INTRAORAL RADIOGRAPHIC TECHNIQUE MANUAL
INTRAORAL RADIOGRAPHIC TECHNIQUE MANUALUtilizing the Paralleling PrincipalDepartment of Oral Health & Diagnostic Sciences3
A full mouth radiographic series (FMX) consists of 20 images composed of periapical (16) andbitewing (4) projections.Periapical radiographs are intended to evaluate the periapical region of the tooth and surroundingbone. Therefore, it is essential to obtain the full length of the tooth and at least 2 mm ofperiapical bone.Bitewing radiographs record, on a single image, the crowns and coronal 1/3 of the interproximalbone of both arches. Bitewings are useful for detecting interproximal carious lesions, boneheight, pulp chamber size and shape, pulp stones, and overhangs on interproximal restorations.It is therefore essential to position the image receptor and x-ray beam so that there is an equaldistribution of both arches in the resulting radiographic image.Instrument Assembly:The Rinn XCP Instrument for a full mouth series (FMX) of x-rays consists of 3 parts:1. 3 biteblocks for the anterior, posterior, and bitewing set-ups.2. 3 Indicator rods for the anterior, posterior, and bitewing set-ups.3. 2 Aiming rings for the anterior, posterior, and bitewing set-ups.a. The same aiming ring is used for the anterior and bitewing set-ups4
Posterior RINN set up for upper right and lower left and upper left and lower right, respectivelyPosterior RINN set up for Upper right and left respectively5
Posterior RINN set up for Lower right and left respectivelyGENERAL RULE FOR PSP PLACEMENT IN RINN INSTRUMENTS: When you lookthrough the aiming ring, you should ONLY see the sensitive side of the image receptor. Thesensitive side is indicated by the black side of the PSP packet (see below images).6
Videos are available that demonstrate proper operatory set-up, Rinn instrument assembly, andscanning of PSP plates.MAXILLARY CENTRAL-LATERAL PROJECTION Use a #1 size Photostimulable Phosphor (PSP) plateCenter the PSP plate vertically in the anterior bite block with the black dot in the groove(black dot in the slot) and the black side of the PSP packet towards the source ofradiation.CORRECT POSITIONING OF THE PSP Center the CENTRAL-LATERAL INCISOR CONTACT on the PSP plate.Place the PSP plate as far back into the mouth as possible so that the PSP plate is asparallel as possible to the long axes of the teeth. This is accomplished by engaging the incisal edges of the incisors in the FIRSTOR SECOND GROOVE of the biteblock. The first or second grooves are located on the outer edge of the biteblock(edge towards the source of radiation).Position the PSP-plate so that the appropriate contact will be open (central-lateralcontact). This is accomplished by projecting the x-ray beam through the contact area/s ofinterestPress the holder against the MAXILLARY INCISORS FIRST, then have the patientgently bite together.NOTE: Sometimes, greater stability of the bite block may be achieved if a cotton roll isplaced BETWEEN the biteblock and the MANDIBULAR TEETH before having thepatient close.Slide the aiming ring down the indicator rod to approximate the skin surface beforemaking the exposure.Resulting radiograph1. The central-lateral contact should be centered in the image.7
2. At least 2 mm of apical bone is visible above the root apex.3. Central-lateral contact is open.MAXILLARY CANINE PROJECTION Use a #1 size Photostimulable Phosphor (PSP) plateCenter the PSP plate vertically in the anterior biteblock with the black dot in the groove(black dot in the slot) and the black side of the PSP packet towards the source ofradiation.CORRECT POSITIONING OF THE PSP 8Center the CANINE in the middle of the PSP plate.Place the PSP plate well away from the palatal surface of the teeth so that the PSP plate isas parallel as possible to the long axis of the cuspid.o This is accomplished by engaging the incisal edge of the cuspid in the FIRST orSECOND GROOVE of the biteblock.Position the PSP-plate so that the appropriate contact will be open.o This is accomplished by projecting the x-ray beam through the contact area ofinterest.o Note: the contact to open is the lateral-canine contact. Do not attempt to open thedistal canine contact; it will be visualized on different views.Press the holder against the canine FIRST, then have the patient gently bite together.NOTE: Sometimes greater stability of the biteblock may be achieved if a cotton roll isplaced BETWEEN the biteblock and the MANDIBULAR TEETH before having thepatient close.Slide the aiming ring down the indicator rod to approximate the skin surface beforemaking the exposure.
Resulting Radiograph1. The canine should be centered in the image.2. At least 2 mm of apical bone is visible above the root apex.3. The lateral-canine contact is open.MAXILLARY PREMOLAR PROJECTION Use a #2 size PSP plate. Center the PSP plate HORIZONTALLY in the posterior biteblock with the black dot in thegroove (black dot in the slot) and the black side of the PSP packet towards the source ofradiation.CORRECT POSITIONING OF THE PSP 9Position the PSP plate near the midline of the palate to ensure that the PSP plate is placedas parallel as possible to the long axes of the premolarso This is accomplished by engaging the buccal cusps in the First or SecondGroove of the bite block).The anterior edge of the PSP plate should be placed adjacent to the maxillary canine on
the side being radiographed so that the distal ½ of the canine will be included in theradiographic image.Position the PSP-plate so that the appropriate contacts will be open.o This is accomplished by projecting the x-ray beam through the contact areas ofinterest.Slide the aiming ring down the indicator rod to approximate the skin surface beforemaking the exposure.Resulting Radiograph1. The distal half of the canine should be visible as well as all of the first and secondpremolars and first molar and sometimes also the mesial half of the 2nd molar.2. At least 2 mm of apical bone is visible above the root apex.3. The contacts should be open.MAXILLARY MOLAR REGION 10Use a #2 size PSP plate.Center the PSP plate HORIZONTALLY in the posterior biteblock with the black dot in thegroove (black dot in the slot) and the black side of the PSP packet towards the source ofradiation.
CORRECT POSITIONING OF THE PSP Orient the PSP plate so that it is as parallel as possible to the long axes of the teeth.o This is accomplished by placing the buccal cusps of the maxillary teeth in the FIRSTor SECOND GROOVE of the biteblock.o This will place the upper edge of the PSP plate at or across the midline of the palate.Position the PSP-plate so that the appropriate contacts will be open.o This is accomplished by projecting the x-ray beam through the contact areas ofinterest.Position the PSP plate to cover the first, second, and third molar areas. The anterior bordershould just cover the distal aspect of the second premolar.o Note: the mesial placement of the edge of the PSP will usually NOT include any ofthe 1st premolar.Slide the aiming ring down the indicator rod to approximate the skin surface before makingthe exposure.Resulting Radiograph1. Radiograph should show all of the first, second, and third molar areas.2. At least 2 mm of apical bone is visible above the root apex.3. The contacts should be open.11
MANDIBULAR CENTRAL-LATERAL PROJECTION Use a #1 size Photostimulable Phosphor (PSP) plateCenter the PSP plate vertically in the anterior biteblock with the black dot in the groove(black dot in the slot) and the black side of the PSP packet towards the source ofradiation.CORRECT POSITIONING OF THE PSP Center the central-lateral contact in the middle of the PSP plate.Engage the biteblock against the INCISAL EDGES of the mandibular incisors in the vicinityof the center hole.The bottom edge of the PSP plate should be placed UNDER THE TONGUE extendingposteriorly into the 2nd premolar-1st molar region.Position the PSP-plate so that the appropriate contact will be open.o This is accomplished by projecting the x-ray beam through the contact area ofinterest.ROTATE the PSP plate DOWNWARD into the floor of the mouth until it is as parallel aspossible to the long axes of the incisors.Press lightly downward and backward on the PSP plate and biteblock to ensure that theholder maintains continuous contact with the incisal edges.Note: sometimes greater stability can be accomplished by placing a cotton roll BETWEENthe top of the biteblock and the MAXILLARY TEETH before having the patient close.Slide the aiming ring down the indicator rod to approximate the skin surface before makingthe exposure.Resulting Radiograph1. The central-lateral contact should be centered in the image.2. At least 2 mm of apical bone is visible below the root apex.3. The central-lateral contact is open.12
MANDIBULAR CANINE PROJECTION Use a #1 size Photostimulable Phosphor (PSP) plate Center the PSP vertically in the anterior biteblock with the black dot in the groove (blackdot in the slot) and the black side of the PSP packet towards the source of radiation.CORRECT POSITIONING OF THE PSP 13Center the canine in the middle of the PSP plate.The PSP plate is placed under the tongue and across the midline.Engage the biteblock against the INCISAL EDGE of the mandibular canine in thevicinity of the center hole.Position the PSP-plate so that the appropriate contact will be open.o This is accomplished by projecting the x-ray beam through the contact area ofinterest.o Note: the contact to open is the lateral-canine contact. Do not attempt to open thedistal canine contact; it will be visualized on different views.ROTATE the PSP plate DOWNWARD into the floor of the mouth until it is as parallel aspossible to the long axis of the canine.Press lightly downward and backward on the PSP plate holder to ensure that the biteblockmaintains continuous contact with the incisal edge of the canine.Note: sometimes greater stability can be achieved by placing a cotton roll BETWEEN thetop of the biteblock and the MAXILLARY TEETH before having the patient close.Slide the aiming ring down the indicator rod to approximate the skin surface beforemaking the exposure.
Resulting Radiograph1. The canine should be centered in the image.2. At least 2 mm of apical bone is visible below the apex.3. The lateral-canine contact is openMANDIBULAR PREMOLAR REGION Use a #2 size PSP plate.Center the PSP plate HORIZONTALLY in the posterior bite block with the black dot in thegroove (black dot in the slot) and the black side of the PSP packet towards the source ofradiation.CORRECT POSITIONING OF THE PSP 14Insert the PSP plate and holder into the mouth and carry it past the central incisors to a pointwhere the anterior edge of the PSP plate is adjacent to the mandibular canine on the sidebeing radiographed.Adjust the PSP plate DOWNWARD past the lateral border of the tongue so that the bottomedge of the PSP plate will pass BETWEEN THE TEETH AND THE TONGUE.o Displace the PSP plate medially (toward the middle of the tongue) to make surethe bottom edge is not pressing against the muscle attachment for the floor of themouth.The biteblock should rest on the MANDIBULAR occlusal surfaces near the center hole.The PSP plate should also be positioned parallel to the lingual surface of the mandibular
teeth.Position the PSP plate so that the appropriate contacts will be open.o This is accomplished by projecting the x-ray beam through the contact areas ofinterest.Ask the patient to gently close together and stabilize the holder, if necessary, with a cottonroll between the biteblock and the MAXILLARY TEETH.Slide the aiming ring down the indicator rod to approximate the skin surface before makingthe exposure.Resulting Radiograph1. Radiograph should show the distal half of the cuspid, all of the first and secondpremolars, the first molar, and sometimes the mesial half of the 2nd molar.2. At least 2 mm of apical bone is visible below the root apex.3. The contacts should be open.MANDIBULAR MOLAR REGION Use a #2 size PSP plate.Center the PSP plate HORIZONTALLY in the posterior biteblock with the black dot in thegroove (black dot in the slot) and the black side of the PSP packet towards the source ofradiation.CORRECT POSITIONING OF THE PSP 15Insert the PSP plate and holder into the mouth and carry it past the central incisors to a point
where the anterior edge of the PSP plate is adjacent to the mandibular second premolar on theside being radiographed.Adjust the PSP plate DOWNWARD past the lateral border of the tongue so that the bottomedge will pass BETWEEN THE TEETH AND THE TONGUE.The bite block should rest on the MANDIBULAR occlusal surfaces near the center hole.Position the PSP-plate so that the appropriate contacts will be open.o This is accomplished by projecting the x-ray beam through the contact areas ofinterest.Ask the patient to gently close together and stabilize the biteblock, if necessary, with a cottonroll between the biteblock and the MAXILLARY TEETH.Slide the aiming ring down the indicator rod to approximate the skin surface before makingthe exposure.Resulting Radiograph1. Radiograph should show the first, second and third molar areas.2. At least 2 mm of apical bone is visible below the root apex.3. The contacts should be open.PREMOLAR BITEWING PROJECTION (horizontal technique) Use a #2 size PSP plate. Center the PSP plate in the bitewing biteblock with the black side of the PSP packet towardsthe source of radiation.16
CORRECT POSITIONING OF THE PSP Position the PSP plate so that its mesial edge will include the distal half of the mandibularcanine.Holding onto the edge of the positioning device, place the biteblock in contact with theMANDIBULAR TEETH.Horizontally, position the PSP plate so that the x-ray beam is directed through themandibular contacts.o There may be some difference in the curvature of the mandibular and maxillaryarches. However, when the x-ray beam is accurately directed through the mandibularpremolar contacts, overlapping is minimal or absent in the maxillary premolarsegment.o Typically this projection requires a 10 angle of the BID (with the patient’s occlusalplane parallel to the floor).Make sure that the PSP plate is BETWEEN the lingual surfaces of the teeth and the lateralborder of the tongue.Slide the aiming ring down the indicator rod to approximate the skin surface before makingthe exposure.Resulting radiograph1. Radiograph should show an equal distribution of both arches.2. The distal half of the maxillary and mandibular canines should be visible as well as the 1stand 2nd premolars, 1st molars and occasionally the second molars.3. The contacts should be open17
MOLAR BITEWING PROJECTION (horizontal technique) Place the PSP plate between the tongue and the teeth and far enough posteriorly to includethe distal of the last erupted tooth in the arch.Typically this projection requires a 10 angle of the BID (with the patient’s occlusal planeparallel to the floor).Horizontally, project the x-ray beam through the contact areas of interest. It is helpful toalign the indicator rod with the maxillary contacts.Resulting Radiograph1.Radiograph should show an equal distribution of both arches.2.Radiograph should include the distal of the last erupted tooth in the arch.3.The contacts should be open.4.It is preferable to see the distal surfaces of the maxillary and mandibular secondpremolars.18
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GRU RADIOGRAPHIC TECHNIQUEMAXILLARY ANTERIOR EXPOSUREAnterior Rinn Instrument, Use #1 PSP plate, place black dot in the slot, black side towards ring 20Patient’s Mouth Open Center area of interest on biteblockLean biteblock so that teeth are in 1st or 2nd grooveIf needed, place cotton roll under the biteblock touching the incisal edges of mandibular anterior teethPatient’s mouth closesSlide the aiming ring down the indicator rod to approximate the skin surfacePlace cone flush with ring and make exposure
MANDIBULAR ANTERIOR EXPOSUREAnterior Rinn Instrument Use #1 PSP plate, place black dot in the slot, black side towards ring 21Patient’s Mouth Open Center area of interest on biteblockLean biteblock so that teeth are in middle grooveIf needed, place cotton roll on top of the biteblock touching the maxillary teethPatient’s mouth closesSlide the aiming ring down the indicator rod to approximate the skin surfacePlace cone flush with ring and make exposure
MAXILLARY POSTERIOR EXPOSUREPosterior Rinn Instrument, Use #2 PSP plate, Place PSP plate horizontally in biteblock, place black dot in the slot,place black side towards ring 22Patient’s Mouth OpenCenter area of interest on bite blockLean biteblock so that teeth are in 1st or 2nd grooveMake PSP plate parallel to lingual of teethIf needed, place cotton roll below the biteblock touching the occlusal surfaces of mandibular posterior teethPatient’s mouth closesSlide the aiming ring down the indicator rod to approximate the skin surfacePlace cone flush with ring and make exposure
MANDIBULAR POSTERIOR EXPOSUREPosterior Rinn Instrument, Use #2 PSP plate, Place PSP plate horizontally in biteblock, place black dot in the slot,place black side towards ring23 Patient’s Mouth Open Slide the aiming ring down the indicator rod to approximate the skin surfaceCenter area of interest on biteblockLean biteblock so that teeth are in middle grooveMake PSP plate parallel to lingual of teethIf needed, place cotton roll against occlusal surfaces of maxillary teethPatient’s mouth closesPlace cone flush with ring and make exposure
BITEWING EXPOSURERinn Bitewing Instrument, Use size #2 PSP plate, place PSP plate horizontally in holder, dot does not matter, black sidetowards ring24 Patient’s Mouth Open Slide the aiming ring down the indicator rod (aiming arm) to approximate the skin surfaceCenter area of interest on biteblockPlace biteblock against mandibular teethAlign aiming arm with mandibular contacts (for premolar bitewing projection)Align aiming arm with maxillary contacts (for molar bitewing projection)Patient’s mouth closesPlace cone flush with ring and make exposure
QUALITY EVALUATION CRITERIAGENERAL CHARACTERISTICS OF A QUALITY RADIOGRAPHIMAGE CONTRAST, DENSITY, SHARPNESS, IDENTIFICATIONRadiographic image should permit differentiation between the various structures of the teeth, theperiodontal ligament space, the lamina dura, the supporting bone and normal anatomiclandmarks.IMAGE COVERAGEAll crowns and roots, including apices, are fully depicted together with the interproximalalveolar crests, contact areas, and surrounding bone regions.IMAGE DEFECTSImages of all teeth and other structures are shown in proper relative size and contour withminimal distortion, without overlapping images where anatomically possible, and without partialimages (cone cuts).ANATOMICAL ACCURACYA properly exposed radiograph is said to have anatomical accuracy when:1. The labial and lingual cemento-enamel junctions of the anterior teeth are superimposed.2. The buccal and lingual cusps of posterior teeth (especially the molars) are superimposed.3. The contacts of the teeth are opened in at least one of the projections of a given area.4. The buccal portion of the alveolar crest is superimposed over the lingual portion of thealveolar crest.5. There is no superimposition of the zygomatic bone over the roots of the maxillary molarteeth.25
EACH SPECIFIC REGION OF THE FMX SHOULD INCLUDE THE FOLLOWING:Maxillary molar areaAll crowns and roots of the maxillary molars including the apices are fully depicted togetherwith the interproximal alveolar crests, contact areas and surrounding bone region. There is nosuperimposition of the lower border of the zygomatic bone over the roots of maxillary molars.The radiograph should include all of the first, second, and third molars (erupted or not) with openinterproximal spaces.Maxillary premolar areaAll the crowns and roots of the maxillary premolars and fi
It is therefore essential to position the image receptor and x-ray beam so that there is an equal distribution of both arches in the resulting radiographic image. Instrument Assembly: The Rinn XCP Instrument for a full mouth series (FMX) of x-rays consists of 3 parts: 1. 3 biteblocks for the anterior, posterior, and bitewing set-ups. 2.File Size: 1MB
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