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SHORT COMMUNICATION
Year : 2018  |  Volume : 30  |  Issue : 2  |  Page : 193-195

Modified occlusal technique using intraoral periapical film: An alternative approach


1 Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India
2 Department of Oral Medicine and Radiology, C.S.M.S.S. Dental College and Hospital, Aurangabad, India
3 Department of Oral Medicine and Radiology, Rural Dental College, Loni, India
4 Department of Oral and Maxillofacial Surgery, Manas Hospital, Malkapur, Buldhana, India
5 Department of Oral and Maxillofacial Surgery, Sinhgad Dental College and Hospital, Pune, Maharashtra, India

Date of Submission26-Jul-2017
Date of Acceptance05-May-2018
Date of Web Publication16-Jul-2018

Correspondence Address:
Sneha H Choudhary
Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_68_17

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   Abstract 


Most common and difficult problem while taking intraoral periapical radiographs in the posterior region of the jaw is gagging. Thus, in an attempt to obtain the radiographs of maxillary and mandibular third molar without causing much discomfort and additional financial burden to the patient, an alternative technique was devised. This technique requires a dental chair, intraoral dental X-ray machine, regular size 2 periapical film, and artery forcep. The film is placed parallel to the occlusal plane as in case of occlusal radiography with the embossed dot side facing towards the teeth to be radiographed and exposures are made. The resulting radiographs showed complete image of third molars without causing stimulation of gag reflex and without superimposition of zygomatic process on roots of maxillary third molars. Thus, the present technique can be used satisfactorily for taking third molar radiographs in patients with severe gag reflex.

Keywords: Alternative technique, gag reflex, modified occlusal technique, third molar radiography


How to cite this article:
Choudhary SH, Kale LM, Mishra SS, Supe NB, Zaidi NS, Pandey ND. Modified occlusal technique using intraoral periapical film: An alternative approach. J Indian Acad Oral Med Radiol 2018;30:193-5

How to cite this URL:
Choudhary SH, Kale LM, Mishra SS, Supe NB, Zaidi NS, Pandey ND. Modified occlusal technique using intraoral periapical film: An alternative approach. J Indian Acad Oral Med Radiol [serial online] 2018 [cited 2021 Dec 2];30:193-5. Available from: https://www.jiaomr.in/text.asp?2018/30/2/193/236736




   Introduction Top


One of the most common problems faced by the oral radiologist while taking radiograph of third molars is gag reflex. The gag reflex is a normal involuntary defense mechanism that prevents foreign bodies from entering the trachea, pharynx, or larynx.[1] This sensitivity is manifested when the film is placed in the oral cavity adjacent to the posterior dorsum of tongue in case of mandibular teeth and soft palate in case of maxillary teeth.[2] Because of this gag reflex, it is often impossible to take periapical radiograph and patient is subjected to extraoral radiography, which exposes patient to more expensive and higher radiation exposure techniques. In an effort to find a feasible alternative technique for third molar imaging, this new technique was investigated with which the radiograph of maxillary and mandibular third molars can be obtained without causing much discomfort and additional financial burden to the patient. The present technique was used and tested for validation on routine patients who were referred to oral radiology department for intraoral periapical radiograph of maxillary or mandibular third molars and who demonstrated severe gagging. Some of these patients were subjected for extraoral radiographic examination because of the inability of the radiologist to relax the patient and thus suppress the gag reflex, while those who could not afford the higher cost extraoral radiography were recalled the next day early morning. In all these patients, the present technique was used.

Different measures have been described in literature to overcome this gag reflex, which includes brief explanation to the patient about the radiographic procedure and demonstrating the procedure on other patient which helps to reduce the anxiety of the patient. Another method of reducing gag reflex is by indulging the patient in some other activities like asking the patient to hold breath or keep foot or arm suspended during film placement and exposure which may cause distraction of the patient and thus relieving the gag reaction. In severe cases, topical anesthetic agent may be used.[2] If none of the above-mentioned measures are able to relieve or reduce the gag reflex in the patient, extraoral radiography is advised. Extraoral radiographic techniques not only subject the patient to comparatively higher doses of radiation but also increase the cost of radiography. In patients who are referred for third molar radiographs before extraction and who demonstrate severe gagging, this modified occlusal technique can be used.


   Materials and Method Top


The materials required are dental chair, intraoral dental X-ray machine, regular size 2 periapical film, and artery forcep. The technique is as follows: The patient is seated upright in the dental chair with the mid-sagittal plane perpendicular to the floor for both maxillary and mandibular teeth. The occlusal plane is parallel to the floor for maxillary third molar, and for mandibular third molar a line joining the tragus to the corner of mouth is kept parallel to the floor. An adult size 2 film (31 × 41 mm) is inserted into the patient's mouth with the help of an artery forcep in a direction parallel to the occlusal plane. The film is placed as posteriorly as possible such that it completely covers the occlusal surface of the third molar to be radiographed. The surface of the film with the embossed dot is placed towards the tooth to be radiographed with the long axis of the film placed vertically in contrast to the periapical radiography in which it is placed horizontally [Figure 1]. The patient is advised to gently hold the film between the occlusal surfaces of maxillary and mandibular teeth as in case of large occlusal film and the artery forcep is withdrawn [Figure 2] and [Figure 3]. The patient is advised not to apply excessive pressure while holding the film to prevent damage to the film emulsion. After placing the film, the patient's head is tilted slightly to the opposite side in order to bring the X-ray film and the teeth to be radiographed in a desirable relationship with the tube head and the beam is directed towards the center of the film with a vertical angulation of +60° to +65° for maxillary third molar and for mandibular third molar with a vertical angulation of −25° to −30° [Figure 4] and [Figure 5]. Exposure parameters used are the same as that used for periapical projections. The resultant radiograph showed complete image of crown and roots of the third molars. The anatomy of the crown and roots was clearly visible along with its surrounding vital structures, thus helpful in determining the relationship of the roots with the surrounding vital structures. There was no superimposition of zygomatic process or zygomatic bone on the roots of maxillary third molars. However, the images were slightly elongated in some cases [Figure 6] and [Figure 7].
Figure 1: Film placement using artery forcep for mandibular left third molar imaging. Note the side of film with emboss dot facing toward mandibular arch

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Figure 2: Film is stabilized between occlusal surfaces of maxillary and mandibular teeth

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Figure 3: Film is stabilized between occlusal surfaces of maxillary and mandibular teeth for left mandibular third molar

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Figure 4: Patient's head position and placement and angulation of the X-ray tube head for left maxillary third molar. Note the tilting of patient's head to the opposite side

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Figure 5: Patient's head position and placement and angulation of the X-ray tube head for left mandibular third molar. Note the tilting of patient's head to the opposite side

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Figure 6: Radiograph of left maxillary third molar showing full length of teeth without superimposition of zygomatic process or zygomatic bone

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Figure 7: Radiograph of left mandibular third molar showing full length of teeth

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Advantages and limitations

The advantages of this technique are that there is no superimposition of the zygomatic process of maxilla or zygomatic bone on the roots of the maxillary third molar, ease of film positioning in patient's mouth, and no exaggeration of gag reflex thus more patient co-operation. The limitation of this technique is the slight amount of elongation of the resultant image which may occur and film bending or damage to film emulsion because of excessive pressure applied by the patient while holding the film between maxillary and mandibular teeth.


   Conclusion Top


We have proposed a new modification of occlusal radiography using intraoral periapical film for imaging maxillary and mandibular third molars as an alternative approach in patients with severe gag reflex. Although this technique is not superior to intraoral periapical radiography or extraoral radiography, it can definitely prevent a majority of the patients from being exposed to higher exposure extraoral radiography and can reduce the extra financial burden to the patients because of higher cost of extraoral radiography.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kalra AA, Kinra M, Gupta K, Mittal N, Bhanote S, Goyal M. Gaggers and their management. Indian J Dent Sci 2012 ;4:100-3.  Back to cited text no. 1
    
2.
White SC, Pharoah MJ. Oral Radiology: Principles and Interpretation. Mosby; 2004.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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