SLOB Rule Dental XRAY

8/16/2019 SLOB Rule Dental XRAY

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Welcome. In navigating through the slides, you

should click on the left mouse button when (1), you

see the mouse holding an x-ray tubehead (see

below), () you are directed to !click" for the next

action and (#) you are done reading a slide. $itting

!%nter" or !&age 'own" will also work. o go back

to the revious slide, hit !backsace" or !age u".

If you right click anywhere on the screen and select

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lick for next slide


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he following slides describe

bect /ocali0ation, including the

ight 2ngle echni3ue and the

ube +hift echni3ue.

bect /ocali0ation


3/40

2 eriaical film will identify the location of an obect

vertically and in a hori0ontal (mesiodistal) direction.$owever, we cannot tell where the obect is located

buccolingually, since the eriaical film is two-

dimensional. herefore we need another method for

locating obects in a buccolingual direction. he tworimary methods of determining the buccolingual

location of obects are4

ight-2ngle echni3ue (cclusal roection)

&rimarily identifies buccolingual location, but mayalso confirm mesiodistal location seen on eriaical

ube-shift echni3ue (+/5 rule, lark6s rule)

7tili0es two films with different hori0ontal or vertical

angulations

bect /ocali0ation


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ight 2ngle (cclusal) techni3ue

ight 2ngle echni3ue

nce you have identified an obect on the eriaical

film, you can take an occlusal film with the beam at aright angle (erendicular) to the direction of the beam

for the eriaical. he beam may also be erendicular

to the film, esecially in the mandible. he occlusal film

below shows that the imacted canine is linguallyositioned.


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ube-+hift /ocali0ation (lark)

+/5 ule+ame /ingual osite 5uccal

he +/5 rule is used to identify the buccal orlingual location of obects (imacted teeth, root

canals, etc.) in relation to a reference obect

(usually a tooth). If the image of an obect moves

mesially when the tubehead is moved mesially(same direction), the obect is located on the

lingual. If the image of the obect moves distally

when the tubehead moves mesially (oosite

direction), the obect is located on the buccal.


6/40

*or the +/5 rule to work, there must be a

change in the hori0ontal or vertical

angulation of the x-ray beam as the tubeheadis moved. his change in angulation will alter

the relationshi between the obect of

interest and the reference obect, allowing

you to determine the buccal or linguallocation.

he closer the obect to be locali0ed is to thereference obect, the less the amount of

movement of the image of the obect in

relation to the reference obect.


7/40

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 changein location of the obect of interest

in relation to reference obect (see

below). 8oving the tubehead

without changing the beam

direction would often result in acone cut , deending on how far

the tubehead is moved (see below

right).


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When using the +/5 rule, the direction of the beam

must be oosite to the way the tubehead is moved.

$ori0ontal ube +hift4 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).

9ertical ube +hift4 he +/5 rule also works for

movement of the tubehead in a vertical direction.'ownward movement of the tubehead re3uires that the

beam be directed uward and when the tubehead is

moved uward, the beam must be directed downward.


9/40

8oving the tubehead mesially or distally and changing the

direction of the x-ray beam (as described in the revious slide) will

result in the movement of the obect of interest on the film in

relation to the reference obect. In the diagram below, the tubehead

is moved distally with the x-ray beam directed more mesially (from

the distal). he obect of interest, located lingual to the first molar,

moves distally, in the same direction as the tubehead movement.

(bects closer to the film move less distance than obects farther

from the film: in the examle shown below, both the tooth and

obect move forward on the film, but the lingual obect , beingcloser to the film, moves less and !aears" to move distally in

relation to the tooth).


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incisors

canine

remolar

molar

$ori0ontal movement of the tubehead and x-ray beam

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

canine film to the remolar film and the remolar film to the

molar film, the tubehead moves distally and the beam isdirected more mesially. here is not much change in

angulation from the remolar 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 roection.


11/40

In the diagram at left, thebuccal (yellow) and lingual

(red) obects of interest are

suerimosed on each other

because the beam is directederendicular to both of them

and they are in the same

relative osition mesiodistally

and vertically. 5oth images are

located above the second

molar.

mesial

distal

mesialdistal

$ori0ontal movement


12/40

In the diagram at left, the

tubehead is moved distallyand the beam is directed

mesially. n the radiograh,

the buccal obect of interest

(yellow) moves mesially

(oosite to tubehead

movement) in relation to the

second molar and the lingual

obect of interest (red) moves

distally (same direction astubehead) in relation to the

second molar.

mesialdistal

mesial

distal

$ori0ontal movement


13/40

In the diagram at right, the

tubehead is moved mesially

and the beam is directed

distally. n the radiograh, the

buccal obect of interest

(yellow) moves distally(oosite to tubehead


second molar and the lingual

obect of interest (red) movesmesially (same direction as

tubehead) in relation to the

second molar.

mesial

distal

mesialdistal

$ori0ontal movement


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8axillary &2

5W

8andibular &2

9ertical movement of the tubehead and x-ray beam

In moving from the maxillary eriaical to the bitewing

and from the bitewing to the mandibular eriaical, the

tubehead moves down and the beam is redirected

uward (oosite direction: decreased vertical

angulation).


15/40

In the diagram at left, thebuccal (yellow) and lingual

(red) obects of interest are

suerimosed on each other

because the beam is directederendicular to both of them

and they are in the same

relative osition mesiodistally

and vertically. 5oth images are

suerimosed over the

mandibular second remolar.

9ertical movement


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tubehead is moved uward


downward. n the radiograh,


(yellow) moves down(oosite to tubehead


second remolar and the

lingual obect of interest (red)moves u (same direction as


second remolar.

9ertical movement


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tubehead is moved downward


uward. n the radiograh,


(yellow) moves u (oositeto tubehead movement) in

relation to the second

remolar and the lingual

obect of interest (red) movesdown (same direction as


second remolar.

9ertical movement


18/40

7sually when using the tube-shift method of

locali0ation, two films are taken of the same area

using different beam angulations. $owever, this

locali0ation techni3ue will also work when

comaring films taken as art of a comlete series

of radiograhs. he only difficulty is determining

which way the beam was directed when

comaring the molar and remolar films. 7sually

this can be done by comaring the relative

ositions of anatomical structures (e.g., 0ygomatic

rocess in maxilla or mental foramen in mandible)or the angulation of the roots of the teeth.

(+ee following two slides).


19/40

*or the films above, we know that the tubehead was moveddistally from the remolar to the molar film. he 0ygomatic

rocess (red arrows) is located at the distal asect of the

nd molar on the remolar film and it is located over the

distal asect of the 1st molar on the molar film. his

indicates that it moved mesially as the tubehead moved

distally. We know that the 0ygomatic rocess is buccal to

the teeth and, using the +/5 rule, it follows that the x-ray

beam was directed more mesially on the molar film (5uccal

obect moved oosite to tubehead movement).

remolar molar


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remolar molar

2nother way of determining the change in the direction ofthe beam is to look at the angulation of the teeth. In the

remolar 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 uright or

angled slightly mesially, indicating the beam was directedmore mesially (from the distal). herefore, the tubehead

shifted distally and the beam was angled in the oosite

direction, allowing the use of the +/5 rule (hese films

were taken from +lide # in the review films to follow).


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ichard6s 8ethod of bect /ocali0ation

his method of determining the buccolinguallocation of obects was first suggested by

ichards. It utili0es similar ideas to lark6s

method, but it emhasi0es beam direction instead

of tubehead movement. If the beam is directeddistally, buccal obects will move distally in

relation to the reference obect: lingual obects

move mesially, or oosite to beam direction.

2lthough this method certainly works, I feel it iseasier to use tubehead movement (+/5) for

obect locali0ation.


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n the following six re-test slides, identify the

buccal or lingual location of the selected obects.

%ach slide will be followed with a slide indicatingthe correct resonse and a brief exlanation.


23/40

Is the comosite restoration on tooth ; < (arrows)

located on the buccal or lingual=

canine film incisor film1

he restoration is located on the buccal. he tubehead

moves mesially from the canine film to the incisor film

(x-ray beam roected more distally) and the comosite

moves distally, which is the oosite direction.


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canine filmremolar film

he arrow in the canine film is ointing to the gutta

ercha in which canal of the maxillary first remolar=

he arrow identifies the lingual canal. he tubehead moves

mesially from the remolar film to the canine film (beam

directed more distally) and the gutta ercha indicated by

the arrow also moves mesially. (+ee following slide).


25/40

&I' & I

'lingual

buccal

When the tubehead is moved mesially, with the beamdirected distally, the two canals, which are initially

suerimosed (remolar eriaical above) will searate. he

lingual canal (red arrow) will follow the tubehead movement

and the buccal canal (blue arrow) will move in the oosite

direction, as seen on the canine film.

#


26/40

he red arrow is ointing to the gutta ercha in

which canal of this maxillary left first remolar=

his is the buccal canal. he tubehead goes

distally from the canine film to the remolar filmand the gutta ercha moves mesially to be

ositioned over the lingual canal which has the

threaded ost.

he ink arrow oints to a threaded ost. In

which canal of this maxillary left second remolaris the ost located=

he ost is located in the lingual canal. 2s the

tubehead moves distally from the canine film tothe remolar film, the ost also moves distally

to cover the canal that has all gutta ercha.

#

>


27/40

Is the maxillary second

remolar (arrows)

dislaced to the buccal

or the lingual=

remolar film molar film

remolar bitewing

>

he tubehead moves distally from

the remolar film to the molar film.

he second remolar also moves

distally, overlaing the first molar

more in the molar film. In movingfrom the remolar eriaical to the

bitewing, the tubehead moves

down and the remolar also moves

down. he dislacement is to the

lingual.

?


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incisor film canine film

Is the dislaced incisor (arrows) located on the buccal

or the lingual=

?

he lateral incisor is dislaced to the lingual. he

tubehead moves distally from the incisor film to the

canine film. he lateral incisor also moves distally,

covering half the canine on the canine film.

@


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canine film

remolar film

Is the radioa3ue obect identified by the arrows located

on the buccal or the lingual=

@

/ingual. he tubehead moves mesially from the remolar

film to the canine film. he obect also moves mesially,

starting out distal to the first molar on the remolar film and

ending u mesial to the first molar on the canine film. his

obect reresents the ti of the alatal root of the second

molar and is located distal to the first molar and in a lingual

relationshi (+ee following slide).


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film lacement for canine filmfilm lacement for remolar film

& I ' ) l ac e me nt f o r ) r e mo l ar f i l m

& I ' ) l a c e m

e n t f o r c a n

i n e f i l m

root ti


31/40

For slides 7 through 15, identifythe buccal or lingual location of

the structures indicated. Enter

answers on the answer sheet

provided.


32/40

A

he maxillary right lateral incisor is tilted out of osition.

In which direction (buccal or lingual) is it tied=

remolar film incisor film


33/40

incisor film canine film<

he maxillary left canine is imacted. Is it located more to

the buccal or the lingual=


34/40

remolar bitewing film

B

he amalgam restoration

indicated by the arrow is

located on the buccal or

the lingual=

remolar eriaical film


35/40


remolar bitewing film

1C

he mandibular second

remolar is tilted out of

osition. In which

direction (buccal or

lingual) is it tied=


36/40

molar bitewing film

molar eriaical film

11

he arrow oints to a

retention in. Is the

in located in thebuccal or lingual

ortion of the tooth=


37/40

remolar film molar film

1

'oes the arrow oint to the mesiobuccal or mesiolingual

canal=


38/40

molar bitewing film

molar eriaical film

1#

he amalgam article

indicated by the arrows

is located bucally orlingually=

1>


39/40

Is the restoration

indicated by the red

arrows located on the

buccal or lingual of thefirst remolar=

canine eriaical film


remolar bitewing film1>

1?


40/40

1?

incisor film canine film

remolar film

he gutta ercha root canal filling identified by the red

arrows is located in which canal=

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SLOB Rule Dental XRAY