4 Intraoral Radiographic Techniques

INTRAORAL RADIOGRAPHIC TECHNIQUES
CONTENTS:
a. Introduction
b. Periapical Radiography
i. Paralleling Technique
ii. Bisecting Angle Technique
c. Bitewing Radiography
d. Occlusal Radiography
e. Digital Radiography
f. Special considerations
g. References
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INTRODUCTION:
The intraoral radiograph, when correlated with the case history and clinical
examination, is one of the most important diagnostic aids available to the dental practitioner.
When examined under proper conditions, diagnostic-quality intraoral radiographs reveal
evidence of disease that cannot otherwise be found. They also play a major role in forensic
identification.
Two of the fundamental rules of radiography are that 1) the central beam should pass
through the area to be examined, and 2) the x-ray film should be placed in position so as to
record the image with the least amount of image distortion. Each of three types of intraoral
radiologic examinations commonly used in dental practice &dash; periapical, bitewing
(interproximal), and occlusal examinations &dash; depend on the operator’s adherence to
these two rules even though specific techniques, processes, and indications differ widely
among them.
Another aspect that these three examinations have in common pertains to the film
packet. The film packet has two sides, a tube side and a tongue side. The tube side may be
plain or textured. When placed intraorally, the tube side always faces the radiation source,
the tube head. The tongue side may be colored and has a flange to open the packet and
remove the film. When placed intraorally, the tongue side always faces the patient’s tongue,
except in the case of the mandibular occlusal examination.
As technology advances, digital imaging is replacing traditional film in the dental

office. The conveniences associated with digital imaging make it an attractive alternative to
film, while the basic mechanics and principles of radiographic technique remain the same.
Digital film receptors and modified film holders are employed to obtain images. Like film-
based imaging, the clinician is responsible for the majority of errors and retakes that occur in
dental imaging.
Because of patient anatomic variations such as narrow arches, missing teeth, or the
presence of tori, and limitations of the patient’s ability to open sufficiently (caused by age or
other factors), or maintain the film placement, a clinical examination must precede the taking
of films. After the clinical examination, the operator can determine the number and size of
films to expose, the technique modifications necessary, and the type of film retention devices
to be employed.
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Advancements are continually being made in the development and manufacturing of
the actual film packet. These advancements have helped to decrease radiation exposure.
Whenever possible the "fastest" film speed should be used.
PERIAPICAL RADIOGRAPHS:
The purpose of the intraoral periapical examination is to obtain a view of the entire
tooth and its surrounding structures. Two exposure techniques may be employed for
periapical radiography: the paralleling technique and the bisecting angle technique. The
paralleling technique is the preferred method. This technique provides less image distortion
and reduces excess radiation to the patient. The paralleling technique should always be
attempted before other techniques. The bisecting technique can be employed for patients
unable to accommodate the positioning of the paralleling technique.
Candidates may include those with low palatal vaults and children. Disadvantages to
the bisecting technique include image distortion and excess radiation due to increased
angulations involving the eye and thyroid glands. Regardless of the technique, however, the
rules of radiography referred to earlier must be followed.
BITEWING RADIOGRAPHS:
Bitewing examinations were introduced by Raper in 1925. The greatest value of

bitewing radiographs is the detection of interproximal caries in the early stages of
development, before it is clinically apparent. The arrows indicate areas of interproximal
caries. Bitewing projections also reveal the size of the pulp chamber and the relative extent
to which proximal caries have penetrated.
Bitewings also provide a useful adjunct to evaluating periodontal conditions, offer a

good view of the septal alveolar crest, and, in addition, permit changes in bone height to be
accurately assessed by comparison with adjacent teeth. Bitewings do not show the apices of
the tooth and cannot be used to diagnose in this area.
OCCLUSAL RADIOGRAPHS:
Occlusal radiography is a supplementary radiographic examination designed to

provide a more extensive view of the maxilla and mandible. The occlusal radiograph is very
useful in determining the buccolingual extension of pathologic conditions, and provides
additional information as to the extent and displacement of fractures of the mandible and
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maxilla. Occlusal films also aid in localizing unerupted teeth, retained roots, foreign bodies,
and calculi in the submandibular and sublingual salivary glands and ducts. It should be noted
that when imaging soft tissues exposure time needs to be appropriately reduced.
DENTULOUS ADULT SURVEY:
The number of films needed for a full mouth series varies greatly. Some practitioners
may prefer 10 films, while others may prefer 18, 20 or more exposures. The selection of film
sizes used in a full mouth series also varies. A full survey can consist of narrow anterior film
(size #1); standard adult film (size #2); #2 bitewing film or long bitewing film (size #3), and
may include anterior bitewings.
It is generally recommended to use 20 films --- four bitewings and 16 periapical films.
Eight anterior #1 films will allow for ease of film placement on patients with narrow palates.
However in some cases six anterior periapical films will cover the area needed. When using
#3 film only one film is used on both the right and left sides and opening both the premolar
and molar contacts on one film is very difficult. With the use of #2 films for bitewings, the
operator uses a total of four films.
Each film is assigned either premolars or molars. Use of the #2 films instead of #3
films for bitewings is not only more comfortable for the patient but is easier for the operator
to open the contacts.
EDENTULOUS ADULT SURVEY
By definition, an edentulous patient is one without the natural dentition, and a

partially edentulous patient is one who retains some, but not all of the natural dentition.
Merely because a patient’s clinical exam reveals an edentulous state does not disqualify him
or her from diagnostic radiographic examination. In fact, it is commonly accepted that
certain areas of the patient’s jaws may contain tooth roots or impacted teeth. Residual
infection, tumors, cysts, or related pathology may also be found, which, while not visible to
the clinician, would hinder the effectiveness and comfort of an appliance such as a denture
and could potentially cause life threatening conditions to the patient. In addition to the
hidden pathology mentioned above, edentulous surveys reveal the position of the foramina
and the type of bone present.
In the case of the partially edentulous patient, placement of the film holding device
may be complicated by its tendency to tip or slip into the voids which would normally be
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occupied by the crowns of the missing teeth. This can usually be overcome by placing cotton
rolls between the patient’s alveolar ridge and the film holder, thereby supporting the film
holding device in position.
A 14 or 16 film intraoral periapical survey will usually examine the tooth bearing
region in most edentulous patients. Bitewings are not needed because there are no
interproximal areas to be examined.
The use of film holders allow the paralleling technique to be used with edentulous
patients. The operator may be able to reduce radiation exposure in the edentulous patient by
25 % by using the paralleling technique. The film can be held in biteblocks to which cotton
rolls have been taped. To prevent patient discomfort on biting due to missing teeth and
resultant over-closing of the arches, the cotton rolls can be attached to the upper and lower
surfaces of the biteblocks.
Opposing arch denture or partial denture appliances can be left in place to make
contact with the biteblock. The radiographic film should be positioned with approximately
one-third of the film’s vertical dimension protruding beyond the alveolar ridge; that is, the
radiographic image should occupy two-thirds of the film. The horizontal angulation of the
central beam is perpendicular to the film in the horizontal plane. If bisecting, the vertical
angulation of the central beam is much increased for an edentulous patient with minimal
ridges.
The film placement may be similar to that of an occlusal film, and this flat film
placement is the principal cause of dimensional distortion. To determine vertical angulation
it is necessary to estimate the long axis of the ridge instead of the tooth.
MIXED DENTITION SURVEY
The full mouth survey for pediatric patients may vary, depending on the patient’s age,
eruption pattern, behavior, and the size of the child’s mouth. In the six to nine-year-old
group, a 12 film survey, using #1 narrow film is recommended, and would include:
Maxillary:
• Central incisors
• Right and left lateral incisors and canines
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• Right and left primary/permanent molars
Mandibular:
• Right and left lateral incisors and canines
• Right and left primary/permanent molars
Bitewings:
• Right and left primary/permanent molars.
An adult-sized periapical film is used in the posterior region if the child’s first
permanent molar is fully developed. The size of the tooth requires the use of a large
periapical film to capture the complete image.
PRE-SCHOOL CHILD SURVEY
Since pre-school children have smaller mouths, reduced size pediatric films (film size
#0) are used to examine the posterior teeth, and adult films are used for anterior examinations
in children who have only primary (deciduous or "baby") teeth. For this group, an eight film
survey is recommended.
Maxillary:
• Right and left primary molars
Mandibular:
Bitewings:
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The paralleling technique should be used whenever possible. This technique delivers
the lowest dose of radiation possible. The bisecting angle technique is a viable alternative for
pediatric radiography because the apices of the permanent molar teeth tend to lie above the
palate and below the floor of the mouth in the undeveloped mandible. These positions
prevent the image of the apices of the teeth from being projected into the oral cavity when the
x-ray beam is perpendicular to the long axis of the teeth as it is when using the paralleling
technique.
SAFETY AND INFECTION CONTROL:
The CDC published guidelines in 2003 that specifically relate to dental radiography
safety and infection control. Operator safety includes wearing all personal protective
equipment (PPE) – gloves, mask, eyewear, and protective clothing – to prevent
contamination from blood and other bodily fluids that can spatter. Patient protection includes
the use of a protective (usually lead lined) apron that must be large enough to cover the
sitting patient from neck to knees. The use of a protective thyroid collar is also
recommended to reduce exposure to scatter radiation. The apron and collar must be
disinfected after each use.
Before any films can be exposed, the operator must understand the infection control
protocols.
Potential cross contamination between patient, equipment, and environmental surfaces

can happen before, during, and after film exposure. The use of barriers on machinery and
electrical switches are necessary to prevent transmission as they cannot be easily disinfected
or could receive an electrical short from a chemical spray. Each office must establish a
protocol from preparation, to exposure, to processing to maintain the aseptic chain.
Collection and transportation of contaminated films from the patient room to the dark
room must occur in a way that office surfaces are not contaminated. Contaminated gloves
must be removed before entering the daylight loader of an automatic processor to prevent
contamination. Contaminated films that enter a processor will contaminate the processor and
solutions and still exit the machine as contaminated films so a spill-technique protocol must
be established to maintain the aseptic chain. Several steps from beginning to end are
involved and each one should be examined by the dental team to prevent possible cross
contamination.
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PARALLELING TECHNIQUE
Basic Principles:
The paralleling technique of intraoral radiography was developed by Gordon M.

Fitzgerald, and is so named because the object (tooth), receptor (film packet), and end of the
position indicating device (PID) are all kept on parallel planes. Its basis lies in the principle
that image sharpness is primarily affected by focal-film distance (distance from the focal spot
within the tube head and the film), object film distance, motion, and the effective size of the
focal spot of the x-ray tube.
Successfully using the paralleling technique depends largely on maintaining certain

essential conditions. These are: 1) the film packet should be flat; 2) the film packet must be
positioned parallel to the long axis of the teeth; and 3) the central ray of the x-ray beam must
be kept perpendicular to the teeth and film.
To achieve parallelism between the film and tooth (i.e., to avoid bending or angling
the film) there must be space between the object and film. However, remember that as the
object-to-film distance increases, the image magnification or distortion also increases. To
compensate, manufacturers are recessing the target (focal spot) into the back of the tube head.
Depending on the machine & rsquot; age, and placement of the focal spot within the
tube head, you may encounter long, medium, or short cones/PIDs. The goal is to have the
focal spot at least 12" or 30 cm from the film to reduce image distortion.
The anatomic configuration of the oral cavity determines the distance needed between
film and object and varies among individuals. However, even under difficult conditions, a
diagnostic quality radiograph can be obtained provided that the film packet is not more than
20 degrees out of parallel with the tooth, and that the face of the PID/cone is exactly parallel
to the film packet to produce a central beam which is perpendicular to the long axis of the
tooth and the film packet.
The major advantage of the paralleling technique, when done correctly, is that the
image formed on the film will have both linear and dimensional accuracy. The major
disadvantages are the difficulty in placing the film packet and the relative discomfort the
patient must endure as a result of the film holding devices used to maintain parallelism. The
latter is particularly acute in patients with small mouths and in children. In certain
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circumstances the film and holder may be slightly tipped toward the palate to accommodate
oral space and patient comfort. Too much palatal tipping will throw off all parallel planes.
Beam Angulation:
The position of the x-ray tube head is usually adjusted in two directions: vertically
and horizontally. The vertical plane is adjusted by moving the tube head up and down. The
horizontal plane is adjusted by moving the tube head from side to side. By convention,
deflecting the head so that it points downward is described as positive vertical angulation or +
vertical.
Correspondingly, an upward deflection is referred to as negative vertical angulation or

vertical. The degree of vertical angulation is usually described in terms of plus or minus
degrees as measured by a dial on the side of the tube head.
When applying the paralleling technique, the vertical angulation is ALWAYS dictated
to maintaining the parallel plane. There is no set degree number to follow. As stated earlier
under basic principles, the object (tooth), receptor (film packet), and end of the position
indicating device (PID) are all kept on parallel planes. If the vertical angulation is excessive
the image will appear foreshortened. Insufficient vertical angulation produces an elongated
image.
The beam’s horizontal direction determines the degree of overlap among the tooth
images at the interproximal spaces. If the beam is not perpendicular to the specific
interproximal space(s) as it approaches several relatively aligned objects, the objects overlap
and the space(s) between them close.
Imagine a flashlight beam approaching a picket fence perpendicularly at a 90-degree

angle. The spaces between the pickets will remain open in the shadow image unless the
beam angle varies from perpendicular or 90 degrees. The degree of overlapping of the image
will increase or decrease as the beam angle increases or decreases from the perpendicular.
Film Holding Devices:
The paralleling technique requires the use of film holding devices to maintain the
relatively precise positioning needed. A great variety of film holders are commercially
available − simple, complex, light, heavy, reusable, disposable, autoclavable, and non-
autoclavable. A few of the more common include XCP (extension cone paralleling) with
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localizing rings, Snap-a-ray, Precision rectangular paralleling device, Uni-Bite, and Stabe
biteblock .Having several options available will provide the operator different opportunities
for enhanced patient comfort.
It is not uncommon to employ more than one option during the same radiographic
survey. The dental radiographer should be able to assess which holder best conforms to the
technical and diagnostic requirements of the job, the needs of the patient, and infection
control protocols within the office.
PARALLELING TECHNIQUE METHODOLOGY:
When taking a full mouth survey, a definite order of exposure should be preplanned
and then followed. Since patients tolerate anterior films better, they should be done first.
Starting with the maxillary central incisors and proceeding distally, first along one side, then
the other, is recommended. The radiographic parameters or exposure factors should also be
determined prior to placing films in the patient’s mouth.
Patient Positioning:
When positioning a patient, there are two imaginary planes that must be considered.
The occlusal plane runs horizontally, dividing the patient’s head into upper and lower
portions. It can be visualized by imagining the patient holding a ruler between his or her
teeth. A midsagittal plane divides a mass (the patient’s head or body) on a vertical dimension
into equal right and left portions.
When using the paralleling technique to examine the maxillary region, the patient is
positioned so that the occlusal plane of the maxilla is parallel to the floor and the sagittal
plane of the patient’s head is perpendicular to the floor.
When paralleling the mandibular region, the patient’s position must be modified
slightly so that when the mouth is open, the mandible is parallel to the floor and the sagittal
plane is perpendicular. This could mean that the patient must be tilted back in the chair.
Before any radiographs are exposed, the patient must be draped with a protective
apron and thyroid collar. The apron must be properly placed to avoid interference with the
radiographic exposure.
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Full Mouth Exposure with the Use of XCP Device
A) Procedure for the Maxillary Central/Lateral Incisors
1. Assemble the anterior film holder and insert the film packet vertically on the anterior bite
block. Use a #1 film.
2. Center the film on the central/lateral incisors. Position the film in the palate as posteriorly
as possible so that the entire so that the entire tooth length will appear on the film with
approximately a one-eighth inch border below the cuspal ridge. Align the anterior edge of
the film packet with the canine so that the image captured on the anterior border of the film
will include the distal third of the canine.
Position the bite block on the occlusal surfaces of the teeth to be radiographed.
Proper positioning tooth length will appear on the film, with approximately a one-eighth inch
border of the film extending below the incisal edge of the centrals. Position the biteblock on
the incisal edges of the teeth to be radiographed.
Proper positioning in this step will place the central ray of the x-ray beam at the
interproximal contact desired.
3. A cotton roll may be inserted between the mandibular teeth and the biteblock for patient
comfort. Ask the patient to slowly, but firmly, bite onto the block to maintain film position.
4. Slide the aiming ring down the indicator rod to the skin surface, align the x-ray tube close
to the aiming ring, and center.
5. Follow the film and equipment manufacturer’s recommendation concerning exposure

factors. Make the exposure.
B) Procedure for the Maxillary Canines:
1. Assemble the anterior film holder and insert the film packet vertically on the anterior
biteblock. Use a #1 film.
2. Center the film on the canine and first premolar. Position the film in the palate as
posteriorly as possible so that the entire tooth length will appear on the film with
approximately a one-eighth inch border below the incisal edge of the canine. Position the
biteblock on the incisal edges of the teeth to be radiographed.
11

C) Procedure for the Maxillary Premolars:
1. Assemble the posterior film holder and insert the film packet horizontally in the posterior
2. Center the film on the premolars so that it is parallel to the long axis of the teeth. Position
the film in the palate. Center the film on the molars so that it is parallel to the long axis of the
teeth.
Position the film in the palate so that the entire tooth length will appear on the film
with approximately a one-eighth inch border below the cuspal ridge. Align the anterior border
of the film packet with the second premolar so that the image captured on the anterior edge of
the film will be the distal third of the second premolar. Position the biteblock on the occlusal
surfaces of the teeth to be radiographed.
(The occlusal border of the film tends to slip lingually.)

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Procedure for the Maxillary Molar Region
1. Assemble the posterior film holder and insert the film packet horizontally in the posterior
2. Center the film on the molars so that it is parallel to the long axis of the teeth. Position the
film in the palate so that the entire tooth length will appear on the film with approximately a
one-eighth inch border below the cuspal ridge.
Align the anterior border of the film packet with the second premolar so that the
image captured on the anterior edge of the film will be the distal third of the second premolar.
Position the biteblock on the occlusal surfaces of the teeth to be radiographed. Proper
positioning in this step will place the central ray of the x-ray beam at the interproximal
contact desired.

Procedure for the Mandibular Central/Lateral Incisors
2. Center the film on the mandibular central and lateral incisors. It may be necessary to
displace the tongue distally and depress the film onto the floor of the mouth so that the entire
tooth length will show with approximately a one-eighth inch border above the incisal edges.
The film must be as posterior as the anatomy allows and the biteblock should be positioned
on the edges of the incisors to be radiographed. Proper positioning in this step will place the
central ray of the x-ray beam at the interproximal contact desired.
3. A cotton roll may be inserted between the maxillary teeth and the biteblock for patient
The film should be straightened as the patient closes and the floor of the mouth relaxes.
13

Procedure for the Mandibular Canines
2. Center the film on the mandibular canine. It may be necessary to displace the tongue
distally and depress the film onto the floor of the mouth so that the entire tooth length will
show with approximately a one-eighth inch border above the cuspal edge. The film must be
as posterior as the anatomy allows and the biteblock should be positioned on the edges of the
teeth to be radiographed. Proper positioning in this step will place the central ray of the x-ray
beam at the interproximal contact desired.

Procedure for the Mandibular Premolars
1. Assemble the posterior film holder and insert the film packet horizontally on the posterior
2. Center the film on the premolars so that it is parallel to the long axis of the teeth. The
object-to-film distance in both the mandibular premolar and molar regions is minimal since
the oral anatomy only allows the film to be positioned very close to the teeth and still remain
parallel.
Align the anterior border of the film packet with the canine so that the image captured
on the anterior edge of the film will be the distal third of the canine. Position the biteblock on
14
the occlusal surfaces of the teeth to be radiographed. Proper positioning in this step will
place the central ray of the x-ray beam at the interproximal contact desired. Approximately a
one-eighth inch border above the incisal edges. The film must be as posterior as the anatomy
allows and the biteblock should be positioned on the edges of the incisors to be radiographed.
Proper positioning in this step will place the central ray of the x-ray beam at the interproximal
contact desired.

Procedure for the Mandibular Molars
1. Assemble the posterior film holder and insert the film packet horizontally on the posterior
2. Center the film on the molars so that it is parallel to the long axis of the teeth. Depress the
film onto the floor of the mouth so the entire length of the teeth will appear with
approximately a one-eighth inch border above the occlusal surface. Place the film
horizontally and position it lingually to the molars so that the long axis of the film is parallel
to the long axis of the tooth.
Align the anterior border of the film packet with the second premolar so that the
image captured on the anterior edge of the film will be the distal third of the second premolar.
Position the biteblock on the occlusal surfaces of the mandibular teeth. Proper positioning in
this step will place the central ray of the x-ray beam at the interproximal contact desired.
15
THE BISECTING ANGLE TECHNIQUE
Basic Principles
The bisecting-the-angle or bisecting angle technique is based on the principle of

aiming the central ray of the x-ray beam at right angles to an imaginary line which bisects the
angle formed by the longitudinal axis of the tooth and the plane of the film packet. While it
is not necessary to go into a long dissertation on plane geometry to understand this concept, a
quick review will help make the technique more clear. To bisect is to divide a line or angle
into two equal portions. A bisector is a plane or line that divides a line or
angle into two equal portions. The below figure shows an equilateral triangle, with legs
AB=BC=CA, and the angles ABC=60 degrees, CAB=60 degrees and BCA=60 degrees.
In the above figure, we can see the following:
1. The dotted line BD bisects the triangle, dividing it exactly in half. Thus, two equal
triangles are formed from the original. Legs AB and BC were unchanged and thus are still
equal.
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2. The original line CA was divided in half by D, and thus the lines AD and CD are equal.
3. We know that the angle at point B was 60 degrees, and since it was bisected (divided
equally), it now is 30 degrees at the intersections of AD and BD.
4. We also know that bisecting the angle did not affect the angle at the old point A which was
60 degrees, and still is.
5. The angle at the bisecting point DC must be 90 degrees because the sum of all the angles in
any triangle is 180 degrees, and thus 180-(60+30)=90.
6. Cyzynski’s Rule of Isometry states that two triangles are equal when they share one
complete side, and have two equal angles. We can see that triangles ADB and BDC share the
common side BD.
7. We know further that the angles ADB and BDC are equal because D was defined as a
bisector of the old angle ABC.
8. Lastly, we know that the angles CAB and BCA were unchanged by bisecting and are still
equal. Therefore, under Cyzynski’s Theorem, we can prove the triangles ABD and CBD are
equal.
In dental radiography, the theorem is applied in the following manner. The film is
positioned resting on the palate or on the floor of the mouth as close to the lingual tooth
surfaces as possible. The plane of the film and the long (vertical) axis of the teeth to be
radiographed form an angle with the apex at the point where the film packet contacts the
teeth. The apex in the above figure is located at the point labeled B.
In the above figure, the long axis through the tooth forms one leg of a triangle (AB),
the plane of the film packet another leg, (BC), both of which intersect at the apex, point B. A
line representing the central x-ray beam will form the third leg of the triangle, AC. If an
imaginary line bisected this axis-packet- ray triangle, the bisector, DB, would form the
common side of two equal triangles as defined by Cyzynski’s Theorem.
Since the sides formed by the tooth’s long axis and the film packet are equal, the
image cast onto the radiographic film would be the same length as the tooth or teeth casting
that image. This linear equality is the basis for diagnostic quality bisecting angle radiographs.
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Anatomical Considerations
The bisecting angle technique is of value when the paralleling technique cannot be
utilized. This may include patients with small mouths and those with low palatal vaults.
Because of the increased exposure to radiation in this technique, it should only be employed
as necessary.
Beam Angulation:
The bisecting technique calls for varying beam angulations, depending on the region
to be examined.
Horizontal angulation: The horizontal angulation of the tube head should be adjusted for
each projection to position the central ray through the contacts in the region to be examined.
This angulation will usually be at right angles to the buccal surfaces of the teeth to be
radiographed.
Vertical angulation: In practice, the operator should position the central ray of the x-ray
beam so that it is perpendicular to the imaginary line bisecting the angle formed between the
tooth long axis and the film. This principle works well with flat, two dimensional structures,
but teeth that have depth or are multirooted will produce distorted images. If the vertical
angulation is excessive the image will appear foreshortened. Insufficient vertical angulation
produces an elongated image. The optimum angle will vary from patient to patient, but the
chart below serves as a general guideline for beam angulation.
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Film Holding Devices
Supporting the film pack with the patient’s forefinger is not recommended. This
method has several drawbacks. In addition to exposing the patient’s digit to additional
radiation, the patient may exert excessive force, thus bending the film and distorting the
radiograph. The film may slip without the operator’s knowledge, and produce a radiograph
outside the proper image field. Therefore, intraoral support is best accomplished using
instruments that restrain the film and help align the beam properly.
BISECTING ANGLE METHODOLOGY
Patient Positioning
Maxillary region: For bisecting angle radiographs of the maxilla, the patient should be
positioned so that the maxillary occlusal plane is parallel to the floor and the sagittal plane of
the patient’s head is perpendicular to the floor.
Mandibular region: For bisecting angle radiographs of the mandible, the patient should be
positioned so that the mandibular occlusal plane is parallel to the floor and the sagittal plane
of the patient’s head is perpendicular to the floor.
Before any radiographs are exposed, the patient must be draped with a protective
FULL MOUTH EXPOSURE
Procedure for the Maxillary Central/Lateral Incisors:
1. Assemble the anterior film holder and insert the film packet vertically on the biteblock.
Use a #1 film.
2. Center the film on the central/lateral incisors as close as possible to the lingual surfaces of
the teeth with approximately a one-eighth inch border of the film extending below the incisal
edge of the centrals. Position the biteblock on the incisal edges of the teeth to be
radiographed
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4. Align the central ray perpendicular to the bisector vertically and at the desired
interproximal contact to be viewed. Horizontally, the central ray should pass between the
contact of the first and second premolar. For maxillary exposures the tube head will be
pointed down for positive (+) angulation.

Procedure for the Maxillary Canines:
Use a #1 film.
2. Center the film on the canine as close as possible to the lingual surfaces of the teeth with
approximately a one-eighth inch border of the film extending below the incisal edge of the
centrals. Position the biteblock on the incisal edges of the teeth to be radiographed.
interproximal contact to be viewed. Horizontally, the central ray should bisect the canine.
For maxillary exposures the tube head will be pointed down for positive (+) angulation.

Procedure for the Maxillary Premolars:
1. Assemble the posterior film holder and insert the film packet horizontally on the biteblock.
Use a #2 film.
2. Center the film on the premolars as close as possible to the lingual surfaces of the teeth.
Position the film in the palate so that the entire tooth length will appear on the film with
approximately a one-eighth inch border below the cuspal ridge. Align the anterior border of
the film packet with the canine so that the image captured on the anterior edge of the film will
be the distal third of the canine. Position the biteblock on the occlusal surface of the teeth
being radiographed.
20
(Watch the occlusal border of the film packet; it tends to slip down anteriorly.)
contact of the first and second premolar. For maxillary exposures the tube head will be
pointed down for positive (+) angulation.

Procedure for the Maxillary Molars:
Use a #2 film.
2. Center the film on the molars as close as possible to the lingual surfaces of the teeth.
Position the film in the palate so that the entire tooth length will appear on the film with
approximately an one-eighth inch border below the cuspal ridge. Align the anterior border of
the film packet with the second premolar so that the image captured on the anterior edge of
the film is the distal third of the second premolar. Position the biteblock on the occlusal
surface of the teeth being radiographed. A cotton roll may be inserted between the
mandibular teeth and the biteblock for patient comfort. Ask the patient to slowly, but firmly,
bite onto the block to maintain film position.
contact of the first and second molar. For maxillary exposures the tube head will be pointed
down for positive (+) angulation.

Procedure for the Mandibular Central/Lateral Incisors:
Use a #1 film
21
2. Center the film on the central/lateral incisors as close as possible to the lingual surfaces of
the teeth with approximately a one-eighth inch border of the film extending above the incisal
edge of the centrals. Position the biteblock on the incisal edges of the teeth to be
radiographed.
3. A cotton roll may be inserted between the maxillary incisors and the biteblock for patient
central/lateral incisors. For mandibular exposures the tube head will be pointed up for
negative (-) angulation.

Procedure for the Mandibular Canines:
Use a #1 film.
2. Center the film on the canine as close as possible to the lingual surfaces of the teeth with
approximately a one-eighth inch border of the film extending above the incisal edge of the
canine. Position the biteblock on the incisal edges of the teeth to be radiographed.
interproximal contact to be viewed. Horizontally, the central ray should bisect the canine.
For mandibular exposures the tube head will be pointed up for negative (-) angulation.

22
Procedure for the Mandibular Premolars:
Use a #2 film.
2. Center the film on the premolars as close as possible to the lingual surfaces of the teeth.
Align the anterior border of the film packet with the canine so that the image captured on the
anterior edge of the film will be the distal third of the canine. Position the biteblock on the
occlusal surface of the teeth to be radiographed.
3. A cotton roll may be inserted between the maxillary premolars and the biteblock for patient
first and second premolars. For mandibular exposures the tube head will be pointed up for
negative (-) angulation.

Procedure for the Mandibular Molars:
Use a #2 film.
2. Center the film on the molars as close as possible to the lingual surfaces of the teeth. Align
the anterior border of the film packet with the second premolar so that the image captured on
the anterior edge of the film will be the distal third of the second premolar. Position the
biteblock on the occlusal surface of the teeth to be radiographed.
3. A cotton roll may be inserted between the maxillary molars and the biteblock for patient
contact of the first and second molar. For mandibular exposures the tube head will be
pointed up for negative (-) angulation.
23
BITEWING RADIOGRAPHY
`Bitewing radiographs are of particular value in detecting interproximal caries in the

early stages of development, before it is clinically apparent. For this reason it is critical that
horizontal angulation be accurately projected following the direction of the interproximal
contacts and no overlapping contacts be present on the film. Bitewing films are also useful in
evaluation of the alveolar crests for detection of early periodontal disease.
Basic Principles
Bitewing radiographs are parallel films because the film is positioned parallel to the
long axis of the teeth and the beam is perpendicular to the film. A bitewing tab is utilized to
stabilize the film as the patient bites together
Beam Angulation and Film Holding Devices
Bitewing radiographs are usually exposed with an indicated vertical angulation of +10
degrees (tube head points down for positive (+) angulation. This angulation provides an
acceptable compromise for the differences between the long axis inclinations of the maxillary
and mandibular teeth. Horizontal angulation is aligned with the direction of the contact, and
the central ray is directed between the contacts of the teeth to be radiographed.
Horizontal angulation is achieved when the central ray of the x-ray beam is directed
specifically between the contacts of the teeth to be radiographed.
The interproximal examination may be done using special #3 bitewing film but is
preferably achieved by using #2 films fitted with a tab.
There are also film holding devices available that support the film as well as provide
an external reference for positioning the tube head. The patient stabilizes the film by gently
biting together on the manufactured tab or on the instrument.
Before any radiographs are exposed, the patient must be protected with a protective
24
INTRAORAL OCCLUSAL RADIOGRAPHY
MAXILLARY TOPOGRAPHICAL OCCLUSAL
This projection shows the palate (roof of the mouth), zygomatic process of the maxilla
(a projection from the maxilla), antero-inferior aspects of each antrum (in this case, the
maxillary sinuses), nasolacrimal canals (tear ducts), teeth from the left second molars to the
central incisors, and the nasal septum (cartilage dividing the nose).
Uses: To view the maxilla for anterior alveolar fractures, cysts, supernumerary teeth and
impacted canines, and to view pathology at the apices of the incisors. It is not used to
diagnose periodontal conditions.
Patient positioning: The patient is seated with the sagittal plane perpendicular to the floor
and the occlusal plane parallel to the floor. Before any radiographs are exposed, the patient
must be draped with a protective apron and thyroid collar. The apron must be properly
placed to avoid interference with the radiographic exposure.
Film placement: With the tube side of the film (size #4) toward the maxilla, the film is
placed crosswise in the mouth, like a sandwich. It is gently pushed backwards until it
contacts the anterior border of the mandibular ramus. The patient bites down gently to
maintain position.
Exposure factors: Follow the recommendations of the film and equipment manufacturer.
Direction of the central ray: The central ray is directed at the center of the film with a
vertical angulation of +65 degrees and a horizontal angulation of 0 degrees. In this case, the
central ray will pass through the bridge of the nose.
MANDIBULAR TOPOGRAPHICAL OCCLUSAL
Uses: To view the anterior portion of the mandible for fractures, cysts, root tip and periapical
pathology. It provides a very good view of the symphysis region of the mandible.
Patient positioning: The patient is seated with the head tilting slightly backward, so that the
occlusal plane (ala-tragus line) is 45 degrees above the horizontal plane. Before any
radiographs are exposed, the patient must be draped with a protective apron and thyroid
collar. The apron must be properly placed to avoid interference with the radiographic
exposure.
25
Film Placement: With the tube side of the film (size #4) toward the mandible, the film is
placed crosswise in the mouth, like a sandwich. It is gently pushed backwards until it
contacts the anterior border of the mandibular ramus. The patient bites down gently to
maintain position.
Direction of the central ray: The central ray is directed between the apices of the mandibular
central incisors and the tube is angled at -55 degrees relative to the film
MAXILLARY VERTEX OCCLUSAL
Uses: To view the buccopalatal relationships of unerupted teeth in the dental arch
Patient positioning: The patient is seated with the sagittal plane perpendicular to the floor
and the occlusal plane parallel to the floor. Before any radiographs are exposed, the patient
Film placement: The film (size #4) is placed in the same manner as the Maxillary
Topographical Occlusal.
Direction of the central ray: The central ray is directed through the top of the skull (hence
the name vertex occlusal). Since the beam must penetrate a considerable amount of bone and
soft tissue, the exposure time must be increased. The central ray is perpendicular to the film
plane and is directed to the center of the film.
MANDIBULAR CROSS-SECTIONAL OCCLUSAL
Uses: To view the entire mandible for fractures, foreign bodies, root tips, salivary calculi,
tori, etc.
Patient positioning: The patient’s head may be in any comfortable position that allows the
central ray to be directed perpendicular to the plane of the film packet. Before any
26
radiographs are exposed, the patient must be draped with a protective apron and thyroid
exposure.
Film placement: The film (size #4) is placed in the same manner as the Mandibular
Topographical Occlusal.
Direction of the central ray: The central ray is perpendicular to the film plane and is
directed to the center of the film.
POSTERIOR OBLIQUE MAXILLARY OCCLUSAL
Uses: To view the maxillary posterior region and provide a topographical view of the
maxillary sinus. The projection may be used in place of periapical films in patients who have
a tendency to gag and for examining periapical pathology and root tips.
Patient positioning: The patient is seated with the occlusal plane parallel to the floor and the
sagittal plane perpendicular to the floor. Before any radiographs are exposed, the patient
Film placement: The film (size #4) plane should be parallel to the floor, and the packet
should be pushed posteriorly as far as possible. The lateral border of the film should be
positioned parallel to the buccal surfaces of the posterior teeth and extend laterally
approximately one-half inch past the buccal cusps on the side of interest. The patient should
bite down gently to maintain film position.
Direction of the central ray: The tube is directed at an angle of +60 degrees. Horizontal
angulation should be such that the central ray is approximately at right angles to the curve of
the arch, and strikes the center of the film packet.
POSTERIOR OBLIQUE MANDIBULAR OCCLUSAL
Uses: The projection is used to view the posterior teeth of the mandible to locate cysts,
fractures, supernumerary teeth, and periapical pathology. It can be used in place of posterior
periapical films.
27
Patient positioning: The patient is seated with the occlusal plane parallel to the floor and the
sagittal plane perpendicular to the floor. Before any radiographs are exposed, the patient
Film placement: The film (size #4) plane should be parallel to the floor, and the packet
should be pushed posteriorly as far as possible. The lateral border of the film should be
positioned parallel to the buccal surfaces of the posterior teeth and extend laterally
approximately one-half inch past the buccal cusps on the side of interest. The patient should
bite down gently to maintain film position.
Direction of the central ray: The tube is directed at the apex of the mandibular second
premolar, and the central ray should strike the center of the film packet. The vertical
angulation is -50 degrees.
MODIFIED OBLIQUE POSTERIOR MANDIBULAR OCCLUSAL
Uses: This projection is especially useful to detect calculi in the submandibular gland.
Calculi are often difficult to detect on conventional radiographs due to superimposition of the
mandibular bone darkroom processing time and exposure to processing chemicals. Digital
imaging has environmental advantages with reduced waste production and also paper and
film consumption.
Immediate viewing, and ability to easily and cost effectively transmit directly to third
party facilities or affiliating dental offices are added advantages.
Additional computerized advantages include the ability to enhance the image for
viewing. Once an image is in the computer, brightness and contrast and image reversal can
be enhanced for optimal viewing of tissue and bone levels.
Patient positioning and film placement: With the tube side of the film (size #4) toward the
mandible the film is placed in the patient’s mouth crosswise like a sandwich. The film plane
should be parallel to the floor, and the packet should be pushed posteriorly as far as possible.
The lateral border of the film should be positioned parallel to the buccal surfaces of the
posterior teeth and extend laterally approximately one-half inch past the buccal cusps on the
side of interest.
28
The patient’s head is then rotated to the side and lifted up. Before any radiographs are
exposed, the patient must be draped with a protective apron and thyroid collar. The apron
must be properly placed to avoid interference with the radiographic exposure.
Direction of the central ray: The tube is positioned under and behind the mandible and the
central ray is directed onto the center of the film so that it passes inside the ascending ramus
so that the submandibular gland will be between the tube and the film.
DIGITAL RADIOLOGY
Digital imaging was introduced into dentistry in 1987. Digital sensors are used instead
of x-ray film. Sensors can be wired or wireless depending on the system used. Sensors and
tube head placement are the same for digital imaging as film and tube head placement is for
traditional radiology. Most standard radiographic machines can be converted to acquire
digital images. Digital imaging still uses ionizing radiation, and therefore, before any
radiographs are exposed, the patient must be protected with a protective apron and thyroid
exposure.
The sensors are slightly thicker than a regular film. Modified film holders must be
utilized in the placement of the sensors. These modified holders can be purchased from any
major dental supply company. The sensors can be reused several times. Proper use of
intraoral barrier and OSHA techniques must be observed.
The advantages of digital radiology are decreased exposure time to the patient,
elimination of efficiency and access is increased. Files and films are stored within the
computer system and retrieved easily.
The main disadvantages are substantial start up costs including machinery and
operatory computer technology, and compatibility with other software program and RAM
capacity.
Considerations must also be noted that although your office may utilize digital
radiography, other facilities may not and the transfer of images between them could be more
difficult.
29
The digital sensors are considered a disadvantage by some operators as they are
thicker than film and more difficult to orient in the oral cavity. Also, the sensors cannot be
sterilized and must be protected by a barrier before handling and placement.
SPECIAL CONSIDERATIONS
The radiographic procedures that have been described in this chapter are for the
“well” patient. These procedures may need to be modified for patients who have unusual
difficulties. Specific modifications depend on the patient’s physical and emotional
characteristics. As with any dental procedure, however, the dental assistant begins the
examination by showing appreciation of the patient ’ s condition and sympathy for any
problems that might occur for either of them. If the assistant is kind but firm, the patient’s
confidence increases, which helps the patient relax and cooperate. Following are a few
conditions and circumstances that may be encountered, with some recommendations and
suggestions that may help the clinician achieve an adequate radiographic examination.
Infection:
Infection in the orofacial structures may result in edema and lead to trismus of some
of the muscles of mastication. As a result, intraoral radiography may be painful to the patient
and difficult for both the patient and radiologist. Under such circumstances extraoral or
occlusal techniques may offer the only possibility of an examination. The choice of a specific
extraoral projection depends on the condition and the areas to be examined. Although the
resulting radiograph may not be ideal in many respects, it usually provides more useful
information than the diagnostician would have without it. In the case of edema in an area to
be examined, exposure time should be increased to compensate for the tissue swelling.
Trauma
A patient who has undergone trauma may have a dental or facial fracture. Dental
fractures are best appreciated by using periapical or occlusal radiographs. Special care must
be taken when making these views because of the condition of the patient. Skeletal fractures
are usually best seen with panoramic or other extraoral views or a computed tomography
examination. In some cases patients with fractures of the facial skeleton may be bedridden
because of involvement of other injuries. Consequently, an extraoral radiographic
examination with the patient in the supine position is necessary. However, the circumstances
30
need not compromise the techniques, and satisfactory intraoral radiographs can be produced
if the proper relative positions of the tube, patient, and receptor are observed.
Patients with Mental Disabilities:
Patients with mental disabilities may cause some difficulty for the radiologist who is
attempting an examination. The difficulty usually is the result of the patient’s lack of
coordination or inability to comprehend what is expected. However, when the radiographic
examination is performed speedily, unpredictable moves by the patient can be minimized. In
some cases sedation may be required. Radiographic examination of mixed dentition consists
of two incisor views, four canine views, four posterior views, and two bitewing views.
Handheld x-ray machine useful for patients in remote situations. Operator dose is reduced by
internal shielding and shield on aiming cylinder to reduce backscatter.
Patients with Physical Disabilities:
Patients with physical disabilities (e.g., loss of vision, loss of hearing, loss of the use
of any or all extremities, congenital defects such as cleft palate) may require special handling
during a radiographic examination. These patients usually are cooperative and eager to assist.
They may be accustomed to so much discomfort and inconvenience that their tolerance level
is high, and they are not challenged by the relatively slight irritation represented by the x-ray
procedures. Generally, intraoral and extraoral radiographic examinations may be performed
for these patients if a good rapport between the patient and radiology technician is established
and maintained. Members of the patient ’s family often are very helpful in assisting the
patient into and out of the examination chair and in receptor positioning and holding, in as
much as they usually are familiar with the patient ’ s condition and accustomed to coping
with it.
Gag Reflex:
Occasionally, patients who need a radiographic examination manifest a gag reflex at

the slightest provocation. These patients usually are very apprehensive and frightened by
unknown procedures; others simply seem to have very sensitive tissue that precipitates a gag
reflex when stimulated. This sensitivity is manifested when the receptor is placed in the oral
cavity. To overcome this disability, the radiologist should make an effort to relax and
reassure the patient. The radiologist can describe and explain the procedures. Often gagging
can be controlled if the operator bolsters the patient’s confidence by demonstrating technical
31
competence and showing authority tempered with compassion. The gag reflex often is worse
when a patient is tired; therefore it is advisable to perform the examination in the morning,
when the individual is well rested, especially in the case of children.
Stimulating the posterior dorsum of the tongue or the soft palate usually initiates the
gag reflex. Consequently, during the placement of the receptor, the tongue should be very
relaxed and positioned well to the floor of the mouth. This can be accomplished by asking the
patient to swallow deeply just before opening the mouth for placement of the receptor. (The
dentist should never mention the tongue, nor ask patients to relax the tongue; this usually
makes them more conscious of it and precipitates involuntary movements.) The receptor is
carried into the mouth parallel to the occlusal plane. When the desired area is reached, the
receptor is rotated with a decisive motion, bringing it into contact with the palate or the floor
of the mouth. Sliding it along the palate or tongue is likely to stimulate the gag reflex. Also,
the dentist must keep in mind that the longer the receptor stays in the mouth, the greater the
possibility that the patient will start to gag. The patient should be advised to breathe rapidly
through the nose because mouth breathing usually aggravates this condition.
Any little exercise that can be devised that does not interfere with the x-ray
examination but shifts the patient’s attention from the receptor and the mouth is likely to
relieve the gag reaction. Asking patients to hold their breath often can create such a
distraction or to keep a foot or arm suspended during receptor placement and exposure. In
extreme cases, topical anesthetic agents in mouthwashes or spray can be administered to
produce temporary numbness of the tongue and palate to reduce gagging. However, in our
experience this procedure gives limited results. The most effective approach is to reduce
apprehension, minimize tissue irritation, and encourage rapid breathing through the nose. If
all measures fail, an extraoral examination may be the only means, short of administering
general anesthesia, to examine the patient radiographically.
Radiographic Techniques for Endodontics:
Radiographs are essential to the practice of endodontics. Not only are they
indispensable for determining the diagnosis and prognosis of pulp treatment, they also are the
most reliable method of managing endodontic treatment. The presence of a rubber dam,
rubber dam clamp, and root canal instruments may complicate an intraoral periapical
examination by impairing proper receptor positioning and aiming cylinder angulation.
Despite these obstacles, certain requirements must be observed:
32
1. The tooth being treated must be centered in the image.
2. The receptor must be positioned as far from the tooth and apex as the region permits to
ensure that the apex of the tooth and some periapical bone are apparent on the radiograph.
For maxillary projections, the patient is seated so that the sagittal plane is
perpendicular and the occlusal plane is parallel to the floor. For mandibular projections, the
patient is seated upright with the sagittal plane perpendicular and the tragus-to-corner of the
mouth line parallel to the floor. Specially designed receptor holders for endodontic
radiographs are available. These instruments fit over files, clamps, and the rubber dam
without touching the subject tooth. The aiming cylinder is aligned so as to direct the central
ray perpendicular to the center of the receptor.
Often a single radiograph of a multirooted tooth made at the normal vertical and
horizontal projection does not display all the roots. In these cases, when it is necessary to
separate the roots on multirooted teeth, a second projection may be made. The horizontal
angulation is altered 20 degrees mesially for maxillary premolars, 20 degrees mesially or
distally for maxillary molars, or 20 degrees distally for an oblique projection of mandibular
molar roots.
If a sinus tract is encountered, its course is tracked by threading a No. 40 gutta-percha

cone through the tract before the radiograph is made. It also is possible to localize and
determine the depth of periodontal defects with this gutta-percha tracking technique.
A final radiograph of the treated tooth is made to demonstrate the quality of the root
canal filling and the condition of the periapical tissues after removal of the clamp and rubber
dam. EndoRay receptor holder used for endodontic radiographs.
Pregnancy
Although a fetus is sensitive to ionizing radiation, the amount of exposure received by

an embryo or fetus during dental radiography is extremely low. No incidences have been
reported of damage to a fetus from dental radiography. Regardless, prudence suggests that
such radiographic examinations be kept to a minimum consistent with the mother’s dental
needs. As with any patient, radiographic examination is limited during pregnancy to cases
with a specific diagnostic indication. With the low patient dose afforded by use of optimal
radiation safety techniques, an intraoral or extraoral examination can be performed whenever
a reasonable diagnostic requirement exists.
33
Edentulous Patients
Radiographic examination of edentulous patients is important, whether the area of

interest is one tooth or an entire arch. These areas may contain roots, residual infection,
impacted teeth, cysts, or other pathologic entities that may adversely affect the usefulness of
prosthetic appliances or the patient’s health. After a determination has been made that these
entities are not present, repeated examinations to detect them are not warranted in the absence
of signs or symptoms.
If available, a panoramic examination of the edentulous jaws is most convenient. If

abnormalities of the alveolar ridges are identified, the higher resolution of periapical receptor
is used to make intraoral projections to supplement the panoramic examination.
In a completely or partly edentulous patient, a receptor-holding device is used for

intraoral radiography of the alveolar ridges. Placement of the receptor-holding instrument
may be complicated by its tipping into the voids normally occupied by the crowns of the
missing teeth. To manage this difficulty, cotton rolls are placed between the ridge and the
receptor holder, supporting the holder in a horizontal position. An orthodontic elastic band to
hold cotton rolls to the biteblock on the receptor holder often is useful when several such
projections must be exposed. With elastics, it is simple to maneuver the cotton rolls into the
areas that require support. The patient may steady the receptor-holding instrument with a
hand or an opposing denture.
If panoramic equipment is not available, an examination consisting of 14 intraoral

views provides an excellent survey. The exposure required for an edentulous ridge is
approximately 25% less than that for a dentulous ridge. This examination consists of seven
projections in each jaw (adult No. 2 receptor) as follows:
Central incisors (midline): one projection
Lateral canine: two projections
Premolar: two projections
Molar: two projections
34
REFERENCES
• Essentials of Dental Radiography and Radiology (4th Edition) by Eric Whaites
• Oral Radiology: Principles and Interpretation By Stuart C. White, DDS, PhD and
Michael J. Pharoah, DDS
• TEXT BOOK OF ORAL RADIOLOGY : Freny karjodkar
• Principles of Dental Imaging :Langland ,Langlais, Preece 2nd edition
• Dental Radiography: Principles and Techniques by Joen I. Haring, Laura Jansen 3rd
edition
35

4 Intraoral Radiographic Techniques

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INTRAORAL RADIOGRAPHIC TECHNIQUES

ii. Bisecting Angle Technique

As technology advances, digital imaging is replacing traditional film in the dental

Bitewing examinations were introduced by Raper in 1925. The greatest value of

Bitewings also provide a useful adjunct to evaluating periodontal conditions, offer a

Occlusal radiography is a supplementary radiographic examination designed to

DENTULOUS ADULT SURVEY:

EDENTULOUS ADULT SURVEY

By definition, an edentulous patient is one without the natural dentition, and a

MIXED DENTITION SURVEY

• Right and left lateral incisors and canines

• Right and left lateral incisors and canines

• Right and left primary/permanent molars

• Right and left primary/permanent molars.

PRE-SCHOOL CHILD SURVEY

• Right and left primary molars

• Right and left primary molars

• Right and left primary molars

SAFETY AND INFECTION CONTROL:

Potential cross contamination between patient, equipment, and environmental surfaces

The paralleling technique of intraoral radiography was developed by Gordon M.

Successfully using the paralleling technique depends largely on maintaining certain

Correspondingly, an upward deflection is referred to as negative vertical angulation or

Imagine a flashlight beam approaching a picket fence perpendicularly at a 90-degree

Film Holding Devices:

PARALLELING TECHNIQUE METHODOLOGY:

A) Procedure for the Maxillary Central/Lateral Incisors

5. Follow the film and equipment manufacturer’s recommendation concerning exposure

B) Procedure for the Maxillary Canines:

5. Follow the film and equipment manufacturer’s recommendation concerning exposure

C) Procedure for the Maxillary Premolars:

5. Follow the film and equipment manufacturer’s recommendation concerning exposure

5. Follow the film and equipment manufacturer’s recommendation concerning exposure

Procedure for the Mandibular Central/Lateral Incisors

5. Follow the film and equipment manufacturer’s recommendation concerning exposure

Procedure for the Mandibular Canines

5. Follow the film and equipment manufacturer’s recommendation concerning exposure

Procedure for the Mandibular Premolars

5. Follow the film and equipment manufacturer’s recommendation concerning exposure

Procedure for the Mandibular Molars

THE BISECTING ANGLE TECHNIQUE

The bisecting-the-angle or bisecting angle technique is based on the principle of

In the above figure, we can see the following:

BISECTING ANGLE METHODOLOGY

FULL MOUTH EXPOSURE

Procedure for the Maxillary Central/Lateral Incisors:

5. Follow the film and equipment manufacturer’s recommendation concerning exposure

Procedure for the Maxillary Canines:

5. Follow the film and equipment manufacturer’s recommendation concerning exposure

Procedure for the Maxillary Premolars:

5. Follow the film and equipment manufacturer’s recommendation concerning exposure

Procedure for the Maxillary Molars:

5. Follow the film and equipment manufacturer’s recommendation concerning exposure

Procedure for the Mandibular Central/Lateral Incisors:

5. Follow the film and equipment manufacturer’s recommendation concerning exposure

Procedure for the Mandibular Canines:

5. Follow the film and equipment manufacturer’s recommendation concerning exposure

5. Follow the film and equipment manufacturer’s recommendation concerning exposure

Procedure for the Mandibular Molars: