCREASE THE PERIAPICAL COVERAGE ON THE RESULTANT IMAGE.

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-2 I MAGE RECEPTOR POSITION TO AVOID MOLAR OVERLAP. T HE ANTERIOR PORTION OF THE IMAGE RECEPTOR IS PLACED A GREATER DISTANCE AWAY FROM THE LINGUAL SURFACES OF THE TEETH.

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-3 M INIMIZE CANINE AND PREMOLAR OVERLAP. (A) T HE CURVE OF THE ARCHES IN THIS REGION SUPERIMPOSES THE LINGUAL CUSP OF THE PREMOLAR ONTO THE DISTAL EDGE OF THE CANINE. (B) S HIFTING THE HORIZONTAL ANGULATION SLIGHTLY TO DIRECT THE X - RAY BEAM TO INTERSECT THE IMAGE RECEPTOR FROM THE DISTAL WILL HELP AVOID OVERLAP OF THESE TWO TEETH. (C) N OTE THE ELIMINATION OF OVERLAP ERROR IN THE RADIOGRAPH ON THE RIGHT.

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-4 D IFFERENT HORIZONTAL ANGLUATION IS REQUIRED WHEN TEETH ARE MALALIGNED.

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-5 S HALLOW PALATE. T HE TISSUE EDGE OF THE IMAGE RECEPTOR IS SHOWN TIPPED AWAY FROM THE TEETH. W HEN THE LACK OF PARALLELISM IS LESS THAN 15 DEGREES, THE RESULTANT RADIOGRAPH WILL GENERALLY BE ACCEPTABLE.

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-6 I NCREASED VERTICAL ANGULATION RECORDED MORE OF ATHE APICAL REGION IMAGING THIS SUPERNUMERARY ( EXTRA ) IMPACTED PREMOLAR, WHILE CUTTING OFF A PORTION OF THE OCCLUSAL REGION OF THE TEETH.

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-7 M AXILLARY TORUS. I MAGE RECEPTOR PLACED ON THE FAR SIDE OF THE TORUS AWAY FROM THE TEETH.

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-8 M ANDIBULAR TORUS. I MAGE RECEPTOR PLACED BETWEEN THE TORUS AND THE TONGUE.

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-9 P ARTIALLY EDENTULOUS MOUTH. C OTTON ROLLS OR POLYSTYRENE BLOCKS CAN BE USED TO SUBSTITUTE FOR MISSING TEETH TO HELP HOLD THE IMAGE RECEPTOR HOLDER IN PLACE. (A) E DENTULOUS MANDIBULAR ANTERIOR REGION. (B) E DENTULOUS MAXILLARY POSTERIOR REGION.

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-10 T OTALLY EDENTULOUS MOUTH. W HEN ALL TEETH ARE MISSING, COTTON ROLLS, POLYSTYRENE BLOCKS, OR A COMBINATION OF BOTH CAN BE USED AS SUBSTITUTES FOR THE CROWNS OF THE TEETH. T HESE WILL ALLOW THE PATIENT TO BITE AND STABILIZE THE IMAGE RECEPTOR HOLDER. T HE THICKNESS OF THE COTTON ROLLS OR BLOCKS WILL DETERMINE THE AMOUNT OF EDENTULOUS RIDGE RECORDED. (A) M AXILLARY ANTERIOR REGION. (B) M ANDIBULAR POSTERIOR REGION.

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-11 I LLUSTRATION OF THE BISECTING TECHNIQUE FOR AN EDENTULOUS PATIENT. T HE CENTRAL RAY IS DIRECTED PERPENDICULAR TO THE BISECTOR, AN IMAGINARY LINE ESTIMATED TO BE HALFWAY BETWEEN THE PLANE OF THE IMAGE RECEPTOR AND A LINE DRAWN VERTICALLY THROUGH THE RIDGE TO SUBSTITUTE FOR THE LONG AXES OF THE TEETH. (A) M AXILLARY EDENTULOUS RIDGE, (B) M ANDIBULAR EDENTULOUS RIDGE.

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-12 E NDODONTIC FILM HOLDER. (C OURTESY OF D ENTSPLY R INN.)

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-13 M ODIFYING A FILM HOLDER FOR USE IN ENDODONTIC THERAPY. R EMOVING A PORTION OF THIS DISPOSABLE POLYSTYRENE IMAGE RECEPTOR HOLDER WILL ALLOW THE ENDODONTIC MATERIALS PLACED IN THE TOOTH TO REMAIN IN PLACE DURING THE EXPOSURE.

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-14 R INN S NAP -A-R AY IMAGE RECEPTOR HOLDER.

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-15 H EMOSTAT AS A FILM HOLDER FOR ENDODONTIC PROCEDURES ELIMINATES THE NEED TO OCCLUDE ON ON A BITEBLOCK.

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-16 H EMOSTAT FACILITATES HOLDING THE IMAGE RECEPTOR IN A PARALLEL POSITION TO THE LONG AXIS OF THE TOOTH.

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson M ETHODS OF L OCALIZATION Definitive evaluation method Right-angle method Tube shift method (buccal-object rule)

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-17 D EFINITIVE METHOD OF LOCALIZATION. N OTE THE BARELY VISIBLE SUPERNUMERARY ( EXTRA ) ROOT ON THIS FIRST MOLAR. A PPLYING THE DEFINITIVE METHOD OF LOCALIZATION, IT IS MOST LIKELY A BUCCAL ROOT. T HE BUCCAL POSITION WOULD PLACE THIS ROOT A GREATER DISTANCE AWAY FROM THE IMAGE RECEPTOR, RESULTING IN ITS MAGNIFIED AND LESS DISTINCTLY DEFINED APPEARANCE.

26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-18 R IGHT ANGLE METHOD OF LOCALIZATION. (A) A FOREIGN OBJECT APPEARS IN THE PERIODONTAL POCKET BETWEEN THE SECOND PREMOLAR AND THE FIRST MOLAR. I T IS IMPOSSIBLE TO TELL FROM THIS PERIAPICAL RADIOGRAPH WHETHER THE OBJECT IS LOCATED TOWARD THE BUCCAL OR THE LINGUAL. (B) T HE OCCLUSAL RADIOGRAPH, PLACED AT A RIGHT ANGLE POSITION TO THE TOOTH, CLEARLY IMAGES THE OBJECT ON THE BUCCAL SIDE OF THE POCKET.

27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-19 H ORIZONTAL TUBE SHIFT. (A) I N THE ORIGINAL RADIOGRAPH, BUCCAL AND LINGUAL OBJECTS ARE SUPERIMPOSED. (B) W HEN THE TUBE HEAD IS MOVED DISTALLY, THE BUCCAL OBJECT APPEARS TO MOVE MESIALLY, WHEREAS THE LINGUAL OBJECT APPEARS TO MOVE DISTALLY. (C) W HEN THE TUBE HEAD IS MOVED MESIALLY, THE BUCCAL OBJECT APPEARS TO MOVE DISTALLY, WHEREAS THE LINGUAL OBJECT APPEARS TO MOVE MESIALLY.

28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-20 V ERTICAL TUBE SHIFT. (A) I N THE ORIGINAL RADIOGRAPH, BUCCAL AND LINGUAL OBJECTS ARE SUPERIMPOSED. (B) W HEN THE TUBE HEAD IS MOVED SUPERIORLY, THE BUCCAL OBJECT APPEARS TO MOVE INFERIORALLY, WHEREAS THE LINGUAL OBJECT APPEARS TO MOVE SUPERIORLY. (C) W HEN THE TUBE HEAD IS MOVED INFERIORLY, THE BUCCAL OBJECT APPEARS TO MOVE SUPERIORLY, WHEREAS THE LINGUAL OBJECT APPEARS TO HAVE MOVED INFERIORALLY.

29. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson M ETHODS OF L OCALIZATION SLOB “Same on Lingual—Opposite on Buccal”

30. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson PROCEDURE 28-1 D ISTO - OBLIQUE PERIAPICAL RADIOGRAPHS

31. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-21 D ISTO - OBLIQUE PERIAPICAL TECHNIQUE. T HE HORIZONTAL ANGULATION IS SHIFTED 10 DEGREES FROM THE DISTAL, AND THE VERTICAL ANGULATION IS INCREASED 5 DEGREES.

32. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-22 C OMPARISION OF STANDARD AND DISTO - OBLIQUE PERIAPICAL RADIOGRAPHS. (A) S TANDARD PERIAPICAL RADIOGRAPH IMAGES A PORTION OF THE IMPACTED THIRD MOLAR. (B) D ISTO - OBLIQUE PERIAPICAL RADIOGRAPH IMAGES MORE OF THE IMPACTED THIRD MOLAR. N OTE THAT SHIFTING THE TUBE HORIZONTALLY CAUSES OVERLAP ERROR, AND SHIFTING THE TUBE HEAD VERTICALLY CAUSES THE CROWNS TO BE CUT OFF THE THE IMAGE.

33. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F ILM D UPLICATING P ROCEDURE Duplicating film Film duplicator Procedures for film duplication

34. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-23 R ADIOGRAPH DUPLICATING MACHINES. C ONTAIN A BUILT - IN ULTRAVIOLET FLUORESCENT LIGHT SOURCE AND A TIMER TO PERMIT VARIATIONS IN DENSITY. T HESE X - RAY FILM DUPLICATORS ACCOMMODATE DUPLICATION OF MULTIPLE FILMS AT A TIME, WITH ROOM FOR A FULL MOUTH SERIES, OR A PANORAMIC RADIOGRAPH. (C OURTESY OF D ENSPLY R INN.)

35. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson F IGURE 28-24 S MALL RADIOGRAPH DUPLICATOR ACCOMMODATES FILM SIZES #0, #1, AND #2.

36. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson PROCEDURE 28-2 F ILM DUPLICATION

37. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson P ROCEDURE 28-2 ( CONTINUED ) F ILM DUPLICATION

38. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson R EVIEW : C HAPTER S UMMARY Anatomical conditions may require alterations in the radiographic technique. A skilled radiographer can apply acceptable variations in aligning the horizontal and vertical angulations and still produce diagnostic quality radiographs.

39. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson R ECALL : S TUDY Q UESTIONS General Chapter Review

40. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson R EFLECT : C ASE S TUDY A patient has presented at your practice today for a consult regarding extensive dental work. This patient has several areas of missing teeth and has expressed an interest in dentures. The dentist has prescribed a full mouth series of radiographs and you are preparing to take the exposures.

41. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson R EFLECT : C ASE S TUDY After performing a cursory exam of the patient’s oral cavity you note the following: Several missing and/or broken down teeth. Malaligned and crowded teeth. Partially erupted third molars. Large torus palatinus and torus mandibularis. A shallow palatal vault.

42. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson R EFLECT : C ASE S TUDY  Consider the following and write out your answers: 1. Describe the alterations in technique you will apply to obtain radiographs in the edentulous areas. 2. Describe the alterations in technique you will apply to avoid overlap error in the areas of malaligned and crowded teeth.

43. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson R EFLECT : C ASE S TUDY 3. Identify and describe the technique you will use to best image the partially erupted third molars. 4. Describe the problems you anticipate facing with the presence of large tori and a shallow palatal vault. 5. Identify alterations in techniques that will help you overcome these obstacles.

44. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson R EFLECT : C ASE S TUDY 6. If broken root tips or other foreign objects are identified on the radiographs, describe how the interpretation of these can reveal whether or not the objects in question are located on the buccal or the lingual. 7. Describe other methods of localization that can aid in making this determination. 8. Identify reasons why this patient’s radiographs may need to be duplicated.

45. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson R ELATE : L ABORATORY A PPLICATION Proceed to Chapter 28, Laboratory Application, to complete this activity.