Extraoral Imaging

drg. Shanty Chairani, M. Si.

Lateral Jaw Imaging
 It is used to examine the posterior region of the mandible
 It is valuable for use in children, in patients with limited
jaw opening due to a fracture or swelling, and in patients
who have difficulty stabilizing or tolerating intraoral
receptor placement.
 The receptor in this projection is positioned lateral to the
jaw during exposure.
 The following two techniques are used with lateral jaw
projection:
 Body of mandible
 Ramus of mandible
Body of Mandible

 This projection demonstrates the mandibular

premolar and molar regions aswell as the inferior
border of the mandible
 Receptor Placement.
 The cassette is placed flat against the patient’s cheek and is
centered over the body of the mandible.
 The cassette must also be positioned parallel with the body
of the mandible.
 The patient must hold the cassette in position, with the
thumb placed under the edge of the cassette and the palm
against the outer surface of the cassette.
Body of Mandible

 Head Position. The head is tipped approximately 15

degrees toward the side being imaged. The chin is
extended and elevated slightly.
 Beam Alignment.
 The central ray is directed to a point just below the inferior
border of the mandible on the side opposite the cassette.
 The beam is directed upward (−15 to −20 degrees) and
centered on the body of the mandible.
 The beam must be directed perpendicular to the
horizontal plane of the receptor.
Ramus of Mandible

 This projection demonstrates a view of the ramus

from the angle of the mandible to the condyle
 Receptor Placement.
 The cassette is placed flat against the patient’s cheek
and is centered over the ramus of the mandible.
 The cassette is also positioned parallel with the ramus
of the mandible.
 The patient must hold the cassette n position, with the
thumb placed under the edge of the cassette and the
palm placed against the outer surface of the cassette.
Ramus of Mandible

 Head Position. The head is tipped approximately

15 degrees toward the side being imaged. The
chin is extended and elevated slightly.
 Beam Alignment.
 The central ray is directed to a point posterior to the
third molar region on the side opposite the cassette.
 The beam is directed upward (−15 to −20 degrees)
and centered on the ramus of the mandible.
 The beam must be directed perpendicular to the
horizontal plane of the receptor.
Skull Imaging

 Skull imaging is used to examine the bones of

the face and skull.
 The most common skull images used in
dentistry include the following:
 Lateral cephalometric projection
 Posteroanterior projection
 Waters projection
 Submentovertex projection
 Reverse Towne projection
Posteroanterior Projection

 It is to evaluate facial growth and development,

trauma, and disease and developmental
abnormalities.
 This projection also demonstrates the frontal and
ethmoid sinuses, the orbits, and the nasal cavity .
 Receptor Placement.
 The cassette is positioned perpendicular to the floor in a
cassette-holding device.
 The long axis of the cassette is positioned vertically.
Posteroanterior Projection

 Head Position.
 The patient faces the cassette; the forehead and nose
both touch the cassette.
 The midsagittal plane is aligned perpendicular to the
floor, and the Frankfort plane is aligned parallel to
the floor.
 The head is centered over the cassette.
 Beam Alignment. The central ray is directed
through the center of the head and
perpendicular to the cassette
Waters Projection

 It is to evaluate the maxillary sinus area.

 This projection also demonstrates the frontal
and ethmoid sinuses, the orbits, and the
nasal cavity
 Receptor Placement.
 The cassette is positioned perpendicular to the floor
in a cassette-holding device.
 The long axis of the cassette is positioned
vertically.
Waters Projection

 Head Position.
 The patient faces the cassette and elevates the chin;
the chin touches the cassette, and the tip of the nose
is positioned 12 to 1 inch away from the cassette.
 The midsagittal plane must be aligned perpendicular
to the floor, and the head is centered over the
cassette.
 Beam Alignment. The central ray is directed
through the center of the head and
perpendicular to the cassette.
Submentovertex Projection

 It is to identify the position of the condyles,

demonstrate the base of the skull, and evaluate
fractures of the zygomatic arch.
 This projection also demonstrates the sphenoid
and ethmoid sinuses and the lateral wall of the
maxillary sinus
 Receptor Placement.
 The cassette is positioned perpendicular to the floor in a
cassette-holding device.
 The long axis of the cassette is positioned vertically.
Submentovertex Projection
 Head Position.
 The patient’s head and neck are tipped back as far as possible;
the vertex (top) of the skull touches the cassette.
 Both the midsagittal plane and the Frankfort plane are aligned
perpendicular to the floor.
 The head is centered on the cassette.
 Beam Alignment. The central ray is directed through the
center of the head and perpendicular to the cassette.
 If the zygomatic arch is the area of interest, the
exposure time is reduced to approximately one third the
normal exposure time for a submentovertex projection.
Reverse Towne Projection

 It is to identify fractures of the condylar neck

and ramus area
 Receptor Placement.
 The cassette is positioned perpendicular to the floor
in a cassette-holding device.
 The long axis of the cassette is positioned
vertically.
Reverse Towne Projection

 Head Position.
 The patient faces the cassette, with the head tipped
down and the mouth open as wide as possible; the
chin rests on the chest, and the top of the forehead
touches the cassette.
 The midsagittal plane must be aligned perpendicular
to the floor, and the head is centered on the cassette.
 Beam Alignment. The central ray is directed
through the center of the head and
perpendicular to the cassette.
Temporomandibular Joint Imaging

 Temporomandibular joint imaging can be

used to show bone and the relationship of the
joint components.
 For example, changes in bone (e.g., erosions,
bony deposits) can be seen on TMJ images.
Transcranial Projection (Lindblom
Technique)
 It is to evaluate the superior surface of the condyle and the
articular eminence
 This projection can also be used to evaluate movement of the
condyle when the mouth is opened and to compare the joint
spaces (right versus left).
 Receptor Placement. The cassette is placed flat against the patient’s
ear and is centered over the TMJ.
 Head Position. The midsagittal plane must be aligned perpendicular
to the floor and parallel to the cassette.
 Beam Alignment. The central ray is directed toward a point 2 inches
above and 0.5 inch behind the opening of the ear canal. The beam
is directed downward (+25 degrees) and forward (20 degrees) and
is centered on the TMJ that is being imaged.
THANK YOU