drg. Shanty Chairani, M. Si.

The basic principles of shadow casting are:

1. The focal spot (source of radiation) should be as small as
possible
2. The focal spot-object distance should be as long as possible
3. The object-film distance should be as small as possible
4. The long axis of the object and the film planes should be
parallel
5. The X-ray beam should strike the object and the film
planes at right angles
6. There should be no movement of the tube, film or patient
during exposure.
Terminology
Parallel: Moving or lying in the same
plane, always separated by the same
distance and not intersecting
Perpendicular: Intersecting at or forming a
right angle
Right angle: An angle of 90 degrees formed
by two lines perpendicular to each other
Long axis of the tooth: An imaginary line that
divides the tooth longitudinally into two
equal halves
Central ray: The central portion of the
primary beam of x-radiation
Paralleling Technique
Also known as the extension cone paralleling [XCP]
technique, right-angle technique, and long-cone
technique)
Basic principle of this technique :
The receptor is placed in the mouth parallel to
the long axis of the tooth being radiographed.
The central ray of the x-ray beam is directed
perpendicular (at a right angle) to the
receptor and the long axis of the tooth
A beam alignment device must be used to
keep the receptor parallel with the long axis
of the tooth. The patient cannot hold the
receptor in this manner.
Receptors Used for Paralleling
Technique
The sizes of intraoral receptors used in the
paralleling technique depend on the teeth
being radiographed.
In the anterior regions, size 1 receptor is
used; this narrow size is needed to permit
placement high in the palate without bending
or curving. Size 1 is always positioned with
the long portion of the receptor in a
vertical (upright) direction.
In the posterior regions, size 2 receptor is
used. Size 2 is always placed with the long
portion of the receptor in a horizontal
(sideways) direction
Beam Alignment Devices
The paralleling technique requires the use
of a beam alignment instrument to position
the receptor parallel to the long axis of
the tooth.
Beam alignment devices (film holders) are used
to position an intraoral receptor in the
mouth and maintain the receptor in
position during exposure
Some commercial beam alignment devices : the XCP
(extension cone paralleling) instruments, grip
receptor holder, stable bite block
Rules for Paralleling Technique
Receptor placement : Thereceptor must be
positioned to cover the prescribed area of
teeth to be examined.
Receptor position. The receptor must be
positioned parallel to the long axis of the
tooth. The receptor and beam alignment
device must be placed away from the
teeth and toward the middle of the
oral cavity
 Vertical angulation. The central ray of the
x-ray beam must be directed perpendicular
(at a right angle) to the receptor and
the long axis of the tooth
Horizontal angulation. The central ray of
the x-ray beam must be directed through
the contact areas between teeth
Film receptor exposure. The x-ray beam must
be centered on the receptor to ensure
that all areas are exposed.
The film and long axis of the tooth are parallel. The central
ray is perpendicular to the tooth and the film. An increased
target film distance (16 inches) is required
 The locator ring of film holder automatically sets the
vertical and horizontal angles and centers the X-ray
beam on the film packet.
Vertical angulation: The central ray of the X-ray beam
must be directed perpendicular to the film and the long
axis of the tooth.
Horizontal angulation: The central ray of theX-ray beam
must be directed through the contact areas between the
teeth
MODIFICATIONS IN
PARALLELING TECHNIQUE
Shallow Palate
In a patient with a shallow palate,
tilting of the bite-block occurs, which
results in a lack of parallelism between
the receptor and the long axis of the
tooth.
If the lack of parallelism between the
receptor and the long axis of the tooth
does not exceed 20 degrees, the
resultant image is generally acceptable
 When the lack of parallelism is greater than 20
degrees, a modification in technique is necessary, as
follows:
Cotton rolls. To position the receptor parallel to the
long axis of the tooth, two cotton rolls can be placed,
one on each side of the bite-block. As a
result, however, periapical coverage is reduced.
Vertical angulation. To compensate for the lack of
parallelism, the vertical angulation can be increased by 5
to 15 degrees more than the XCP instrument indicates.
However, image distortion occurs as a result.
 Bony Growths
For maxillary torus, the receptor must be placed on
the far side of the torus (not on the torus) and then
exposed
For mandibular tori, the receptor must be placed
between the tori and the tongue (not on the tori) and
then exposed
 Mandibular Premolar Region
The receptor is tipped away from the tongue while the
bite-block is placed firmly on the mandibular premolars.
When the patient closes on the bite-block, the receptor
is moved into proper position
Film. The lower edge of the film can be gently curved,
or softened, to prevent discomfort.
Advantage of Paralelling Technique
Accuracy : the image is very representative of the
actual tooth, free of distortion and exhibits maximum
detail and definition.
Simplicity : film holder with a beam alignment device
eliminates the need to determine horizontal and
vertical angulations.
Duplication: easy to standardize and can be accurately
duplicated or repeated, when serial radiographs are
indicated.
Disadvantage of Paralelling
Technique
Film placement: The film holding device is difficult to
place and adjust especially in child patients and adults
with a small mouth or shallow palate.
Positioning the holders within the mouth can be
difficult for inexperienced operators.
Patient discomfort: The film holding device may
impinge on the oral soft tissues and cause discomfort
and gagging.
Object film distance is increased.
Positioning the film in the third molar region can be
difficult.
BITE WING RADIOGRAPH
The Bite Wing Technique or the Interproximal
Technique is a method used to examine the
interproximal surfaces of teeth.
Indications
1. Detection of interproximal caries.
2. Monitoring progression of dental caries.
3. To study the height of the pulp chamber
4. Detection of secondary caries below restorations.
5. Evaluating periodontal conditions.
6. To study the height of the alveolar bone or
assessment of bone loss
7. For detecting calculus deposited in the interproximal
areas
8. In the diagnosis of pulp stone
BITE WING RADIOGRAPH
Principles
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 of 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 recommended to compensate
for the slight bend of the upper portion of the film and
the slight tilt of the maxillary teeth, so it preclude
overlap of the cusps onto the occlusal surface.
Bite-Wing Receptors
Size 0 is used to examine the posterior teeth of children
with primary dentitions. This receptor is always placed
with the long portion of the receptor in a horizontal
(sideways) direction.
The size 1 bite-wing film is used to examine the anterior
teeth in children.
Size 2 is used to examine the posterior teeth in adults
and may be placed horizontally or vertically. For most bite-
wing exposures, a size 2 receptor is placed with the long
portion of the receptor in a horizontal direction. When a
vertical posterior bite-wing exposure is indicated, a size 2
receptor is placed with the long portion of the receptor in a
vertical direction.
Bite-Wing Receptors
Size 3 is longer and narrower than the standard size 2
receptor and is used only for bite-wing exposures. One
receptor is exposed on each side of the arch to examine
all the premolar and molar contact areas. A size 3
receptor is placed with the long portion of the receptor
in a horizontal direction.
 In the adult patient, a size 2 receptor is recommended
for bite-wing exposures.
The size 3 receptor is not recommended. With a size 3
receptor, overlapped contacts often result because of
the difference in the curvature of the arch between the
premolar and molar areas. In addition, the crestal
bone areas may not be adequately seen on the dental
images of patients with bone loss because of the
narrow shape of the receptor.
Beam Alignment Device and Bite-
Wing Tab
In the bite-wing technique, either a beam alignment
device or a bite-wing tab is used to stabilize the
receptor.
Rules of Bite-Wing Technique
Receptor placement. The bite-wing receptor must
be positioned to cover the prescribed area of teeth to
be examined. The identification dot on the film has no
significance in bite-wing film placement.
Receptor position. The bite-wing receptor must be
positioned parallel to the crowns of both maxillary and
mandibular teeth. The receptor must be stabilized
when the patient bites on the bite-wing tab or on the
bite-wing beam alignment device. The patients
occlusal plane must be parallel to the floor.
 Vertical angulation. When a bite-wing tab is used,
the central ray of the x-ray beam must be directed at
+10 degrees
Horizontal angulation. When a bite-wing tab is
used, the central ray of the x-ray beam must be
directed through the contact areas between teeth.
Receptor exposure. The x-ray beam must be centered
on the receptor to ensure that all areas of the receptor
are exposed.
The film is parallel to the crown of the upper end lower
teeth. The central ray is directed downwards (+10 vertical
angulation)
VERTICAL BITE-WINGS
A vertical bite-wing image can be used to examine the
level of alveolar bone in the mouth.
This bite-wing is placed with the long portion of the
receptor in an up-and-down, or vertical, direction
Size 2 receptors may be used for all exposures, or a
combination of size 1 (anterior teeth) and size 2
(posterior teeth) may be used.
BITE-WING TECHNIQUE
MODIFICATIONS
Edentulous Spaces
A cotton roll must be placed in the area of the missing tooth
(or teeth) to support the bite-wing tab or the beam alignment
device.
When the patient closes, opposing teeth occlude on the cotton
roll and support the bite-wing tab or the beam alignment
device.
Bony Growths
The receptor must be placed between the tori and the tongue
(not on the tori) and then exposed.
In large tori, a bite-wing beam alignment device is
recommended.
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