Localization tech

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Localization tech

  1. 1. Localization techniques Islam Kassem Level 6 ikassem@dr.com
  2. 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. 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. 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. 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. 6. Principles of the Paralleling Technique ikassem@dr.com
  7. 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. 8. Steps of the Paralleling Technique• Film placement: position film to cover prescribed area (teeth to be examined) ikassem@dr.com
  9. 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. 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. 11. Steps of the Paralleling Technique Two- point contact Radiation beam Maxillary molar ikassem@dr.com
  12. 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. 13. Steps of the Paralleling Technique Horizontal position of film ikassem@dr.com
  14. 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. 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. 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. 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. 18. Positioning• Client Film packet ikassem@dr.com
  19. 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. 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. 21. XCP Holders• Assembly• Positioning• Step-by-step procedures ikassem@dr.com
  22. 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. 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. 24. Long Axes of the Teeth Maxillary Arch ikassem@dr.com
  25. 25. Long Axes of the Teeth Mandibular Arch ikassem@dr.com
  26. 26. Sequence of Films• Several possibilities• Need to remember which films have been exposed• #1-32• Cross arch• Anterior first ikassem@dr.com
  27. 27. XCP Placement Into Oral Cavity ikassem@dr.com
  28. 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. 29. Stabe Holder• Film Placement – Holder – Oral Cavity ikassem@dr.com
  30. 30. Stabe Holder• Anatomical considerations – Long axes – Apices location• Beam alignment/angulation – Vertical – Horizontal – Point of entry – Centering exposure field ikassem@dr.com
  31. 31. Stabe Holder• Design features – Radiolucent – Rigid back – Disposable – Bite stability – Long bite portion ikassem@dr.com
  32. 32. Stabe Holder Film Placement• Dot in slot• Center film in holder – Anterior = vertical – Posterior = horizontal ikassem@dr.com
  33. 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. 34. Stabe Holder• Anatomical considerations – Long axes – Apices location ikassem@dr.com
  35. 35. Location of Apices•Maxillary: A-T line•Mandibular: Oneinch above inferiorborder of mandible ikassem@dr.com
  36. 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. 37. Stabe Holder• Beam alignment/angulation – Vertical – Horizontal – Point of entry – Centering exposure field ikassem@dr.com
  38. 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. 39. Horizontal Beam Alignment• Align face of PID parallel with film ikassem@dr.com
  40. 40. Center Exposure Field• To avoid cone cut sight down one side and top or bottom of PID ikassem@dr.com
  41. 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. 42. Interproximal Survey Pedo•Two #1 films used ikassem@dr.com
  43. 43. Interproximal Survey Mixed Dentition•Two #2 films used ikassem@dr.com
  44. 44. Interproximal Survey Adult Dentition•Four #2 films used ikassem@dr.com
  45. 45. Interproximal Survey Adult Dentition•Four or six #2 films used for verticalplacement ikassem@dr.com
  46. 46. Interproximal Survey Adult Dentition•Two #3 long bitewing films used ikassem@dr.com
  47. 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. 48. Client Positioning for Interproximal Radiographs• Client positioned upright• Midsaggital plane perpendicular to floor ikassem@dr.com
  49. 49. Film Holders for Interproximal Radiographs• Film placed in tab, loop or XCP holders ikassem@dr.com
  50. 50. Film Placement for Interproximal Radiographs Using XCP• No specific location for dot• Center films behind teeth of interest ikassem@dr.com
  51. 51. Film Placement for Interproximal Radiographs Using XCP• Center films behind teeth of interest in vertical and horizontal position ikassem@dr.com
  52. 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. 53. Premolar Film Placement With XCP ikassem@dr.com
  54. 54. Premolar Film Placement With XCP ikassem@dr.com
  55. 55. Premolar Film Placement With XCP ikassem@dr.com
  56. 56. Diagnostic Premolar Radiograph ikassem@dr.com
  57. 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. 58. Molar Film Placement With XCP ikassem@dr.com
  59. 59. Molar Film Placement With XCP ikassem@dr.com
  60. 60. Molar Film Placement With XCP ikassem@dr.com
  61. 61. Molar Film Placement With XCP ikassem@dr.com
  62. 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. 63. Nondiagnostic Interproximal Radiographs ikassem@dr.com
  64. 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. 65. Criteria for Diagnostic Acceptability ikassem@dr.com
  66. 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. 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. 68. Film Placement for Interproximal Radiographs Using Loops/Tabs• No specific location for dot• Center films behind teeth of interest ikassem@dr.com
  69. 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. 70. Film Placement for Interproximal Radiographs Using Loops/Tabs ikassem@dr.com
  71. 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. 72. Beam Alignment for Interproximal Radiographs Using Loops/Tabs Vertical Angulation ikassem@dr.com
  73. 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. 74. Beam Alignment for Interproximal Radiographs Using Loops/Tabs–Direct radiationperpendicular tocurvature of arch andthrough contact areas ofteeth ikassem@dr.com
  75. 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. 76. Premolar Interproximal Using Loops/Tabs• Center films behind teeth of interest in vertical position ikassem@dr.com
  77. 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. 78. Vertical Beam Alignment for Premolar Interproximal Radiograph• Adjust vertical angulation to + 10 degrees ikassem@dr.com
  79. 79. Vertical Beam Alignment for Premolar Interproximal Radiograph ikassem@dr.com
  80. 80. Vertical Beam Alignment for Premolar Interproximal Radiograph•Direct PID atocclusal plane ikassem@dr.com
  81. 81. Horizontal Beam Alignment for Premolar Interproximal Radiograph Align open end of PID with buccal surfaces of premolar teeth ikassem@dr.com
  82. 82. Centering Exposure for Premolar Interproximal Radiograph •Make sure that PID covers max. & mand canines to avoid cone- cutting ikassem@dr.com
  83. 83. Diagnostic Premolar Interproximal Radiograph ikassem@dr.com
  84. 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. 85. Molar Interproximal Using Loops/Tabs • Center films behind teeth of interest in vertical position ikassem@dr.com
  86. 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. 87. Vertical Beam Alignment for Molar Interproximal Radiograph• Adjust vertical angulation to + 10 degrees ikassem@dr.com
  88. 88. Vertical Beam Alignment for Molar Interproximal Radiograph ikassem@dr.com
  89. 89. Vertical Beam Alignment for Molar Interproximal Radiograph•Direct PID atocclusal plane ikassem@dr.com
  90. 90. Horizontal Beam Alignment for Molar Interproximal Radiograph Align open end of PID with buccal surfaces of molar teeth ikassem@dr.com
  91. 91. Horizontal Beam Alignment for Molar Interproximal Radiograph ikassem@dr.com
  92. 92. Centering Exposure for Molar Interproximal Radiograph•Make sure thatPID covers max. &mand secondpremolars to avoidcone-cutting ikassem@dr.com
  93. 93. Diagnostic MolarInterproximal Radiograph ikassem@dr.com
  94. 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. 95. Vertical Bitewings with Loops/TabsVertical beamalignment = plus 15degreesHorizontal beamalignment = thesame as forhorizontalinterproximals ikassem@dr.com
  96. 96. Nondiagnostic Interproximal Radiographs • Incorrect (negative) vertical angulation ikassem@dr.com
  97. 97. Nondiagnostic Interproximal Radiographs ikassem@dr.com
  98. 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. 99. Criteria for Diagnostic Acceptability ikassem@dr.com
  100. 100. Thank you• You can get the lecture on• http://www.slideshare.net/islamkassem ikassem@dr.com

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