Occlusal techniques

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Occlusal techniques

  1. 1. Occlusal techniquesMandibular techniques Islam Kassem ikassem@dr.com
  2. 2. OutlinesDefinitionPatient managementClassifications : Mand MaxClinical indications & techniques ikassem@dr.com
  3. 3. Dental radiographI – Extra oralII- Intraoral : Periapical Bite wing Occlusal ikassem@dr.com
  4. 4. Occlusal radiography is defined as those intraoral radiographic techniques taken using a dental X-ray set where the film packet (5.7 x 7.6 cm) or a small intraoral cassette is placed in the occlusal plane. ikassem@dr.com
  5. 5. Maxillary occlusal projections• Upper standard occlusal (standard occlusal)• Upper oblique occlusal (oblique occlusal)• Vertex occlusal (vertex occlusal).Mandibular occlusal projections• Lower 90° occlusal (true occlusal)• Lower 45 ° occlusal (standard occlusal)• Lower oblique occlusal (oblique occlusal). ikassem@dr.com
  6. 6. Lower 90° occlusalThis projection shows a plan view of the tooth bearingportion of the mandible and the floor of the mouth. A minor variation of the technique is also used to show unilateral lesions. ikassem@dr.com
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  9. 9. Main clinical indicationsDetection of the presence and position of radiopaque calculi in the submandibular salivary ducts• Assessment of the bucco-lingual position of unerupted mandibular teeth• Evaluation of the bucco-lingual expansion of the body of the mandible by cysts, tumours or osteodystrophies• Assessment of displacement fractures of the anterior body of the mandible in the horizontal plane. ikassem@dr.com
  10. 10. Technique and positioning1. The film packet, with the white (pebbly) surface facing downwards, is placed centrally into the mouth, on to the occlusal surfaces of the lower teeth, with its long axis crossways. The patient is asked to bite together gently.2. The patient then leans forwards and then tips the head backwards as far as is comfortable, where it is supported.3. The X-ray tubehead, with circular collimator fitted, is placed below the patients chin, in the midline, centring on an imaginary line joining the first molars, at an angle of 90° to the film . ikassem@dr.com
  11. 11. Variation of technique. To show a particularpart of the mandible, the film packet is placed inthe mouth with its long axis anteroposteriorly overthe area of interest. The X-ray tubehead, stillaimed at 90° to the film, is centred below the bodyof the mandible in that area.Note: The lower 90° occlusal is mounted as if theexaminer were looking into the patients mouth.The radiograph is therefore mounted with theembossed dot pointing away from the examiner. ikassem@dr.com
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  13. 13. Mandibular OcclusalPathology Sialoliths Pedo anterior
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  16. 16. Maxillary occlusal projections• Upper standard occlusal (standard occlusal)• Upper oblique occlusal (oblique occlusal)• Vertex occlusal (vertex occlusal).Mandibular occlusal projections• Lower 90° occlusal (true occlusal)• Lower 45 ° occlusal (standard occlusal)• Lower oblique occlusal (oblique occlusal). ikassem@dr.com
  17. 17. Lower 45° occlusalThis projection is taken to show the lower anterior teeth and the anterior part of the mandible. The resultant radiograph resembles a large bisected angle technique periapical of this region. ikassem@dr.com
  18. 18. Main clinical indications• Periapical assessment of the lower incisorteeth, especially useful in adults and children unable to tolerate periapical films• Evaluation of the size and extent of lesionssuch as cysts or tumours affecting the anteriorpart of the mandible• Assessment of displacement fractures of theanterior mandible in the vertical plane. ikassem@dr.com
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  20. 20. Technique and positioning1. The patient is seated with the head supportedand with the occlusal plane horizontal and parallel to the floor.2. The film packet, with the white (pebbly)surface facing downwards, is placed centrally into the mouth, on to the occlusal surfaces of the lower teeth, with its long axis anteroposteriorly, and thepatient is asked to bite gently together.3. The X-ray tubehead is positioned in the midline, centring through the chin point, at an angle of 45° to the film ikassem@dr.com
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  23. 23. Maxillary occlusal projections• Upper standard occlusal (standard occlusal)• Upper oblique occlusal (oblique occlusal)• Vertex occlusal (vertex occlusal).Mandibular occlusal projections• Lower 90° occlusal (true occlusal)• Lower 45 ° occlusal (standard occlusal)• Lower oblique occlusal (oblique occlusal). ikassem@dr.com
  24. 24. Lower oblique occlusal• This projection is designed to allow the image of the submandibular salivary gland, on the side of interest, to be projected on to the film. However,because the X-ray beam is oblique, all the anatomical tissues shown are distorted. ikassem@dr.com
  25. 25. Main clinical indications• Detection of radiopaque calculi in a submandibular salivary gland• Assessment of the bucco-lingual position ofunerupted lower wisdom teeth• Evaluation of the extent and expansion ofcysts, tumours or osteodystrophies in theposterior part of the body and angle of themandible. ikassem@dr.com
  26. 26. Technique and positioning1. The film packet, with the white (pebbly) surface facing downwards, is inserted into the mouth, on to the occlusal surfaces of the lowerteeth, over to the side under investigation, with itslong axis anteroposteriorly. The patient is asked to bite together gently.2. The patients head is supported, then rotated away from the side under investigation and the chin is raised. This rotated positioning allows the subsequent positioning of the X-ray tube head.3. The X-ray tubehead with circular collimator is aimed upwards and forwards towards the film, from below and behind the angle of the mandible and parallel to the lingual surface of the mandible ikassem@dr.com
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  29. 29. Thank you

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