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Localization tech

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  • 1. Localization techniques Islam Kassem Level 6 ikassem@dr.com
  • 2. Principles of Image Formation• Ideal results: – Sharp image – Image of the true shape and size of the object being radiographed ikassem@dr.com
  • 3. Five Fundamental Principles of Shadow Casting• Smallest radiation source• Target-film-distance long as practical• Object-film-distance short as possible• Parallel film to long axis of teeth• Perpendicular alignment of beam to film & objects ikassem@dr.com
  • 4. Paralleling Technique• Technique of choice due to image accuracy• Implication of name• Developed 1920• Requires use of long target-film- distance – 16” PID or recessed tubehead ikassem@dr.com
  • 5. Principles of the Paralleling Technique • Film placed parallel to long axis of teeth • Beam directed perpendicular to film & long axis of teeth • Film holder used to keep film flat & unbent • Long PID or TFD to offset increased magnification due to great OFD ikassem@dr.com
  • 6. Principles of the Paralleling Technique ikassem@dr.com
  • 7. Steps of the Paralleling Technique• Film placement• Film position – Vertical dimension • Parallel to long axis • Two-point contact – Horizontal dimension• Beam alignment – Vertical – Horizontal• Film exposure ikassem@dr.com
  • 8. Steps of the Paralleling Technique• Film placement: position film to cover prescribed area (teeth to be examined) ikassem@dr.com
  • 9. Steps of the Paralleling Technique• Film position – Vertical dimension: position film parallel to long axes of teeth by placing far away from lingual surfaces of teeth ikassem@dr.com
  • 10. Steps of the Paralleling Technique• Film position – Vertical dimension: position film parallel to long axes of teeth by placing far away from lingual surfaces of teeth – Two-point contact: maintain contact of top edge of film with palate & bite portion of holder with maxillary occlusal surfaces ikassem@dr.com
  • 11. Steps of the Paralleling Technique Two- point contact Radiation beam Maxillary molar ikassem@dr.com
  • 12. Steps of the Paralleling Technique• Film position – Horizontal dimension: position horizontal plane of film parallel to facial surfaces of teeth being radiographed ikassem@dr.com
  • 13. Steps of the Paralleling Technique Horizontal position of film ikassem@dr.com
  • 14. Steps of the Paralleling Technique• Beam alignment – Vertical: direct radiation beam perpendicular to film & long axes of teeth – Horizontal: direct radiation beam through the contact areas of the teeth ikassem@dr.com
  • 15. Criteria of Diagnostic Acceptability• What’s a “good” film? – Area of interest clearly displayed – Apical regions visible with 2-3 mm of surrounding bone – Entire tooth/teeth length displayed – No cone-cutting in region of interest ikassem@dr.com
  • 16. Beam Alignment Devices• XCP – Plastic bite block or styrofoam – Metal arm supports plastic ring – Arm used to align horizontal & vertical beam alignment ikassem@dr.com
  • 17. Beam Alignment Devices– Ring further aligns beam & prevents cone cutting– Cotton rolls used for stabilization– Rectangular PID or lead collimators available ikassem@dr.com
  • 18. Positioning• Client Film packet ikassem@dr.com
  • 19. Client Positioning• Midsaggital plane perpendicular to floor• Maxillary occlusal plane parallel to floor for maxillary films• Mandibular occlusal plane parallel to floor for mandibular films ikassem@dr.com
  • 20. Film Packet Positioning• Film holder – Anterior: longest dimension of film placed vertically – Posterior: widest dimension of film placed horizontally – Dot in the slot – XCP: flex backing plate to open film slot ikassem@dr.com
  • 21. XCP Holders• Assembly• Positioning• Step-by-step procedures ikassem@dr.com
  • 22. XCP Assembly• Insert rod into openings in bite block• Insert indicator rod into aiming ring slot• Check for correct assembly ikassem@dr.com
  • 23. XCP Placement Into Oral Cavity• Center film & holder behind teeth to be radiographed• Maintain film parallel to long axis of teeth & buccal surfaces of teeth• Stabilized bite block against occlusal surfaces of teeth to be radiographed ikassem@dr.com
  • 24. Long Axes of the Teeth Maxillary Arch ikassem@dr.com
  • 25. Long Axes of the Teeth Mandibular Arch ikassem@dr.com
  • 26. Sequence of Films• Several possibilities• Need to remember which films have been exposed• #1-32• Cross arch• Anterior first ikassem@dr.com
  • 27. XCP Placement Into Oral Cavity ikassem@dr.com
  • 28. XCP Placement Into Oral Cavity• Insert cotton roll under bite block• Instruct client to close firmly• Slide aiming ring along indicator rod until close to client’s skin• Expose film! ikassem@dr.com
  • 29. Stabe Holder• Film Placement – Holder – Oral Cavity ikassem@dr.com
  • 30. Stabe Holder• Anatomical considerations – Long axes – Apices location• Beam alignment/angulation – Vertical – Horizontal – Point of entry – Centering exposure field ikassem@dr.com
  • 31. Stabe Holder• Design features – Radiolucent – Rigid back – Disposable – Bite stability – Long bite portion ikassem@dr.com
  • 32. Stabe Holder Film Placement• Dot in slot• Center film in holder – Anterior = vertical – Posterior = horizontal ikassem@dr.com
  • 33. Stabe Holder Film Placement• Position behind teeth of interest• Place film parallel to long axes of teeth• Stabilize holder against occlusal surfaces of teeth being radiographed (two- point contact) ikassem@dr.com
  • 34. Stabe Holder• Anatomical considerations – Long axes – Apices location ikassem@dr.com
  • 35. Location of Apices•Maxillary: A-T line•Mandibular: Oneinch above inferiorborder of mandible ikassem@dr.com
  • 36. Point of Entry• Central/lateral: side of nose• Canine: ala of nose• Premolar: pupil of eye• Molar: outer corner of eye ikassem@dr.com
  • 37. Stabe Holder• Beam alignment/angulation – Vertical – Horizontal – Point of entry – Centering exposure field ikassem@dr.com
  • 38. Vertical Beam Alignment• Two steps – Step 1: Parallel PID with bite portion of Stabe holder – Step 2: Position center of PID over point of entry ikassem@dr.com
  • 39. Horizontal Beam Alignment• Align face of PID parallel with film ikassem@dr.com
  • 40. Center Exposure Field• To avoid cone cut sight down one side and top or bottom of PID ikassem@dr.com
  • 41. Composition of Interproximal Radiographs • Composition – Adult: four posterior #2 films – Mixed dentition or deciduous: try for two #2, but four #1 are acceptable ikassem@dr.com
  • 42. Interproximal Survey Pedo•Two #1 films used ikassem@dr.com
  • 43. Interproximal Survey Mixed Dentition•Two #2 films used ikassem@dr.com
  • 44. Interproximal Survey Adult Dentition•Four #2 films used ikassem@dr.com
  • 45. Interproximal Survey Adult Dentition•Four or six #2 films used for verticalplacement ikassem@dr.com
  • 46. Interproximal Survey Adult Dentition•Two #3 long bitewing films used ikassem@dr.com
  • 47. Interproximal Radiographic Technique • Principles – Center film behind the teeth of interest – Place film close & parallel to teeth – Direct radiation beam perpendicular to teeth & film ikassem@dr.com
  • 48. Client Positioning for Interproximal Radiographs• Client positioned upright• Midsaggital plane perpendicular to floor ikassem@dr.com
  • 49. Film Holders for Interproximal Radiographs• Film placed in tab, loop or XCP holders ikassem@dr.com
  • 50. Film Placement for Interproximal Radiographs Using XCP• No specific location for dot• Center films behind teeth of interest ikassem@dr.com
  • 51. Film Placement for Interproximal Radiographs Using XCP• Center films behind teeth of interest in vertical and horizontal position ikassem@dr.com
  • 52. Premolar Film Placement Using XCP• Center films behind teeth of interest in horizontal position• Maintain film parallel Plane of to buccal surfaces of buccal premolars surfaces of premolars ikassem@dr.com
  • 53. Premolar Film Placement With XCP ikassem@dr.com
  • 54. Premolar Film Placement With XCP ikassem@dr.com
  • 55. Premolar Film Placement With XCP ikassem@dr.com
  • 56. Diagnostic Premolar Radiograph ikassem@dr.com
  • 57. Molar Film Placement Using XCP• Center films behind teeth of interest in horizontal position Plane of• Maintain film buccal surfaces of parallel to buccal premolars surfaces of molars ikassem@dr.com
  • 58. Molar Film Placement With XCP ikassem@dr.com
  • 59. Molar Film Placement With XCP ikassem@dr.com
  • 60. Molar Film Placement With XCP ikassem@dr.com
  • 61. Molar Film Placement With XCP ikassem@dr.com
  • 62. Vertical Bitewings• Indicated to examine alveolar bone levels in moderate to advanced periodontal disease• Four to six films exposed depending on the number of erupted molars ikassem@dr.com
  • 63. Nondiagnostic Interproximal Radiographs ikassem@dr.com
  • 64. Criteria for Diagnostic Acceptability• What makes a “good” interproximal radiograph? – Teeth of interest visible in the film – Crowns & proximal surfaces of teeth of interest are visible without overlap of contact areas – Alveolar crestal bone is visible surrounding teeth of interest ikassem@dr.com
  • 65. Criteria for Diagnostic Acceptability ikassem@dr.com
  • 66. Client Positioning for Interproximal Radiographs Using Loops/Tabs• Client positioned upright• Midsaggital plane perpendicular to floor• Occlusal plane parallel to floor ikassem@dr.com
  • 67. Film Placement for Interproximal Radiographs Using Loops/Tabs• Slide film into paper loop or place stick-on- tab across center of film ikassem@dr.com
  • 68. Film Placement for Interproximal Radiographs Using Loops/Tabs• No specific location for dot• Center films behind teeth of interest ikassem@dr.com
  • 69. Film Placement for Interproximal Radiographs Using Loops/Tabs• Fold tab upward against film• Hold film between thumb & index finger• Insert into oral cavity• Place lower half of film between tongue & teeth• Turn tab downward & hold against occlusal surfaces of the mandibular teeth ikassem@dr.com
  • 70. Film Placement for Interproximal Radiographs Using Loops/Tabs ikassem@dr.com
  • 71. Beam Alignment for Interproximal Radiographs Using Loops/Tabs• Vertical angulation: (Up/down plane) – May be positive or negative – Measured in degrees on outside of tubehead – Positive vertical angulation: PID above occlusal plane & beam directed toward floor – Negative vertical angulation: PID below occlusal plane & beam directed toward ceiling ikassem@dr.com
  • 72. Beam Alignment for Interproximal Radiographs Using Loops/Tabs Vertical Angulation ikassem@dr.com
  • 73. Beam Alignment for Interproximal Radiographs Using Loops/Tabs• Horizontal angulation: (Side-to-side plane) – Determines appearance of proximal teeth surfaces ikassem@dr.com
  • 74. Beam Alignment for Interproximal Radiographs Using Loops/Tabs–Direct radiationperpendicular tocurvature of arch andthrough contact areas ofteeth ikassem@dr.com
  • 75. Premolar Interproximal Using Loops/Tabs•Insert film packetinto oral cavitybetween tongueand premolars•Position film farenough forward toinclude distal halfof canines ikassem@dr.com
  • 76. Premolar Interproximal Using Loops/Tabs• Center films behind teeth of interest in vertical position ikassem@dr.com
  • 77. Premolar Interproximal Using Loops/Tabs• Center films behind teeth of interest in horizontal position• Maintain film parallel Plane of to buccal surfaces of buccal premolars surfaces of premolars ikassem@dr.com
  • 78. Vertical Beam Alignment for Premolar Interproximal Radiograph• Adjust vertical angulation to + 10 degrees ikassem@dr.com
  • 79. Vertical Beam Alignment for Premolar Interproximal Radiograph ikassem@dr.com
  • 80. Vertical Beam Alignment for Premolar Interproximal Radiograph•Direct PID atocclusal plane ikassem@dr.com
  • 81. Horizontal Beam Alignment for Premolar Interproximal Radiograph Align open end of PID with buccal surfaces of premolar teeth ikassem@dr.com
  • 82. Centering Exposure for Premolar Interproximal Radiograph •Make sure that PID covers max. & mand canines to avoid cone- cutting ikassem@dr.com
  • 83. Diagnostic Premolar Interproximal Radiograph ikassem@dr.com
  • 84. Molar Interproximal Using Loops/Tabs•Insert film packetinto oral cavitybetween tongue andmolars•Position film farenough back toinclude the distal ofthe most posteriorlyerupted molar ikassem@dr.com
  • 85. Molar Interproximal Using Loops/Tabs • Center films behind teeth of interest in vertical position ikassem@dr.com
  • 86. Molar Interproximal Using Loops/Tabs• Center films behind teeth of interest in horizontal position Plane of• Maintain film buccal surfaces of parallel to buccal premolars surfaces of molars ikassem@dr.com
  • 87. Vertical Beam Alignment for Molar Interproximal Radiograph• Adjust vertical angulation to + 10 degrees ikassem@dr.com
  • 88. Vertical Beam Alignment for Molar Interproximal Radiograph ikassem@dr.com
  • 89. Vertical Beam Alignment for Molar Interproximal Radiograph•Direct PID atocclusal plane ikassem@dr.com
  • 90. Horizontal Beam Alignment for Molar Interproximal Radiograph Align open end of PID with buccal surfaces of molar teeth ikassem@dr.com
  • 91. Horizontal Beam Alignment for Molar Interproximal Radiograph ikassem@dr.com
  • 92. Centering Exposure for Molar Interproximal Radiograph•Make sure thatPID covers max. &mand secondpremolars to avoidcone-cutting ikassem@dr.com
  • 93. Diagnostic MolarInterproximal Radiograph ikassem@dr.com
  • 94. Vertical Bitewings with Loops/Tabs• Indicated to examine alveolar bone levels in moderate to advanced periodontal disease• Four to six films exposed depending on the number of erupted molars ikassem@dr.com
  • 95. Vertical Bitewings with Loops/TabsVertical beamalignment = plus 15degreesHorizontal beamalignment = thesame as forhorizontalinterproximals ikassem@dr.com
  • 96. Nondiagnostic Interproximal Radiographs • Incorrect (negative) vertical angulation ikassem@dr.com
  • 97. Nondiagnostic Interproximal Radiographs ikassem@dr.com
  • 98. Criteria for Diagnostic Acceptability• What makes a “good” interproximal radiograph? – Teeth of interest visible in the film – Crowns & proximal surfaces of teeth of interest are visible without overlap of contact areas – Alveolar crestal bone is visible surrounding teeth of interest ikassem@dr.com
  • 99. Criteria for Diagnostic Acceptability ikassem@dr.com
  • 100. Thank you• You can get the lecture on• http://www.slideshare.net/islamkassem ikassem@dr.com

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