Intraoral Projection

Periapical

Indication

● Detection of apical infection/inflammation

● Assessment of the periodontal status

● After trauma to the teeth and associated alveolar bone

● Assessment of the presence and position of unerupted teeth

● Assessment of root morphology before extractions

● During endodontics

● Preoperative assessment and postoperative appraisal of apical surgery

● Detailed evaluation of apical cysts and other lesions within the alveolar bone

● Evaluation of implants postoperatively.
Technique
- Paralleling technique
- Bisecting technique
Error
Ideal Quality

Ideal quality criteria

Irrespective of the type of image receptor or tech

nique being used, typical quality criteria for a

periapical radiograph should include:

● The image should have acceptable definition

with no distortion or blurring.

● The image should include the correct anatomi

cal area together with the apices of the tooth/

teeth under investigation with at least 3–4 mm

of surrounding bone.

● There should be no overlap of the approximal

surfaces of the teeth.

The desired density and contrast for film

captured images will depend on the clinical

reasons for taking the radiograph, e.g.

– to assess caries, restorations and the periapical

tissues films should be well exposed and

show good contrast to allow differentiation

between enamel and dentine and between

the periodontal ligament space, the lamina

dura and trabecular bone.

– to assess the periodontal status films should be

underexposed to avoid burnout of the thin

alveolar crestal bone. (see Ch. 22)

● The images should be free of coning off or cone

cutting and other film handling errors.

● The images should be comparable with previ

ous periapical images, both geometrically and

in density and contrast.
Angle

CR=central ray

Bitewing

Theory
- Merupakan Suatu teknik foto Intra oral dimana pasien menggigit sayap kecil yang direkatkan di film
- Hasil foto menunjukkan mahkota Premolar dan Molar
Indication
- Detection of lesions of caries
- Monitoring the progression of dental caries
- Assessment of existing restorations
- Assessment of the periodontal status.
Technique
- Komunikasi dan Prosedur Awal
- Mempersiapkan posisi penderita
- Pasang film
- Procedure
- Central Ray
- Exposure
- Finishing
- Positioning
Image
Ideal Quality

Ideal quality criteria

Irrespective of the type of image receptor being

used, typical quality criteria for a bitewing radio

graph should include:

● The image should have acceptable definition

with no distortion or blurring.

● The image should include from the mesial

surface of the first premolar to the distal surface

of the second molar – if the third molars

are erupted then the 7/8 contact should be

included.

● The occlusal plane/bite-platform should be in

the middle of the image so that the crowns and

coronal parts of the roots of the maxillary teeth

are shown in the upper half of the image and

the crowns and coronal parts of the roots of the

mandibular teeth are shown in the lower half of

the image, and the buccal and lingual cusps

should be superimposed.

● The maxillary and mandibular alveolar crests

should be shown.

● There should be no overlap of the approximal

surfaces of the teeth.

● The desired density and contrast for film

captured images will depend on the clinical
Failure
- Match Band Effect
- Cervical Burn Out
Lembar Interpretasi
TOPIK 3. PSA

Evaluasi mutu Kualitas RO Bitewing
1. Menentukan apakah kontras, detil dan ketajaman radiograf baik : Kontras : Terdapat perbedaan antar daerah radioopak dan radiolusen. Daerah yang tidak terdapat obyek harus tampak sangat hitam/radiolusen, dan daerah dengan kepadatan tinggi (contoh : email) harus tampak sangat putih/radioopak. Detail : Struktur anatomis objek terlihat jelas Ketajaman : Outline/ batas tepi dari setiap struktur anatomis terlihat jelas.
2. Menentukan apakah daerah interdental terlihat jelas: • Tujuan dari melihat daerah interdental ialah melihat ada tidaknya distorsi horizontal. Jika distorsi horizontal minimal maka daerah interdental terlihat jelas.
3. Menentukan apakah cusp bukal dan palatal/ lingual terletak sebidang : Tujuannya untuk melihat ada/ tidaknya distorsi vertikal. Untuk gigi anterior yang menjadi indikator ialah singulum. • Jika sudut vertikal terlalu besar maka gigi tampak memendek sehingga singulum berhimpit dengan 1/3 servikal mahkota dan tampak gambaran radiopak tegas, jika sudut vertikal terlalu kecil maka gigi tampak elongasi sehingga jarak singulum menjauhi servikal line dan tampak gambaran radiopak difus.
4. Menentukan apakah distorsi yang terjadi minimal : • Amati distorsi vertikal dan distorsi horizontal yang terjadi kemudian tentukan besarnya. Jika distorsi tidak minimal/ besar, maka radiograf tidak dapat diinterpretasi.
5. Menyimpulkan apakah radiograf dapat diinterpretasi : Radiograf dapat diinterpretasi apabila masuk kriteria 1 atau 2 pada tingkatan kualitas secara subyektif pada radiograf

Occlusal

Classification
- Maxillary occlusal projections
  - Upper standard (or anterior) occlusal (standard occlusal) /Topografi RA
    - Menghasilkan gambaran radiografik bagian anterior / gigi-gigi anterior rahang atas sampai dengan daerah apikalnya.
    - Sinar-X diarahkan ke bawah, kearah batang hidung, dengan sudut 65° – 70° terhadap film.
    - Image
    - Indication
      - Periapical assessment of the upper anterior teeth, especially in children but also in adults unable to tolerate periapical holders
      ● Detecting the presence of unerupted canines, supernumeraries and odontomes
      
      ● As the midline view, when using the parallax method for determining the bucco/palatal position of unerupted canines (see Ch. 24)
      
      ● Evaluation of the size and extent of lesions such as cysts or tumours in the anterior maxilla
      
      ● Assessment of fractures of the anterior teeth and alveolar bone.
  - Upper oblique occlusal (oblique occlusal) / Oklusal Oblik RA
    - Memperlihatkan gambaran radiografik satu sisi rahang atas / gigi gigi daerah posterior.
    - Sinar-X diarahkan ke bawah, kearah pipi dengan sudut 65° – 70° terhadap film, di pertengahan regio yang diperiksa.
    - Indication
      
      ● Periapical assessment of the upper posterior teeth, especially in adults unable to tolerate periapical image receptor holders
      
      ● Evaluation of the size and extent of lesions such as cysts, tumours or other bone lesions affecting the posterior maxilla
      
      ● Assessment of the condition of the antral floor
      
      ● As an aid to determining the position of roots displaced inadvertently into the antrum during attempted extraction of upper posterior teeth
      
      ● Assessment of fractures of the posterior teeth and associated alveolar bone including the tuberosity
    - Image
  - Vertex occlusal (vertex occlusal) – no longer used/ Crosssection RA
    - Memperlihatkan gambaran radiografik potongan melintang rahang atas.
    - dengan memodifikasi teknik Topografi Rahang Alas, yaitu dengan memperbesar sudut sinar-X terhadap film, menjadi + 80° dan di arahkan ke dahi pasien
    - Teknik :
      1. Film diletakkan antara gigi RA dan RB
      2. Pasien diinstruksikan menggigit film
      3. Tube diletakkan pada atap tengkorak pada bagian depan
      4. Arah sinar sentral sejajar dengan sumbu/ panjang gigi incisivus anterior
      5. Teknik ini digunakan untuk menentukan letak gigi impaksi pada hubungan buccopalatinal dalam lengkung gigi.
    - Image
- Mandibular occlusal projections
  - Lower 90° occlusal (true occlusal/vertex oclusal)/ Crossection RB
    - Memperlihatkan potongan melintang rahang bawah / gigi gigi dan dasar mulut.
    - Sinar-X diarahkan ke atas di pertengahan rahang bawah, mengarah ke daerah Molar, dengan sudut 90° terhadap film.
    - Indication
      
      ● 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
      
      ● Assessment of fracture displacement of the anterior mandible in the horizontal plane
      
      ● Assessment of mandibular width prior to implant placement.
    - Image
  - Lower 45° (or anterior) occlusal (standart occlusal)/ Topografi RB
    - Memperlihatkan rahang bawah/gigi anterior rahang bawah. Gambaran radiografiknya mirip teknik biseksi, tapi mencakup daerah yang lebih luas.
    - Sinar-X diarahkan ke atas di pertengahan rahang bawah, mengarah ke dagu penderita dengan sudut 45° terhadap film.
    - Indication
      - Periapical assessment of the lower incisor teeth, especially useful in adults and children unable to tolerate periapical image receptor holders
      ● Evaluation of the size and extent of lesions such as cysts or tumours affecting the anterior part of the mandible
    - Image
  - Lower oblique occlusal (oblique occlusal)./Oklusal Oblik RB
    
    Menghasilkan gambaran radiografik satu sisi rahang bawah, terutama daerah kelenjar submandibula. Akan tetapi karena sinar-X arahnya oblik, maka gambaran anatomis RB yangterproyeksi mengalami distorsi.  Sinar-X diarahkan ke atas dan ke depan, dari arah belakang, di bawah angulus mandibula
    - Indication
      
      ● Periapical assessment of the lower incisor teeth,
      
      especially useful in adults and children unable
      
      to tolerate periapical image receptor holders
      
      ● Evaluation of the size and extent of lesions such
      
      as cysts or tumours affecting the anterior part
      
      of the mandible
      
      ● Assessment of fracture displacement of the
      
      anterior mandible in the vertical plane.
    - Image
Lembar Interpretasi
BNSL
- Komunikasi dan Prosedur Awal
- Mempersiapkan posisi penderita
- Pasang film
- Central Ray
- Exposure
- Finishing
Interpretation
- Lesion
- Outline
- Effect on adjacent surrounding structure
  - The teeth
    
    There may be evidence of:
    
    ● Resorption, which is a feature of long-standing,
    
    benign but locally aggressive lesions, chronic
    
    inflammatory lesions, and malignancy
    
    ● Displacement
    
    ● Delayed eruption
    
    ● Disrupted development, resulting in abnormal
    
    shape and/or density
    
    ● Loss of associated lamina dura
    
    ● Increase in the width of the periodontal liga
    
    ment space
    
    ● Alteration in the size of the pulp chamber
    
    ● Hypercementosis.
  - Surrounding bone
    
    There may be evidence of:
    - Expansion:
      
      – Buccal
      
      – Lingual
      
      – In other directions
    - Displacement or involvement of surrounding
      
      structures, including the:
      
      – Cortex of the inferior dental canal
      
      – Mental foramen
      
      – Lower border cortex of the mandible
      
      – Floor of the antrum
      
      – Floor of the nasal cavity
      
      – Orbits
    ● Ragged destruction
    
    ● Increased density (sclerosis)
    
    ● Subperiosteal new bone formation
    
    ● An increase in the normal width of the inferior
    
    dental canal
    
    ● Irregular bone remodelling, resulting in an
    
    abnormal shape or unusual overall bone
    
    pattern.