Tube-Shift Localization (Clark)

SLOB Rule
Same Lingual Opposite Buccal
The SLOB rule is used to identify the buccal or
lingual location of objects (impacted teeth, root
canals, etc.) in relation to a reference object
(usually a tooth). If the image of an object moves
mesially when the tubehead is moved mesially
(same direction), the object is located on the
lingual. If the image of the object moves distally
when the tubehead moves mesially (opposite
direction), the object is located on the buccal.

For the SLOB rule to work, there must be

a change in the horizontal or vertical
angulation of the x-ray beam as the
tubehead is moved. This change in
angulation will alter the relationship
between the object of interest and the
reference object, allowing you to
determine the buccal or lingual location.
The closer the object to be localized is to
the reference object, the less the amount
of movement of the image of the object in
relation to the reference object.

In the diagram at right, the

tubehead is moved, but there is
no change in direction of the x-ray
beam, which results in no change
in location of the object of interest
in relation to reference object
(see below). Moving the tubehead
without changing the beam
direction would often result in a
cone cut , depending on how far
the tubehead is moved (see below
right).

When using the SLOB rule, the direction of the beam

must be opposite to the way the tubehead is moved.
Horizontal Tube Shift: When the tubehead is moved
mesially, the beam must be directed more distally
(from the mesial). If the tubehead is moved distally, the
direction of the beam must be more towards the mesial
(from the distal).
Vertical Tube Shift: The SLOB rule also works for
movement of the tubehead in a vertical direction.
Downward movement of the tubehead requires that the
beam be directed upward and when the tubehead is
moved upward, the beam must be directed downward.

Moving the tubehead mesially or

distally and changing the direction of
the x-ray beam (as described in
previous slide) will result in the
movement of the object of interest on
the film in relation to the reference
object. In the diagram at right, the
tubehead is moved distally with the xray beam directed more mesially (from
the distal). The object of interest,
located lingual to the first molar,
moves distally, in the same direction
as the tubehead movement.

Horizontal movement of the tubehead and x-ray beam

incisors
canine
premolar
molar
In moving from the incisor film to the canine film, the
canine film to the premolar film and the premolar film to the
molar film, the tubehead moves distally and the beam is
directed more mesially. There is not much change in
angulation from the premolar to the molar film; the normal
situation would be that the beam is directed slightly more
from the distal (or to the mesial) as the tubehead is moved
distally for the molar projection.

mesial

Horizontal movement
In the diagram at left, the
buccal (yellow) and lingual
(red) objects of interest are
superimposed on each other
because the beam is directed
perpendicular to both of them
and they are in the same
relative position mesiodistally
and vertically. Both images are
located above the second
molar.

distal

distal

mesial

Horizontal movement

mesial

In the diagram at left, the

tubehead is moved distally
and the beam is directed
mesially. On the radiograph,
the buccal object of interest
(yellow) moves mesially
(opposite to tubehead
movement) in relation to the
second molar and the lingual
object of interest (red) moves
distally (same direction as
tubehead) in relation to the
second molar.

distal

distal

mesial

mesial

Horizontal movement
In the diagram at right, the
tubehead is moved mesially
and the beam is directed
distally. On the radiograph,
the buccal object of interest
(yellow) moves distally
(opposite to tubehead
movement) in relation to the
second molar and the lingual
object of interest (red) moves
mesially (same direction as
tubehead) in relation to the
second molar.

distal

distal

mesial

Vertical movement of the tubehead and x-ray beam

Maxillary PA

BW
Mandibular PA
In moving from the maxillary periapical to the bitewing
and from the bitewing to the mandibular periapical, the
tubehead moves down and the beam is redirected
upward (opposite direction; decreased vertical
angulation).

Vertical movement
In the diagram at left, the
buccal (yellow) and lingual
(red) objects of interest are
superimposed on each other
because the beam is directed
perpendicular to both of them
and they are in the same
relative position mesiodistally
and vertically. Both images are
superimposed over the
mandibular second premolar.

Vertical movement
In the diagram at left, the
tubehead is moved upward
and the beam is directed
downward. On the radiograph,
the buccal object of interest
(yellow) moves down
(opposite to tubehead
movement) in relation to the
second premolar and the
lingual object of interest (red)
moves up (same direction as
tubehead) in relation to the
second premolar.

Vertical movement
In the diagram at left, the
tubehead is moved downward
and the beam is directed
upward. On the radiograph,
the buccal object of interest
(yellow) moves up (opposite
to tubehead movement) in
relation to the second
premolar and the lingual
object of interest (red) moves
down (same direction as
tubehead) in relation to the
second premolar.

Usually when using the tube-shift method of

localization, two film are taken of the same area
using different beam angulations. However, this
localization technique will also work when
comparing films taken as part of a complete series
of radiographs. The only difficulty is determining
which way the beam was directed when
comparing the molar and premolar films. Usually
this can be done by comparing the relative
positions of anatomical structures (e.g., zygomatic
process in maxilla or mental foramen in mandible)
or the angulation of the roots of the teeth.
(See following two slides).

premolar

molar

For the films above, we know that the tubehead was moved
distally from the premolar to the molar film. The zygomatic
process (red arrows) is located at the distal aspect of the 2 nd
molar on the premolar film and it is located over the distal
aspect of the 1st molar on the molar film. This indicates that
it moved mesially as the tubehead moved distally. We know
that the zygomatic process is buccal to the teeth and, using
the SLOB rule, it follows that the tubehead was directed
more mesially on the molar film (Buccal object moved
opposite to tubehead movement).

premolar

molar

Another way of determining the change in the direction

of the beam is to look at the angulation of the teeth. In
the premolar film, the roots of the teeth are angled
distally, indicating that the beam was directed distally
(from the mesial). In the molar film, the roots are more
upright or angled slightly mesially, indicating the beam
was directed more mesially (from the distal). Therefore,
the tubehead shifted distally and the beam was angled
in the opposite direction, allowing the use of the SLOB
rule (These films were taken from Slide 3 in the review
films to follow).

On the following slides, identify the buccal or

lingual location of the selected objects. Each
slide will be followed with a slide indicating the
correct response and a brief explanation.

canine film

incisor film

Is the composite restoration on tooth # 8 (red arrow)

located on the buccal or lingual?

canine film

incisor film

The restoration is located on the buccal. The tubehead

moves mesially from the canine to the incisor film (x-ray
beam projected more distally) and the composite moves
distally, which is the opposite direction.

2
premolar film

canine film

The red arrow in the canine film is pointing to the gutta

percha in which canal of the maxillary first premolar?

2
premolar film

canine film

The arrow identifies the lingual canal. The tubehead

moves mesially from the premolar to the canine film
(beam directed more distally) and the gutta percha
indicated by the arrow also moves mesially.

lingual
buccal

PID

D
PI

When the tubehead is moved, with the beam angulation

redirected in the opposite direction, the two canals, which
are initially superimposed (premolar periapical above) will
separate. The lingual canal (red arrow) will follow the
tubehead movement and the buccal canal (blue arrow) will
move in the opposite direction, as seen on the canine film.

premolar film

molar film

Is the maxillary second

premolar displaced to the
buccal or the lingual?

premolar bitewing

premolar film

premolar bitewing

molar film

The tubehead moves distally from the

premolar film to the molar film. The
second premolar also moves distally,
overlapping the first molar more in the
molar film. In moving from the
premolar periapical to the bitewing,
the tubehead moves down and the
premolar also moves down. The
displacement is to the lingual.

incisor film

canine film

Is the displaced incisor (arrow) located on the buccal or

the lingual?

incisor film

canine film

The lateral incisor is displaced to the lingual. The

tubehead moves distally from the incisor to the canine
film. The lateral incisor also moves distally, covering
half the canine on the canine film.

canine film

premolar film

Is the radiopaque object identified by the arrow located

on the buccal or the lingual?

canine film

premolar film

Lingual. The tubehead moves mesially from the premolar

film to the canine film. The object also moves mesially,
starting out distal to the first molar on the premolar film and
ending up mesial to the first molar on the canine film. This
object is apparently located toward the center of the palate
because of the extreme movement from distal to mesial on
the films.

premolar film

incisor film

The maxillary right lateral incisor is tilted out of position.

In which direction (buccal or lingual) is it tipped?

premolar film

incisor film

The tubehead moves mesially from the premolar film to the

incisor film. The lateral incisor also moves mesially, starting
out overlying the canine on the premolar film and ending up
over the central incisor on the incisor film. Since the lateral
moves the same direction as the tubehead, it is tipped
lingually.

incisor film

canine film

The maxillary left canine is impacted. Is it located more to

the buccal or the lingual?

incisor film

canine film

The tubehead moves distally from the incisor film to the

canine film. The impacted canine also moves distally,
starting out overlying # 9 on the incisor film and ending up
over the lateral incisor on the canine film. The impacted
tooth is located on the lingual (palatal).

premolar periapical film

premolar bitewing film

The amalgam restoration

indicated by the arrow is
located on the buccal or
the lingual?

premolar periapical film

premolar bitewing film

8
The tubehead moves down
from the premolar
periapical film to the
bitewing film. The
restoration also moves
down, starting out above
the two occlusal
restorations (red arrows)
on the periapical film and
ending up overlapping the
occlusal restorations on
the bitewing film. The
restoration (black arrow) is
located on the lingual.

premolar bitewing film

premolar periapical film

The mandibular second

premolar is tilted out of
position. In which
direction (buccal or
lingual) is it tipped?

premolar bitewing film

premolar periapical film

The tubehead moves

down from the premolar
bitewing film to the
periapical film. The
second premolar also
moves down, indicating
that it is lingually tipped.

molar bitewing film

10

molar periapical film

The arrow points to a

retention pin. Is the
pin located in the
buccal or lingual
portion of the tooth?

molar bitewing film

molar periapical film

10
The tubehead moves
down from the molar
bitewing film to the
periapical film. The
pin identified by the
arrows also moves
downward. Since the
movement of the pin
follows the direction
the tubehead was
moved, it is located
toward the lingual
aspect of the tooth.

11
premolar film

molar film

Does the arrow point to the mesiobuccal or mesiolingual

canal?

11
premolar film

molar film

The tubehead moves distally from the premolar film to the

molar film. The canal indicated by the arrow also moves
distally to align with the other canal, which moves mesially
(The canals have to move in opposite directions in order to
be superimposed on each other). The indicated canal
(arrow) is located mesiolingually.

molar bitewing film

molar periapical film

12

The amalgam particle

indicated by the arrows
is located bucally or
lingually?

molar bitewing film

12

molar periapical film

The tubehead moves down

from the bitewing film to the
mandibular periapical film.
The amalgam particle moves
upward (opposite direction),
indicating that it is located
buccally.

Is the restoration
indicated by the red
arrows located on the
buccal or lingual of the
first premolar?

13

premolar bitewing film

canine periapical film

premolar periapical film

13
The tubehead moves distally from

premolar bitewing film

the canine film to the premolar

periapical. The restoration moves
mesially. From the bitewing to the
mandibular premolar periapical, the
tubehead moves down and the
restoration moves up. The
restoration is located on the buccal
of # 21.
canine periapical film

premolar periapical film

14

premolar film
incisor film

canine film

The gutta percha root canal filling identified by the red

arrows is located in which canal?

14

premolar film
incisor film

canine film

In moving from the incisor film to the canine film, and

then from the canine film to the premolar film, the
tubehead moves distally. The gutta percha (red arrow)
also moves distally in each case. Therefore, it is in the
lingual canal.