DENTAL RADIOGRAPHY FOR THE PEDIATRIC PATIENT

PRESENTED BY:

AZIZI.NAVID SOTOUDEH.MARYAM

INDICATIONS:
A: Trauma B: Toothache C: Suspected developmental disturbances D: Proximal caries

Selection of Appropriate Radiograph for Child Patient Depend on:

A: Age of the child B: Size of the oral cavity C: Level of the patient cooperation

Biological Effects of the Low Level Radiation

Carcinogenic (cancer) Teratogenesis (malformation) Mutagenesis (mutation)

Methods of Protection
A: B: C: D: Lead apron and thyroid collar Faster film speed Film screen combination Quality control begins with the dark room

NOTE : natural radiation averaging for each human being: 360 (mrem /y) or 3.60
(msiv/y)

Child patient managment

Employ tell-show-do technique Introduce child to X-ray machine & explain procedure Set timer & position cone in approximate angulation before placing film Obtain confidence & co-operation of child & take easy film for patient first Talk to child calmly to distract attention & establish co-operation

PATIENT CATEGORY

PRIMARY DENTITION (PRIOR TO ERUPTION OF FIRST PERMANENT TOOTH)

New patient* All new patients to assess dental diseases and growth and development Proximal bite-wing examination if proximal surface of primary teeth cannot be visualized or probed

CHILD TRANSITIONAL DENTITION (FOLLOWING ERUPTION OF FIRST PERMANENT TOOTH) Individualized radiographic examination consisting of periapical/occlusal views and posterior bite-wings and panoramic examination and posterior bite-wings

Recall patient* Clinical caries or high-risk factors for caries No clinical caries and no factors for caries

Posterior bite-wing examination 6-month intervals or until no carious lesions are evident

Posterior bite-wing examination at 12- to 24-month intervals if proximal surfaces of primary teeth cannot be visualized or probed

Posterior bite-wing examination at 12- to 24-month intervals

Periodontal disease or a history of periodontal treatment

Individualized radiographic examination consisting of selected periapical and/or bite-wing radiographs for areas where periodontal disease (other than non-specific gingivitis) can be demonstrated clinically Usually not indicated Individualized radiographic examination consisting of a periapical/occlusal or panoramic examination

Growth and development assessment

Types of radiographic films

Intra-oral films: are meant for positioning inside the mouth during exposure Extra-oral films: are kept outside the mouth during exposure

Intra-oral radiographs
three type: Intra-oral periapical radiograph (IOPA)

Bitewing radiograph
Occlusal radiograph

FILM SIZES

2 kindS of radiographic techniques:

There are two basic techniques for obtaining periapical radiographs:

Paralleling technique.
Bisection of the angle technique.

The Paralleling Technique: Basic Rules

Film placement: Position the film so that it will cover the teeth.

Film position: Position the film parallel to the long axis of the tooth. The film in the film holder must be placed away from the teeth and toward the middle of the mouth.
Vertical angulation: Direct the central ray of the x-ray beam perpendicular to the film and the long axis of the tooth. Horizontal angulation: Direct the central ray of the x-ray beam through the contact areas between the teeth. Central ray: Center the x-ray beam on the film to ensure that all areas of the film are exposed.

Assembling the XCP (Extension-Cone Paralleling Instruments), Anterior Assembly.

Fig. 41-10

Positions of the film teeth and central ray of the x-ray beam in the paralleling technique.

Fig. 41-5

The x-rays pass through the contact areas of the premolars because the central ray is directed through the contacts and perpendicular to the film.

Fig. 41-6

Fig. 41-14

The Bisecting Technique

The bisection of the angle technique is based on a geometric principle of bisecting a triangle (bisecting means dividing into two equal parts). The angle formed by the long axis of the teeth and the film is bisected, and the x-ray beam is directed perpendicular to the bisecting line. Perpendicular means at a right angle to the film.

The bisecting technique.

Fig. 41-20

Image field Maxilary central incisor Maxillary lateral incisor Maxillary canine Maxillary premolar

Cortical angulation

Point of intery Midline about through the tip of the nose Through the ala of nose about 1cm from the midline

+55 degrees
+55-50 degrees

+45 degrees Through the ala of nose +35 degrees

Below the pupil of eye , close to the level of the ala tragus line
The cheek in line with the outer contus of eye below the zygoma and anterior posterior level with second mollar

Maxillary molar
Mandibular central lateral , incisor

+25 degrees
-25 degrees -20-15 degrees -10 degrees -5 -0degrees

Below the vermilion border of the lip approximately 1cm from the midline

Mandibular canine

Through the canine approximately 3cm from the midline

Through the interproximal space between the first and second premolar teeth
On the cheek below the lateral conthus of eye approximately 3cm above the inferior border of mandible

Mandibular premolar

Mandibular molar

Maxillary incisor exposure.

Fig. 41-30 C & D

Maxillary canine exposure.

Fig. 41-29 C & D

Maxillary premolar exposure.

Fig. 41-33 A & D

Maxillary molar exposure.

Fig. 41-34 A & D

Mandibular incisor exposure.

Fig. 41-32 C & D

Mandibular canine exposure.

Fig. 41-31 C & D

Mandibular premolar exposure.

Fig. 41-35 A & D

Mandibular molar exposure.

Fig. 41-36 A & D

Bite-wing Examinations

A bite-wing radiograph shows the crowns and interproximal areas Bite-wing radiographs are also useful in examining the crestal bone levels between the teeth.(pocket formation)

Basic Principles of the Bite-wing Technique

The film is placed in the mouth parallel to the crowns of both the upper and lower teeth. The film is stabilized when the patient bites on the bite-wing tab or bite-wing film holder. The central ray of the x-ray beam is directed through the contacts of the teeth, using a +10 vertical angulation.

+10 vertical angulation is used to compensate for the slight bend of the upper portion of the film and the tilt of the maxillary teeth.

Fig. 41-37

Premolar bite-wing. A, Film placement. B, Resultant radiograph.

Fig. 41-39

Mounted full mouth series with eight anterior films using the paralleling technique.

Fig. 41-2 B

THANK YOU