1. Radiology in pedodontic
practice
GUIDED BY :
Presented by:
Dr. Neeraj solanki
Saadia meraj khan
Dr.Megha
Roll no. 8749074
Dr. Piyush
2. ACKNOWLEDGEMENT
I am extremely thankful to all the staff members of the
Department of Pedodontics throughout our clinical
posting.The immense knowledge and experience of
Dr.Neeraj Solanki and his continuous help,support and
encouragement has been extremely useful to us.
We would like to thank Dr. Piyush and Dr.Megha for
their skillful and gentle support in the presentation of
content.Without their active participation and help this
project would have been impossible to complete.
3. INTRODUCTION
• Plays a vital role in the diagnosis and treatment
planning of both children and adults.
• Plays a significant role in the assessment of growth
and development.
• At the simplest level, help in the detection of dental
caries and at the most complex level, in the diagnosis
of cysts, tumors or any other major craniofacial
disorders.
4. Points to be considered before
planning for radiographs
• Avoiding retakes by
• Obtaining the previous radiographic history
• Following the appropriate guidelines for the
correct size, number and type of film used
• All area to be radiographed should be
included within the film borders, avoiding
cone cut, overlapping, elongation, shortening
and correctly processing the film.
5. Contd.
• Radiographs should be an adjunct for clinical
examination and should not replace full
mouth clinical examination.
• Determination of appropriate number and size
of films required to take radiographs of the
particular region and unnecessarily not the
whole mouth.
• Placement of lead apron and thyroid collar on
the patient and parent.
6. Dental X – Ray machine
Dental X-ray machine: A: Positioning
Device; B: Tube head; C: Control panel
or the timer
7. Component of IOPA film packet
Components of IOPA film packet: A. Outer plastic
wrapper; B. Black paper; C. Film; D. Lead foil
8. Guidelines for prescribing radiographs
• Evaluation of the Development of Dentition
• Stages of development, eruption and
exfoliation of teeth
• Amount of root formation
• Physiologic root resorption
• Amount of bone over the erupting tooth
• Degree of pulp maturity.
9. Contd.
• Pathologic Evaluation
• Caries detection
• Evaluation of traumatic injuries
• Degree of pulp involvement such as proximity of
caries to pulp horn, internal resorption or calcific
degeneration
• Evaluation of periodontal health by observing
thickness of periodontal ligament, furcation
involvement, bone loss, external resorption etc.
10. Contd.
• Detection of Developmental Anomalies
• Widely divergent roots
• Sharply curved pulp canals
• Alterations in the number and length of roots
• Ectopically positioned teeth
• Ankylosis
• Supernumerary teeth
• Congenitally missing teeth
• Malformed teeth such as microdontia, macrodontia, dens
in dente, taurodontism, gemination, fusion, root
dilacerations etc.
11. Contd.
• Post-treatment Evaluation
• Accuracy of treatment
• Type and success of pulp treatment
• Post surgical healing
• Treatment failure
12. Radiographic examinations
Four film series: This series consists of a
maxillary and mandibular occlusal radiographs
and two posterior bitewing radiographs.
13. Radiographic examinations
Eight film survey:
• This survey includes a maxillary and
mandibular anterior occlusal radiographs.
• Four molar periapical radiographs.
• Two posterior bitewings
14. Radiographic examinations
Twelve film survey:
• This survey include maxillary and mandibular
permanent incisor periapical radiographs.
• Four primary canine periapical radiographs.
• Four molar periapical radiographs.
• Two posterior bitewing radiographs
16. Radiographic examinations
Sixteen film survey: This examination consists of
the twelve-film survey and the addition of
four permanent molar radiographs.
17. Suggested radiographic protocol for the
child patient with no previous radiographs
Age Consideration Radiograph
3-5 No apparent abnormalities (open contacts) None
No apparent abnormalities (closed contacts)
2 posterior bite wings, size 0
Extensive caries film
Deep caries 4-film survey
Selected periapical
radiographs in addition to
4-film survey
18. Contd.
Age Consideration Radiograph
6-7 No apparent abnormalities 8-film survey (available by 7
years of age)
Extensive or deep caries Selected periapical
radiographs in addition to
8-film survey
19. Contd.
Age Consideration Radiograph
8-9 No apparent abnormalities or extensive or deep 12-film survey
caries
10-12 No apparent abnormalities or extensive or deep 12 or 16 film survey
caries depending upon size
20. Intraoral film size
• Size 0 - Used for bite wing and IOPA of small
children
• Size 1 - Used for anterior teeth in adults
• Size 2 - Standard film, used for anterior
occlusal, IOPA and bite wing in mixed and
permanent dentition
• Occlusal films - 57 x 76mm used for maxillary
or mandibular occlusal radiographs
21. Radiographic techniques commonly
used in children
Intraoral
• lOPA
• Bite wing
• Occlusal
• Panoramic
Extraoral
• TMJ and lateral oblique view (film size is 1.5 x 7inches)
• Lateral cephalograms, PNS view (film size is 8 x 10 inches)
• Orthopantomography (film size is 6 x 12 inches)
22. Intraoral Periapical (IOPA) Radiographs
Indications:
• To evaluate the development of the root end and to
study the periapical tissue
• To detect alterations in the integrity of the periodontal
membrane
• To evaluate the prognosis of the pulp treatment by
observing the health of the periapical tissues
• To identify the stage of development of unerupted
teeth
• To detect developmental abnormalities like
supernumerary, missing or malformed teeth
23. Contd.
Indications:
• For early detection of pathologic changes
associated with teeth
• For space analysis in the mixed dentition
• To assess the path of eruption of permanent
teeth
• To evaluate the extent of traumatic injuries to the
root and alveolus
24. Techniques for taking IOPA
• The paralleling technique
• The bisecting angle technique
25. The paralleling technique
• The film is positioned in the mouth using
extension cone parallel (XCP) instruments or
precision film holders such that the film is held
parallel to the long axis of the tooth to be
radiographed.
• The X-ray tube head is aimed at right angles to
the tooth and the film.
26. The paralleling technique
Advantage:
• Little magnification
• Periodontal bone level are well represented
• Radiographs are accurately reproducible by
different operators
29. Bisecting angle technique
• The film is placed close to the tooth to be
radiographed using snap a ray film holder or
hemostat
• The X-ray tube is adjusted such that the central
ray of the X-ray bisects the angle formed between
the long axis of the film and the tooth.
30.
31. Bisecting angle technique
Advantage:
• Film positioning is easy and comfortable for
the patient
• If positioned based on correct angulations, the
image size does not alter
32. Bisecting angle technique
Disadvantage:
• Variables are many in this technique making it
difficult to reproduce accurately every time.
• Incorrect vertical angulation results in elongation
of the image and incorrect horizontal angulation
results in overlapping of the images of the crown
and root or cone cut .
• Periodontal bone level are not clear.
• Detection of proximal caries is difficult.
33. Bite Wing Radiographs
Indications :
• Early detection of incipient interproximal caries
• To understand the configuration of the pulp
chamber
• Record the width of spaces created by premature
loss of deciduous teeth
• Determine the presence or absence of premolar
teeth
• To determine the relation of a tooth to the
occlusal plane for possibility of tooth Ankylosis
35. Bite Wing Radiographs
Technique:
• The head is positioned such that the midsagittal plane is
perpendicular and the ala-tragus line is parallel to the
floor.
• The lower edge of the film is placed in the floor of the
mouth between the tongue and the lingual aspect of the
mandible and the bite tab is placed on the occlusal
surfaces of the mandibular teeth.
• The film is positioned to cover all the region of concern.
• The central ray enters at the occlusal plane at a point
below the pupil, vertical angle being +8 degrees.
36. Occlusal Radiograph
Indications:
• Determine the presence, shape and position of midline
supernumerary teeth
• Determine impaction of canines
• Determine the presence or absence of incisors
• Assess the extent of trauma to teeth and anterior
segments of the arches
• In case of trismus and trauma, where the patient
cannot open the mouth completely
• Determine the medial and lateral extent of cysts and
tumors.
37. Anterior maxillary occlusal technique
• In the anterior maxillary occlusal technique, the
patient's occlusal plane should be parallel to the floor
and the sagittal plane should be perpendicular to the
floor
• A No.2 periapical film is placed in the patient's mouth
so that the long axis of the film runs from left to right
rather than anteroposteriorly and the midsagittal plane
bisects the film.
• The patient is instructed to bite lightly to hold the
film.The anterior edge of the film should extend
approximately 2 mm in front of the incisal edge of the
central incisors.
38. Contd.
• The central ray is directed to the apices of the
central incisors and a half inch above the tip of
the nose and through the midline. The vertical
angle is + 60 degrees.
• The film is exposed at the usual setting for
maxillary incisor periapical films.
40. Posterior maxillary occlusal technique
• In the poste-rior maxillary occlusal
technique, the patient's occlusal plane should be
parallel to the floor, and the sagittal plane should
be perpendicular to the floor
• A No.2 periapical film is placed in the patient's
mouth so that the long axis of the film is parallel
to the floor.
• The anterior edge of the film should extend just
mesial to the canine. The outer buccal edge of
the film should extend ap-proximately 2 mm
beyond the primary molar crowns.
41. Contd.
• The patient is instructed to bite lightly to hold
the film. The central ray is directed toward the
apices of the primary molars as well as
inter-proximally.
• The vertical angle is + 50 degrees. The film is
exposed at the usual setting for maxillary
premolar periapical films.
42. Anterior mandibular occlusal technique.
• The film placement for the anterior mandibular
occlusal technique is identical to that for the
anterior maxillary occlusal technique, except that
• The patient's head is positioned so that the
occlusal plane is at a – 45 degree angle.
• The cone is then aligned at a – 15 degree vertical
angle, and the central ray is directed through the
symphysis.
43. Panoramic Radiographs
• It is an extra oral radiograph in which the X-ray
film and the X-ray source move in opposite
directions.
• It can be used to visualize the entire dentition.
• This reduces the total number of films and thus
reduces the radiation exposures.
• This can also be used to introduce the child to
radiography as it is an extraoral radiograph.
44. Contd.
• It requires a total of 15 to 22 seconds to record.
• Although it is considered as a supplement it
cannot substitute intraoral radiographs in the
diagnosis of caries or for viewing the periapical
region.
• This view can be useful in handicapped children
and for viewing a wide area of the TMJ and
associated region.
47. Special technique for the handicapped
child
• The physically handicapped child cannot usually
hold a film in hisher mouth with fingers.
• In such a child radiograph can be taken by the
parent holding the child or by the use of film
holding devices.
• If the child is unable to open the mouth, extra
oral radiographs such as panoramic view, lateral
jaw projections, anterior occlusal screening,
should be preferred.
48. Management Techniques
• One of the most challenging tasks for the clinical staff
is to obtain diagnostic quality radiographs on a young
patient (under three years of age) without
psychological trauma.
• The first step is to desensitize the child to the dental
experience
• By explaining to the child what you plan to do in
words easily comprehended by the child.
• Using a "tell, show, do" technique.
49. Contd.
• The child is positioned to gain maximum cooperation.
• In the child less than three years of age it may be necessary
for the child to sit in the parent’s lap while the radiograph is
exposed.
• Such positioning reduces the child’s anxiety, provides
additional emotional security for the child, increases
cooperation and also enables the parent to adequately
restrain child and avoid any unexpected sudden movements.
• Obtaining the least difficult radiograph first (such as an
anterior occlusal) desensitizes the child to the procedure.
• Correct settings are made on the apparatus and the x-ray
head is properly positioned before placing the film in the
child’s mouth.
50. Positioning the Radiograph
• Positioning the radiograph
vertically in the mouth for both
periapical and bitewing radiographs
reduces the distal extension of the
radiograph and may result in
greater tolerance by patients,
especially those with a mild gag
reflex.
• The vertical bitewing radiograph
provides greater detail of the
periapical area.
51. Contd.
• The Snap-A-Ray is also useful for
those patients that have a fear
of swallowing the radiograph.
• By biting on the large positioning
device and watching in a mirror
they are assured they will not
swallow the radiograph.
52. Contd.
• A self sticking sponge tab may also
reduce impingement of the
radiograph on the intraoral soft
tissue.
• For patients frightened of the
procedure itself, desensitization
techniques may be necessary to
gain the patient cooperation.
53. Desensitization Techniques
• Desensitization is defined as gradually exposing the
child to new stimuli or experiences of increasing
intensity.
• An example of this is introducing the patient to x-
rays by initially taking an anterior radiograph which
is easier to tolerate than a posterior radiograph.
54. Contd.
• Another example of desensitization is
the “Lollipop Radiograph
Technique.” The child is given a lollipop
to lick (preferably sugarless).
• After a few licks, the lollipop is taken
from the child and a radiograph is
attached to the lollipop using an
orthodontic rubber band. The lollipop
with the attached film is returned to the
child, who is told to lick the lollipop
again.
• After a few licks, the child is told to hold
the lollipop in his mouth while we take a
tooth picture. The exposure is made.
55. Probable Technical Errors
• Improper placements of films.
• Cone cutting
• Incorrect horizontal angulations
• Incorrect vertical angulations
• Over exposure due to defective devices.
• A high exposure of the patient to radiation because of
repetition of taking X-rays due to an uncooperative
child.
56. Radiation hygiene measures
• Proper registration and maintenance of radiographic units
• Training of personnel who are associated with radiography
• Dosage monitoring
• Radiation protection of the child patients by using lead apron with
thyroid collar.
• Use of long lead-lined cylinder and cone positioning devices
• Use of electronically controlled exposure timer
• Use of high speed films
• Use of automatic processing machines that give good consistent result
• Employing proper technique to avoid the chances of repeating
exposure.
