occlusal techniques

Occlusal techniques Mandibular techniques

Islam Kassem

ikassem@dr.com

Outlines

Definition

Patient management

Classifications : Mand

Max

Clinical indications & techniques

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Dental radiograph

I – Extra oral

II- Intraoral : Periapical

Bite wing

Occlusal

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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.

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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).

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Lower 90° occlusal

This projection shows a plan view of the tooth bearing

portion of the mandible and the floor of the mouth. A minor variation of the technique is also used to show unilateral lesions.

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ikassem@dr.com

ikassem@dr.com

Main clinical indications

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Detection 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.

Technique and positioning

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1. 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 patient's chin, in the midline, centring on an imaginary line joining the first molars, at an angle of 90° to the film .

Variation of technique. To show a particular part of the mandible, the film packet is placed in the mouth with its long axis anteroposteriorly over the area of interest. The X-ray tubehead, still aimed at 90° to the film, is centred below the

bodyof the mandible in that area. Note: The lower 90° occlusal is mounted as if the examiner were looking into the patient's mouth. The radiograph is therefore mounted with the embossed dot pointing away from the examiner.

ikassem@dr.com

ikassem@dr.com

Mandibular Occlusal

Pathology Sialoliths Pedo anterior

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ikassem@dr.com

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

Lower 45° occlusal

This 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.

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Main clinical indications

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• Periapical assessment of the lower incisor

teeth, especially useful in adults and children unable to tolerate periapical films

• Evaluation of the size and extent of lesions

such as cysts or tumours affecting the anterior

part of the mandible

• Assessment of displacement fractures of the

anterior mandible in the vertical plane.

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Technique and positioning

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1. The patient is seated with the head supported and 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

ikassem@dr.com

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).

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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.

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Main clinical indications

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• Detection of radiopaque calculi in a submandibular salivary gland

• Assessment of the bucco-lingual position of

unerupted lower wisdom teeth

• Evaluation of the extent and expansion of

cysts, tumours or osteodystrophies in the

posterior part of the body and angle of the

mandible.

Technique and positioning

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1. The film packet, with the white (pebbly) surface facing downwards, is inserted into the mouth, on to the occlusal surfaces of the lower

teeth, over to the side under investigation, with its long axis anteroposteriorly. The patient is asked to bite together gently. 2. The patient's 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

ikassem@dr.com

Thank you