extraoral periapical radiography

1. EXTRAORAL PERIAPICAL
RADIOGRAPHY : A TECHNIQUE
UNVEILED

2. STUDY
• Michael E. Newman and Seymour Friedman
first proposed in 2003 in patients having
complication to films and sensor in
endodontic therapy.
Journal of Endodontic volume:29 issue:6 June 2003

3. • An Aiming Device for an Extraoral
Radiographic Technique - Chia-Hui Chen
Journal of Endodontics—Volume 33, Number 6, June 2007

4. • Extraoral Periapical Radiology-A Technique
Unvieled – S Reddy and A Kaushik
JIAOMR , JULY –SEPTEMBER 2011 S NO: 336-339

5. • Extraoral periapical radiography: an
alternative approach to intraoral periapical
radiography - R Kumar, N khambete and E
Priya
US national Library of Medicine NCBI december 2011 volume 41(4)

6. Extraoral periapical radiography is a technique
where the film is placed extraorally overlying
the tooth of interest and the x-ray beam is
directed from the opposite side of the face.

8. • Intraoral radiograph serves as valuable
diagnostic tool in dental disease’s such as
caries , periodontal disease , periapical disease
etc .
• For the patients with severe gag reflex,
paediatric dental patients, patients with
restricted mouth opening IOPAR cannot be
done with great result.

9. POSSIBLE INDICATION FOR EOPAR
• Exaggerated Gag reflex
• Shallow palate
• Developmental anomalies of floor of the
mouth
• Maxillary and Mandibular tori
• Painful mucosal conditions
> Ulcer
> Infection and intraoral diseases

10. • Endodontics procedure
• Ridge resorption in edentulous patients
• Pediatric patients
• Impacted third molars
• Patients with low pain threshold
• Differently abled patients
• Dental phobia patients

11. MATERIALS AND METHOD
The aiming devices consist of :
1. Two locator rings
2. Two straight metal supporting indicator
3. A bite block
4. A rubber tube or acrylic splint of 2 mm

12. COMPONENTS OF THE AIMING DEVICES
A: locator rings
B: Metallic rod
C: Bite block
D: Rubber tube

13. ASSEMBELING THE AIMING DEVICE
• The two metal indicator rods are inserted into
two locator rings .
• The bite block is attached on one end and the
film/PSP sensor is placed firmly into slot of the
bite block with exposing surface directed into
the cone
• The two indicator rods are connected together
using the rubber tube or acrylic splint.

16. PARAMETERS FOR PREMOLAR AND
MOLARS
• Radiographic film or sensor on the bite block
is placed parallel to premolars and molars
such that the tooth of interest must come in
centre of film or sensor

17. • The central ray is projected such that the
beam is diverted through the opposite side
buccal soft tissue without opposing the crown
of opposite side teeth.
• Angulations is made -20 to -30 degree for
maxillary teeth and -10 to -15 degree for
mandibular teeth.

19. Film / sensor placed
Parallel to the
maxillary tooth.
The centre ray beam
The EOPAR parameters for maxillary teeth

21. The EOPAR parameters for mandibular teeth
Film / sensor placed
Parallel to the
mandibular tooth
The centre ray beam

22. CASE REPORTS
Chia-Hui Chen
• Using extraoral technique took images of 12
volunteers aged between 26 to 65 years
• Volunteers were asked to firmly hold the
aiming device with angulation of -20 to -30
degree for upper teeth and -10 to -15 degree
for lower teeth

23. • Standard intraoral sensor ( 30 x 40 mm ) was
used
• X- ray source 7mA 60 KV was used
• Exposure time of 0.5 sec for the lower teeth
and 1.0 sec for upper teeth.

24. (A) Taking an image of the right lower
third molar area using the
extraoral radiographic technique under
the guidance of the aiming device
(B)The resultant image shows the right
lower second molar. No third molar is
noted, but the alveolar canal can be
seen (arrow)
Journal of Endodontics—Volume 33, Number 6, June 2007

25. A) Taking radiograph of left upper third
molar
B) The resultant image shows third
and second left upper molar with implant
Placement mesial to second molar.
Journal of Endodontics—Volume 33, Number 6, June 2007

26. Application in the patient with limited mouth
opening
• Age – 35/ male
• Chief complaint – Pain and swelling in
maxillary left posterior region
• Examination – Masseteric space abscess
secondary to carious maxillary left first and
second molar
- Restricted mouth opening
25mm.

27. A) Intraoral radiograph and B) Radiograph taken by extraoral
method was found to have adequate diagnostic value.
US National Library of Medicine NCBI December 2011 volume 41(4)

28. Application in pediatric patients :
• Age – 7 yrs/ male
• Chief complaint – Severe pain in maxillary
deciduous second molar region
• Examination – Deciduous maxillary second
molar was grossly carious
Patient was highly reluctant to intraoral sensor
Hence ; EOPAR technique was used
Angulation -20 degree
Exposure time 0.35-0.40 second

29. The radiograph provided the essential diagnostic details of the
deep carious lesion extending into bifurcation, and it was decided
to extract the tooth followed by placement of a space maintainer.
US National Library of Medicine NCBI December 2011 volume 41(4)

30. • Even though conventional intraoral
radiography has been used widely in dental
field, sometimes there are problems in taking
the radiographs in pediatric patients, disabled
patients, obtaining third molar radiographs,
and obtaining radiographs in endodontics.

31. • Extraoral radiography technique is not
intended as a substitute for conventional
intraoral radiography but it can be used as a
supplement.