Use of Extraoral Periapical Radiography in Indian Population
Content
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Use of extraoral periapical radiography in Indian
population: Technique and case reports
DATASET · FEBRUARY 2013
CITATION
READS
1
183
2 AUTHORS:
Rahul Kumar
Neha Khambete
MGM University of Health Sciences
Chatrapati Shahu Maharaj Shikshan Sanstha
49 PUBLICATIONS 38 CITATIONS
36 PUBLICATIONS 43 CITATIONS
SEE PROFILE
SEE PROFILE
Available from: Rahul Kumar
Retrieved on: 23 February 2016
[Downloaded free from http://www.ijdr.in on Saturday, September 21, 2013, IP: 115.240.65.102] || Click here to download free Android application for this journal
Short Communication
Use of extraoral periapical radiography in Indian
population: Technique and case reports
Rahul Kumar, Neha Khambete1
Department of Conservative
Dentistry and Endodontics,
MGM Dental College and
Hospital, Navi Mumbai,
1
Department of Oral Medicine
and Radiology, CSMSS
Dental College and Hospital,
Aurangabad, India
ABSTRACT
Received
: 22‑02‑11
Review completed : 18-05-12
Accepted
: 07‑02‑13
Performing intraoral radiography in certain patients is difficult as these patients are unable to
tolerate intraoral film placement. To assist such patients a new technique has been innovated
using extraoral film placement. Use of this technique has been documented in Caucasian and
Taiwanese populations. In this paper we report use of this technique for Indian population.
We have done about 40 cases using this technique and have found the average angulation for
maxillary (‑25+/‑5 degrees) and mandibular (‑15+/‑5 degrees) teeth for Indian population. We
recommend use of this technique in the personal dental clinics where panoramic radiographic
machines are not readily available. Here we report the technique and cases where diagnostic
imaging was performed in patients using the extraoral periapical technique.
Key words: Extraoral radiography, intraoral films/sensors, periapical radiographs
The need for intraoral periapical radiographs is well
established in all branches of dentistry. However, a large
group of patients are unable to tolerate the intraoral film/
sensor placement. To overcome this, Michael Newmann
and Seymour Friedman in 2003 developed an alternative
technique for treating a wide spectrum of patients which
included developmentally disabled patients, patients with
exaggerated gag reflex, pediatric dental patients, anxious
dental patients, patients with trauma and patients with
limited mouth opening.[1,2] Chia‑Hui‑Chen et al., in 2007
developed a sensor beam alignment aiming device for
performing radiographs using this technique.[3] Both of these
reports document use of extraoral periapical technique in
Caucasian and Taiwanese population, respectively.
TECHNIQUE
For maxillary teeth
The patient sits upright, with his/her mouth was opened
Address for correspondence:
Dr. Rahul Kumar
E‑mail: [email protected]
Access this article online
Quick Response Code:
Website:
www.ijdr.in
PMID:
***
DOI:
10.4103/0970-9290.116689
271
as wide as possible, to allow the X‑ray beam to pass to the
sensor unobstructed from the opposite side of the mouth.
The sensor was placed on the external surface of the cheek,
directly buccal to the tooth. A cotton roll was placed
between the sensor and the cheek to parallel the sensor
with the buccal surface of the tooth. The X‑ray cone was
angled approximately ‑25+/‑5 degrees from the horizontal
plane (for Indian population). Additionally, the X‑ray
beam was aligned perpendicular to the sensor to provide
an accurate image [Figure 1a and b].
For mandibular teeth
The patient sits upright with raised chin. The sensor was
placed on the external surface of the cheek, directly buccal to
the tooth. The X‑ray cone was angled approximately ‑15+/‑5
degrees from the horizontal plane (for Indian population).
The X‑ray beam was aligned perpendicular to the sensor to
provide an accurate image [Figure 2a and b]. The images
were obtained using SOPRO digital imaging system (Acteon
Group, Marseills, France) and a 30 × 40 mm standard
intraoral sensor SOPIX (Acteon Group, Marseills, France).
An intraoral X‑ray machine (Biomedicare, Thane, India)
was used to take the radiographs set at 65kVp, 10 mA,
0.45‑0.55 seconds.
CASE SERIES
Application in patients with trismus
A 24‑year‑old male patient reported to us with chief
complaint of extraoral swelling and dull, throbbing pain in
maxillary left posterior region. The patient was a diagnosed
case of oral submucous fibrosis and the interincisal distance
Indian Journal of Dental Research, 24(2), 2013
[Downloaded free from http://www.ijdr.in on Saturday, September 21, 2013, IP: 115.240.65.102] || Click here to download free Android application for this journal
Extraoral periapical radiography
Kumar and Khambete
was 15 mm. Thus, it was not possible to place the X‑ray film
intraorally. Thus, it was decided to use the extraoral
technique for radiograph, which provided us with essential
diagnostic information [Figure 3].
Application in patients with severe gag reflex
Patients with severe gag reflex are unable to tolerate
intraoral film placement. Hence, radiographs were taken for
such patients with extraoral film placement which provided
us with necessary diagnostic information [Figure 4a‑c].
Application in patients with rubber dam
Taking intraoral radiographs in patients with placement
of rubber dam is time consuming and uncomfortable for
patients. Hence, using the extraoral technique in such
patients results in increased patient compliance and
also requires lesser time providing essential diagnostic
information [Figure 5a and b].
Application in pediatric patients
Pediatric patients are generally apprehensive and reluctant
to intraoral film placement. We used the extraoral technique
to obtain radiographs of such apprehensive patients.
The radiographs provide us with essential diagnostic
details [Figure 6]. Also, patients found this technique less
traumatic and it was easier to obtain patient co‑operation.
DISCUSSION
In 1974, Fisher proposed an extraoral radiographic technique
for obtaining images of third molars using occlusal films, but
a
b
Figure 2 (a and b): Patient positioning for taking extraoral radiographs
of mandibular teeth
a
b
Figure 1 (a and b): Patient positioning for taking extraoral radiographs
of maxillary teeth
a
b
c
Figure 4 (a-c): Extraoral periapical radiograph of patients with severe
gag reflex
Figure 3: Extraoral periapical radiograph of patient with trismus
a
b
Figure 5 (a and b): Extraoral periapical radiographs of dental patients
with rubber dam
Indian Journal of Dental Research, 24(2), 2013
Figure 6: Extraoral periapical radiograph of pediatric dental patient
272
[Downloaded free from http://www.ijdr.in on Saturday, September 21, 2013, IP: 115.240.65.102] || Click here to download free Android application for this journal
Extraoral periapical radiography
the requisite high kVP (as high as 90 kVP) had limited its
daily clinical application.[4] We found that, using a digital
imaging system 65 kVP was sufficient to produce image
with adequate diagnostic quality comparable with the
conventional intraoral periapical radiographs.
The extraoral radiographic technique is a useful alternative
technique and has proved to be effective for the patients
who are unable to tolerate the conventional technique.
Appropriate images having been successfully acquired
which provide us with adequate details and diagnostic
quality. However, the disadvantages of this technique are
the procedure being technique sensitive, slightly lower
resolution of images and inability to obtain radiographs of
anterior teeth.
With recent advances in dental radiology, various
techniques like panoramic radiography are available to
manage such patients. However, we recommend use of this
technique in the personal dental clinics where panoramic
273
Kumar and Khambete
radiographic machines are not readily available. Also, this
technique can be used where active treatment is being
carried out.
To conclude, this technique is not meant for replacing
conventional intraoral radiography. However, it can be
used where intraoral film placement is difficult to achieve.
REFERENCES
1.
2.
3.
4.
Newman ME, Friedman S. Extraoral radiographic technique: An
alternative approach. J Endod 2003;29:419‑21.
Ingle JI, Bakland LK, Baumgartner JC. Ingle’s Endodontics. 6th ed. USA:
PMPH Publisher; 2008. p. 554‑600.
Chen CH, Lin SH, Chiu HL, Lin YJ, Chen YK, Lin LM. An aiming device
for an extraoral radiographic technique. J Endod 2007;33:758‑60.
Fisher D. Extraoral radiographic technique of third molars. Aust Dent J
1974;19:306‑7.
How to cite this article: Kumar R, Khambete N. Use of extraoral periapical
radiography in Indian population: Technique and case reports. Indian J Dent
Res 2013;24:271-3.
Source of Support: Nil, Conflict of Interest: None declared.
Indian Journal of Dental Research, 24(2), 2013
Use of extraoral periapical radiography in Indian
population: Technique and case reports
DATASET · FEBRUARY 2013
CITATION
READS
1
183
2 AUTHORS:
Rahul Kumar
Neha Khambete
MGM University of Health Sciences
Chatrapati Shahu Maharaj Shikshan Sanstha
49 PUBLICATIONS 38 CITATIONS
36 PUBLICATIONS 43 CITATIONS
SEE PROFILE
SEE PROFILE
Available from: Rahul Kumar
Retrieved on: 23 February 2016
[Downloaded free from http://www.ijdr.in on Saturday, September 21, 2013, IP: 115.240.65.102] || Click here to download free Android application for this journal
Short Communication
Use of extraoral periapical radiography in Indian
population: Technique and case reports
Rahul Kumar, Neha Khambete1
Department of Conservative
Dentistry and Endodontics,
MGM Dental College and
Hospital, Navi Mumbai,
1
Department of Oral Medicine
and Radiology, CSMSS
Dental College and Hospital,
Aurangabad, India
ABSTRACT
Received
: 22‑02‑11
Review completed : 18-05-12
Accepted
: 07‑02‑13
Performing intraoral radiography in certain patients is difficult as these patients are unable to
tolerate intraoral film placement. To assist such patients a new technique has been innovated
using extraoral film placement. Use of this technique has been documented in Caucasian and
Taiwanese populations. In this paper we report use of this technique for Indian population.
We have done about 40 cases using this technique and have found the average angulation for
maxillary (‑25+/‑5 degrees) and mandibular (‑15+/‑5 degrees) teeth for Indian population. We
recommend use of this technique in the personal dental clinics where panoramic radiographic
machines are not readily available. Here we report the technique and cases where diagnostic
imaging was performed in patients using the extraoral periapical technique.
Key words: Extraoral radiography, intraoral films/sensors, periapical radiographs
The need for intraoral periapical radiographs is well
established in all branches of dentistry. However, a large
group of patients are unable to tolerate the intraoral film/
sensor placement. To overcome this, Michael Newmann
and Seymour Friedman in 2003 developed an alternative
technique for treating a wide spectrum of patients which
included developmentally disabled patients, patients with
exaggerated gag reflex, pediatric dental patients, anxious
dental patients, patients with trauma and patients with
limited mouth opening.[1,2] Chia‑Hui‑Chen et al., in 2007
developed a sensor beam alignment aiming device for
performing radiographs using this technique.[3] Both of these
reports document use of extraoral periapical technique in
Caucasian and Taiwanese population, respectively.
TECHNIQUE
For maxillary teeth
The patient sits upright, with his/her mouth was opened
Address for correspondence:
Dr. Rahul Kumar
E‑mail: [email protected]
Access this article online
Quick Response Code:
Website:
www.ijdr.in
PMID:
***
DOI:
10.4103/0970-9290.116689
271
as wide as possible, to allow the X‑ray beam to pass to the
sensor unobstructed from the opposite side of the mouth.
The sensor was placed on the external surface of the cheek,
directly buccal to the tooth. A cotton roll was placed
between the sensor and the cheek to parallel the sensor
with the buccal surface of the tooth. The X‑ray cone was
angled approximately ‑25+/‑5 degrees from the horizontal
plane (for Indian population). Additionally, the X‑ray
beam was aligned perpendicular to the sensor to provide
an accurate image [Figure 1a and b].
For mandibular teeth
The patient sits upright with raised chin. The sensor was
placed on the external surface of the cheek, directly buccal to
the tooth. The X‑ray cone was angled approximately ‑15+/‑5
degrees from the horizontal plane (for Indian population).
The X‑ray beam was aligned perpendicular to the sensor to
provide an accurate image [Figure 2a and b]. The images
were obtained using SOPRO digital imaging system (Acteon
Group, Marseills, France) and a 30 × 40 mm standard
intraoral sensor SOPIX (Acteon Group, Marseills, France).
An intraoral X‑ray machine (Biomedicare, Thane, India)
was used to take the radiographs set at 65kVp, 10 mA,
0.45‑0.55 seconds.
CASE SERIES
Application in patients with trismus
A 24‑year‑old male patient reported to us with chief
complaint of extraoral swelling and dull, throbbing pain in
maxillary left posterior region. The patient was a diagnosed
case of oral submucous fibrosis and the interincisal distance
Indian Journal of Dental Research, 24(2), 2013
[Downloaded free from http://www.ijdr.in on Saturday, September 21, 2013, IP: 115.240.65.102] || Click here to download free Android application for this journal
Extraoral periapical radiography
Kumar and Khambete
was 15 mm. Thus, it was not possible to place the X‑ray film
intraorally. Thus, it was decided to use the extraoral
technique for radiograph, which provided us with essential
diagnostic information [Figure 3].
Application in patients with severe gag reflex
Patients with severe gag reflex are unable to tolerate
intraoral film placement. Hence, radiographs were taken for
such patients with extraoral film placement which provided
us with necessary diagnostic information [Figure 4a‑c].
Application in patients with rubber dam
Taking intraoral radiographs in patients with placement
of rubber dam is time consuming and uncomfortable for
patients. Hence, using the extraoral technique in such
patients results in increased patient compliance and
also requires lesser time providing essential diagnostic
information [Figure 5a and b].
Application in pediatric patients
Pediatric patients are generally apprehensive and reluctant
to intraoral film placement. We used the extraoral technique
to obtain radiographs of such apprehensive patients.
The radiographs provide us with essential diagnostic
details [Figure 6]. Also, patients found this technique less
traumatic and it was easier to obtain patient co‑operation.
DISCUSSION
In 1974, Fisher proposed an extraoral radiographic technique
for obtaining images of third molars using occlusal films, but
a
b
Figure 2 (a and b): Patient positioning for taking extraoral radiographs
of mandibular teeth
a
b
Figure 1 (a and b): Patient positioning for taking extraoral radiographs
of maxillary teeth
a
b
c
Figure 4 (a-c): Extraoral periapical radiograph of patients with severe
gag reflex
Figure 3: Extraoral periapical radiograph of patient with trismus
a
b
Figure 5 (a and b): Extraoral periapical radiographs of dental patients
with rubber dam
Indian Journal of Dental Research, 24(2), 2013
Figure 6: Extraoral periapical radiograph of pediatric dental patient
272
[Downloaded free from http://www.ijdr.in on Saturday, September 21, 2013, IP: 115.240.65.102] || Click here to download free Android application for this journal
Extraoral periapical radiography
the requisite high kVP (as high as 90 kVP) had limited its
daily clinical application.[4] We found that, using a digital
imaging system 65 kVP was sufficient to produce image
with adequate diagnostic quality comparable with the
conventional intraoral periapical radiographs.
The extraoral radiographic technique is a useful alternative
technique and has proved to be effective for the patients
who are unable to tolerate the conventional technique.
Appropriate images having been successfully acquired
which provide us with adequate details and diagnostic
quality. However, the disadvantages of this technique are
the procedure being technique sensitive, slightly lower
resolution of images and inability to obtain radiographs of
anterior teeth.
With recent advances in dental radiology, various
techniques like panoramic radiography are available to
manage such patients. However, we recommend use of this
technique in the personal dental clinics where panoramic
273
Kumar and Khambete
radiographic machines are not readily available. Also, this
technique can be used where active treatment is being
carried out.
To conclude, this technique is not meant for replacing
conventional intraoral radiography. However, it can be
used where intraoral film placement is difficult to achieve.
REFERENCES
1.
2.
3.
4.
Newman ME, Friedman S. Extraoral radiographic technique: An
alternative approach. J Endod 2003;29:419‑21.
Ingle JI, Bakland LK, Baumgartner JC. Ingle’s Endodontics. 6th ed. USA:
PMPH Publisher; 2008. p. 554‑600.
Chen CH, Lin SH, Chiu HL, Lin YJ, Chen YK, Lin LM. An aiming device
for an extraoral radiographic technique. J Endod 2007;33:758‑60.
Fisher D. Extraoral radiographic technique of third molars. Aust Dent J
1974;19:306‑7.
How to cite this article: Kumar R, Khambete N. Use of extraoral periapical
radiography in Indian population: Technique and case reports. Indian J Dent
Res 2013;24:271-3.
Source of Support: Nil, Conflict of Interest: None declared.
Indian Journal of Dental Research, 24(2), 2013
