Bisecting Angle Technique Research Articles

Radiographic Errors in Intraoral Periapical Radiographs

Background: Radiographs are considered as pivotal aid in the diagnosis and treatment planning of various Oro-dental pathologies. Changes in the quality of radiographs may lead to misinterpretation, which results in incorrect diagnosis and treatment planning. The technical and processing errors can largely influence the radiographic interpretation. Both paralleling and bisecting angle techniques can have both technical and manual errors. Aims: To estimate the frequency of radiographical errors in conventional radiographs taken by undergraduate dental students. Materials And Method: Thousand (1000) dental radiographs taken by undergraduate students were examined. Patient's age ranged between 5 -75 years. X- ray films were examined on X-ray film viewer and were classified according to type of errors and anatomical distribution. Results: The study aimed to identify common faults encountered during routine radiography. The most frequently observed error was Improper Vertical Angulation. Interns performed better in obtaining radiographs compared to Final year students. Keywords: Radiographic errors, Dental students, Bisecting angle technique.

Evaluasi Kualitas Radiograf Periapikal Teknik Bisektris : Kesalahan Penempatan Sudut Penyinaran dan Film

Background: The bisecting angle technique of periapical radiography is more often used in dental practice because the technique is practically adjustable and the patient's ability to adapt is better. Radiograph results are influenced by operator and patient factors, so management that is not optimal can cause a decrease in the quality of the radiograph, which affects interpretation, diagnosis, and treatment planning. The study aimed to determine the quality and frequency of errors in periapical radiographs using the bisecting technique due to errors in X-ray angulation and film placement at the Soelastri Dental and Oral Hospital (RSGM), University of Muhammadiyah Surakarta (UMS).Methods: The type of research is descriptive observational quantitative research with a retrospective approach. A total of 300 bisecting technique periapical radiographs from patients at RSGM Soelastri UMS in January–December 2021 who met the inclusion and exclusion criteria were taken in random stratification and evaluated. Radiographs are compared to ideal quality and given a National Radiological Protection Board (NRPB) rating, as well as looking at the frequency of errors that occur.Results: The rating most often obtained on periapical radiographs using the bisecting technique in the study was 2 for 181 radiographs (60.33%). The frequency of X-ray angulation errors was 62.94%, while the frequency of film placement errors was 37.06%. The highest error in X-ray angulation was cone cutting at 49.13%, while the error in film placement was in the form of apical cuts at 25.65%.Conclusions: The quality of periapical radiographs using the bisecting technique at the Radiology Installation at RSGM Soelastri UMS in the period January to December 2021 generally has a rating of 2 (diagnostically acceptable) according to the NRPB, and errors are still found in the angulation of the X-ray tube and film placement.

VISUALIZATION OF INCISIVE FORAMEN USING TWO INTRAORAL PERIAPICAL RADIOGRAPHIC TECHNIQUES

Background: Intraoral periapical radiographs are reported to show the incisive foramen as a typical anatomical landmark. In order to assess the visibility of the incisive foramen in the bisecting angle and paralleling angle approaches, as well as how visible it is in routine periapical radiographs, the current study was conducted. Methods: This descriptive cross-sectional study evaluated 90 intraoral periapical radiographs of maxillary central incisors. These were scored for visibility of incisive foramen by a radiographic expert using two intraoral radiographic techniques. The data was entered in Microsoft Office Excel sheet 2007 and calculated using SPSS version 20. Results: In both the paralleling and bisecting radiographs, the incisive foramen could be seen in a total of 63.8% and 36.2% of the images, respectively. Conclusions: The dentist must have a thorough awareness of how the incisive foramen appears on standard intraoral radiographs. Our research demonstrates that when compared to the bisecting angle technique, the paralleling technique delivers superior visibility of the incisive foramen. Therefore, it is recommended to use the paralleling technique approach to see the foramen.

The Performance of Paralleling Technique and Bisecting Angle Technique for Taking Periapical Radiographs: A Systematic Review.

Periapical radiography is a routine radiographic procedure performed by dentists on a daily basis. It can be taken with two techniques, the paralleling technique (P tech) and the bisecting angle technique (B tech). This systematic review aimed to identify the relevant literature, compare the use of P and B techs across various dental specialties, and determine the most appropriate technique to be used for different purposes in taking periapical radiographs. In January 2023, we searched PubMed, Web of Science, Scopus, and Google Scholar to identify the studies that compared the two radiographic techniques. The search string was: (paralleling AND ("bisecting angle" OR "bisected angle")). Manual reference tracing was also performed to identify the studies potentially missed. After screening, 26 studies were included for the qualitative review. The 26 included studies were published between 1976 and 2021. Ten of the studies were about general dentistry (dental radiology in general applications), whereas another ten studies were related to endodontics, such as working length estimation. Most studies advocated the use of the P tech for general, endodontics, implantology, and other indications. B tech was advocated for patients with a low palatal height. More future studies are needed to evaluate their performance in different scenarios with standardized equipment and radiographic positioning.

Virtual reality technology using a 360° video: development and evaluation of an educational tool for intraoral radiography using the bisecting angle technique

Intraoral radiography (IOR) practice education is essential for dental students. However, the risk of radiation exposure has resulted in the use of textbooks to learn IOR. Thus, a new educational tool that can effectively use fewer shots or provide indirect experience when practice is not feasible is needed. In this study, we developed a new educational tool called “educational media for the bisecting angle technique” using virtual reality (EMBAT-VR) and evaluated the user experience among students. IOR was divided into 12 steps for 14 teeth, and a scenario was prepared from the perspectives of the operator and patient. On the basis of this scenario, the IOR was reenacted and recorded using a 360° camera. The tool was built on a head-mounted display using the Unity Engine. Eighty-four students were enrolled to evaluate the task performance, browsing search, and satisfaction on a 5-point Likert scale; the corresponding values for the tests were 3. 78 ± 0.70, 3.88 ± 0.76, and 4.01 ± 0.71, respectively. EMBAT-VR was used to investigate the satisfaction (user experience). Responses to 21 questions from 24 students who used traditional textbooks (control group) and 22 students who used the VR educational tool (experimental group) were statistically analyzed using the Mann–Whitney U test. A statistically significant difference was observed between the experimental (4.16 ± 0.64) and control (2.69 ± 0.54) groups. In the usability evaluation, EMBAT-VR presented with a higher score than traditional textbooks. Nonetheless, its effect when performing actual IOR imaging needs follow-up research.

Comparative evaluation of efficacy of bisecting angle technique, modified bisecting angle technique, and paralleling angle technique in avoiding zygomatic arch superimposition over apices of permanent maxillary molars

Comparative evaluation of efficacy of bisecting angle technique, modified bisecting angle technique, and paralleling angle technique in avoiding zygomatic arch superimposition over apices of permanent maxillary molars

A Standard Method for Intraoral Dental Radiography With Dental Photo-Stimulative Phosphor (PSP) Plates in Big Cats

In recent years, dentistry has steadily gained more prominence in veterinary medicine, including exotic and wild animal medicine. It is known that dental diseases are among the most common diseases in captured big cats. However, so far, there is no standardized method for dental radiography in these animals. Therefore, this study aimed to develop a standardized procedure for the systematic radiographic examination of the teeth in big cats. In total, 34 big cats, including 21 lions and 13 tigers, of different ages were examined. Animals that needed treatment for known dental diseases and those that had to be anesthetized for other medically necessary procedures and dental health status examinations were included. Intraoral dental radiographs were captured with digital imaging plates designed for intraoral dental radiography in horses. Based on the intraoral dental radiography procedures used in domestic cats, both the bisecting angle technique and parallel technique were used. A hemisphere model originally developed for horses was used to describe the path and position of the x-ray beam as accurately as possible. The results demonstrated that it was possible to completely image all the teeth of big cat dentition on seven radiographs using the described method. This method can be used to acquire high-quality intraoral dental radiographs in big cats, aiding in the quick and reliable diagnosis of dental diseases.

A technical report on the hamular technique for radiographing maxillary anterior teeth using a digital sensor.

Obtaining an intraoral periapical radiograph of the maxillary anterior teeth can be quite challenging, especially in patients where a rigid digital sensor cannot adequately fit in the palatal vault. This technical report presents a periapical radiographic technique that places the sensor in the space surrounding the hamular notch to avoid the spatial restrictions of the hard palate, opening the possibility of parallel alignment of the sensor and the long axis of the tooth, perpendicular alignment of the tube-head to both, and a minimally distorted resultant radiographic image. Four adult patients demonstrated the quantitative and qualitative features of this hamular technique (HT). A human skull demonstrated relative magnification and image quality. While patient and equipment-specific, comparisons of magnification, distortion, and image quality illustrate the potential capabilities and limitations of the HT. The HT radiographs appeared to be less distorted than the variable-angle technique (VAT-a clinical approximation of the bisecting angle technique) but magnified 7.9-21.6%. A radiograph of an implant showed a 2.0% distortion over true aspect ratio. The HT radiograph from a human skull showed a slightly lighter and less sharp image than the VAT radiograph. Preliminary results showed that while the HT images were magnified, lighter, and less sharp that the VAT, they were diagnosable for caries. In all the HT images presented in this technical report, there was less distortion than comparable techniques. Notably, one HT periapical radiograph of a maxillary lateral implant showed virtually no distortion, suggesting that a nearly parallel projection was achieved using the technique. While further research is needed, this report shows that the HT has the potential to produce minimally distorted digital radiographs of anterior teeth in patients where the sensor cannot adequately fit into the palatal vault.

Knowledge, attitude, and behavior of Turkish dentists about radiation protection and radiation safety.

Dentists use dental imaging methods frequently in the diagnosis and treatment of dental diseases. This study aimed to determine dentists' knowledge, attitudes, and behaviors about radiation protection during dental imaging procedures. Dentists from two major dental health centres in İzmir province were asked to participate in this study. The participants replied to a questionnaire that consisted of questions on the use of radiographic devices, knowledge on the radiation protection of patients and staff, and attitudes and behaviors regarding radiation protection. The questionnaire also included questions about the socio-demographic characteristics of the participants. Descriptive statistics of data were performed using the SPSS software program. Sixty-six dentists participated in the survey. The mean knowledge score of dentists on dental imaging, radiation, and radiation protection was 8.3 ± 2.6 out of 17, while the mean attitude and behavior score was 8.3 ± 2.1 out of 27.97% of the participants stated that medical imaging technicians should carry out imaging procedures. The use of rectangular collimators was 9.1%, and using E/F film was 56.3% among dentists. 23.3% of participants stated that they applied the bisecting angle technique during dental imaging, 23.8% stated that they wear a lead apron during imaging, and 37.8% stated that they always used thyroid shields on the patients. In addition, 37.2% of the dentists stated that the patient holds the film during preapical radiography, and 81.5% used the same imaging parameters for adult and pediatric patients. 62% of dentists stated that they question the pregnancy of female patients before imaging. Findings of the study suggest that the knowledge of dentists about dental imaging procedures and radiation protection needs to be improved. The implementation and the follow-up of quality training programs in accordance with the standards set by the national authority will be of great importance.

Comparison of Dentoalveolar Bony Defects Measurements by Dental Radiography and Computed Tomography in Companion Animals

Background: Dental disorders are commonly encountered in companion animals and diagnosed with dental radiography (DTR) and computed tomography (CT). No study has been reported previously that compares dental measurements from DTR and CT in companion animals with periodontitis-related bone loss. The purpose was to compare the DTR and CT of bony defects in cats and dogs with dental disease.Methods: This is a retrospective study and the records of Jeonbuk Animal Medical Center were reviewed between June 2019 and October 2020. All patients underwent both modalities. In DTR, bisecting angle technique was used. In CT, slice thickness was applied at either 0.5 mm or 1.0 mm depending on the size of the patients. Bony defects of dentoalveolar structures were measured.Result: Eight dogs and eight cats with dental disease were included. All measurements in both cats and dogs were smaller in DTR than in CT. Additionally, CT with thin slice thickness provided more sufficient and accurate information for dental diagnosis. Conclusively, CT examination for dental disease showed to be superior in the assessment of periodontitis-related bone lesions by obtaining precise images without distortion and overlap and can possibly substitute DTR in cats and small dogs.

New device for dental radiographic standardization

Context: The device for dental radiographic standardization (DDRS) was developed to minimize the distortions in conventional periapical radiographs or digital subtraction, improving the effectiveness of the technique. Objectives: The objective of this study is to present the DDRS and prove its effectiveness through comparative test, performed with the techniques of Bissetrix and Parallelism. Configurations and Design: The DDRS adapts to the universal radiographic positioner, is economical, and easy to operate. It is recommended for the use in research, where standardization is a requirement. Subjects and Methods: DDRS is produced using the additive manufacturing method for prototyping, after creating a three-dimensional (3D) model using a specific program (Autodesk Inventor 2016, Autodesk, Inc, California, USA). The final prototype was converted to the STL format, which was later read by a 3D printer (3D Machine ONE, Sao Paulo, Brazil). To perform the tests, three radiographic techniques were compared, Bisecting angle technique, parallelism and DDRS fitted to the universal positioner, and two examiners performed the evaluation independently. Statistical Analysis Used: Differences between the techniques were compared by the analysis of variance, followed by Dunnett’s multiple comparisons. The variability of the measured values among the techniques was compared by the Levene’s test. The intraclass correlation coefficients were calculated to evaluate the reproducibility and interexaminer agreement for each technique and parameter. Results: DDRS eliminates the effect of distortion factors that normally affect conventional methods, allowing greater reliability in the interpretation of the image before, during, and after treatment. Conclusions: The DDRS should be used for clinical and routine research purposes, facilitating comparisons of the same image at different time intervals, with minimized errors of vertical and horizontal angulation. This allows greater reliability in the interpretation of the image in relation to the structures of interest.

New Method of Determining the Incident Beam Angle for the Bisecting Angle Technique in Canine Dental X-ray Examinations

New Method of Determining the Incident Beam Angle for the Bisecting Angle Technique in Canine Dental X-ray Examinations

Multiple Angle of Bisector Rinn Holder for Oral X-Ray

Multiple angle of bisector rinn holder is a film holder instrument that is yet to be developed that is able to use paralleling technique and bisecting angle technique in oral x-ray radiography. It is a device aimed to be able to use multiple techniques in oral radiography while getting a good image quality that helps the dentist in doing their work. This is a project that involves the development of the instruments and the effectiveness of the instruments compared to the existing one. The result of the radiographic image was compared and certain constraint was used to compare the instruments with the existing instruments. This project used CATIA V5 software for the design stage. In this project, the instrument was tested to validate the effectiveness where the testing was conducted at the faculty of dentistry. The outcome was the effectiveness of the instrument as compared to the existing instrument with other certain constraints.

Image Distortion of the Roots of Maxillary Deciduous Molars on IOPA’s Recorded with Bisecting Angle or a Modified Paralleling Technique

The maxillary deciduous molar periapical radiograph often presents a diagnostic challenge for the clinician due to the overlapping of their roots with the developing premolar tooth bud. Clear and distortion free images are necessary for decision making while planning the treatment. However, the practical anatomical difficulties discourage the clinician from using the paralleling technique in children. While looking for an alternative technique, it was hypothesized in the literature that the 20 degree paralleling compromise technique suggested by Van Aken (1969), could override the anatomic challenges in children and provide images that are superior compared to those recorded with the bisecting angle technique. To compare the image quality of maxillary deciduous molar IOPAR taken using the “20 degree paralleling compromise technique” with that taken using the “bisecting angle technique”. Parallel double blinded randomized clinical trial. Sixty children who fulfilled the inclusion criteria were randomly split into two groups. In group A, the bisecting angle technique was used and in Group B the 20 degree paralleling compromise technique was used. The radiographs were categorized into three groups according to the quality of the image (1: Foreshortened image of the roots, 2: Elongated Image of the roots, 3: Undistorted well-defined image) by two independent observers who were blinded to the study and then compared. The obtained data was analysed for inter and intra observer agreements using Kappa statistics and analyzed for significance using the Chi square test. The p values obtained for category 1 and 2 were 0.21 and 0.99 for observer 1 and 0.16 and 0.33 for observer 2 respectively. Under the conditions of the study, there was no difference in the image quality of maxillary deciduous molar roots on IOPAR recorded using either the “bisecting angle” or the “20 degree paralleling compromise” techniques.

New approach in Bisecting angle technique

Since the conventional radiograph was introduced in 1901, it seems that it has wide spectrum in it use in medical, dentistry & engineering branches.The importance came from its value in diagnosis and predicate the causes of different effects. This lead to more researches for more advanced programs , which continued through last century lead to an advanced radiography like digital one, C.T. scan and M.R.I. Still the conventional radiographs are the baseline for this progress a far farther for future progression.Aim of the study is to prove a new approach in "Bisecting angle technique".The present study indicate the new approach in using the bisecting angle technique since the old one give instructions on three main lines:-A. Patients positioning in the dental chair.B. Positioning of dental intraoral film inside patient mouth.C. The position of the cone of X-ray machine in both vertical and horizontal angles.But Al-Safi method gives instructions number D- about the anatomical landmarks that lead to the apex of the tooth to which central beam is directed, by drawing a line from ala of the nose to the tragus of the ear called ala tragus line indicate the apecies of maxillary teeth , for the mandibular arch a line draw indicate apices of mandibular teeth from the angle of the chin to the angle of the mandible in proper manner.In present study, two groups of fifth years students in the college of Dentistry in Baghdad had been taken. The first group had given instructions A-B-C-, second group had given instructions A-B-C- and D- according to Al-Safi method.The statically analysis using t-test shows , a significant difference between the first and second group in the effectiveness of sharpness and allignments artifacts , from the same point of view there were no significant difference between members of second group while there is a significant difference between members of the first group.The results indicate that the new approach in instructing the second group of students were gave wide predictors for their work and better results in decreasing the technical errors and dental artifacts.

Diagnostic Value of Extraoral Periapical Radiograph in Comparison to Intraoral Periapical Radiograph: A Cross-sectional, Institutional Study.

Background:Radiographs form an invaluable adjunct in diagnosis, treatment planning, and postoperative evaluation during patient management in the dental office where intraoral periapical (IOPA) radiographs are the ones most commonly used. However, certain conditions render the placement of film difficult. In such cases, a panoramic radiograph may be taken, but it has the disadvantage of higher radiation exposure and cost. Extraoral periapical (EOPA) technique allows radiographs to be taken on an IOPA film by placing it extraorally. We aimed to evaluate its diagnostic accuracy compared to intraoral bisecting angle technique.Materials and Methods:Forty-five patients were randomly selected. Ninety radiographs were taken; two for each patient. First image was obtained by intraoral bisecting angle technique and second by EOPA technique. A scale was devised for the comparison of radiographs taken by the two techniques. Two experienced oral radiologists rated them based on the scale followed by statistical analysis.Results:Patients reported increased compliance with the EOPA technique. 84.40% of the EOPA radiographs (EOPARs) were diagnostically acceptable; sensitivity and specificity was 84% and 55%, respectively.Conclusion:EOPAR is beneficial in cases where intraoral film placement is difficult, and a radiograph is necessary for patient management, even though it demonstrates comparatively lesser diagnostic accuracy.

External Marker in Bisecting-Angle-Technique: A New Approach to Minimize Dental Radiographic Error

Bisecting-angle-technique is a method used to improve patient comfort during periapical radiography. This technique is usually performed without X-ray beam aiming device and has been commonly associated with dental radiographic error. The use of external marker as a beam aiming device in bisecting-angle-technique is potentially effective to reduce the number of errors occurring during periapical radiography. In this study, 240 periapical radiographs were taken by undergraduate dental students. Periapical radiographs were taken using traditional method of bisecting-angle-technique (BAT), bisecting-angle-technique with the use of external marker (BAT-M) and the standard method in periapical radiography; paralleling technique (PT). All radiographic images were evaluated and errors were classified and tabled according to the type and number of errors. Chi-square test was used to compare the total number of radiographic errors made using these three techniques. One of the most common errors with BAT was cone cut error (13.8%). This error had been markedly reduced to 1.3% and 2.5% by implementation of BAT-M and PT, respectively. The total number of errors was also found to be significantly lesser for BAT-M compared to BAT, p< 0.05.

Comparison between the commonly used radiographic techniques for intra oral imaging in dentistry-A questionnaire study

Aim:-To compare the opinion regarding usage of bisecting-angle technique and the paralleling techniques among BDS students, post graduate students, private practitioners in and around Bhimavaram town for intra oral imaging in dentistry. Materials and methods: A detailed questionnaire composed of questions regarding technical parameters, exposure parameters, operator and patient comfort and image accuracy in diagnosis. Details of the study were explained to the participants preferred option to be marked according to the question mentioned in the questionnaire. Total 500 individuals participated in the present study, with 100 individuals in each group. Data was collected and entered in Microsoft Excel (2010) and statistically analysed using SPSS 20. Chi-square test was used to evaluate differences in the responses with P-value ≤ 0.05 were considered significant. Results: Results showed that in technical parameters most of the people opted for bisecting angle technique with p value≤ 0.05 and found as significant. In aspect of exposure parameters, results are in favour of paralleling technique and p value is ≤ 0.05. In aspect of the operator and patient comfort there is an equal opinion most of them opted for bisecting angle technique and paralleling technique p value is significant. In aspect of image accuracy p value is significant for paralleling technique. Conclusion: Great work should have to be done to alleviate the quality of radiographs and the understanding and perspective of dental graduates regarding dental and maxillo-facial radiology. The results of present study revealed though there is knowledge about the techniques, but lack of application decreases their ability to get more accurate diagnostic radiograph. Paralleling technique being the most accurate in image accuracy should be emphasized to practice and needed to be modified in conditions where it is not feasible to deal with.

Full-Mouth Intraoral Radiographic Survey in Rabbits.

Dental pathologies are highly prevalent in pet rabbit populations, making oral radiography an essential tool in the evaluation of lagomorph dentitions. The unique anatomy of the rabbit's mouth limits the examination of the conscious animal to the rostral portion of it's mouth. In addition, the oral examination of an aradicular hypsodont tooth is restricted to the short coronal fraction of its crown. Erstwhile images obtained by the extraoral technique were once considered the most practical and informative tool in rabbit dentistry; however, limited visualization of the key structures of individual teeth became the major drawback of this technique. As new imaging technologies are becoming widely available and affordable for veterinarians, intraoral radiography offers the ability to prevent, diagnose, and treat oral pathologies in lagomorphs. This article describes a step-by-step procedure to obtain a full-mouth radiographic survey in rabbits. For this technique, a standard dental X-ray generator and intraoral storage phosphor plates are used while applying the bisecting angle technique. Among the advantages of this technique are detailed visualization of internal and external dental structures, identification of early lesions, and detection of occult pathologies. Furthermore, intraoral images offer superior resolution and higher diagnostic quality with minimal radiation exposure, making this method safer for the veterinarian, staff members, and their patients.

Modified Bisecting Angle Technique: A Novel Method to Eliminate Zygomatic Superimposition over the Apices of Maxillary Molars

Objectives: Intra oral radiographic imaging is the most widely used method for obtaining information about root canal anatomy and working length determination. Measuring exact working length is the most essential step for the success of root canal treatment. Bisecting angle technique (BAT) is the most widely used technique for this purpose. However, zygomatic superimposition over the apices of maxillary molars makes it difficult for the dentist to estimate exact working length. The present study made certain modifications in BAT to overcome these undiagnostic shadows. The aim of the study is to compare three techniques, namely paralleling cone technique (PCT), BAT and modified bisecting angle technique (MBAT) to prevent such superimposition over molar apices. Materials and Methods: A total of 53 patients requiring endodontic treatment for maxillary molars were included in the study. Three radiographs one with each PCT, BAT, MBAT were made. Each radiographic image was recorded acceptable or unacceptable based on the zygomatic superimposition. The data thus collected was subjected to statistical analysis using chi-square test. Results: The percentage of acceptability in MBAT was 56.6% (n = 30) when compared with BAT which was only 28.3% (n = 15) and PCT was 58.3% (n = 31) indicating statistically significant difference between BAT and MBAT. But no statistically significant difference was found between MBAT and PCT. Conclusion: In the present study, MBAT was found to be more accurate than BAT, and it was relatively as accurate as PCT in eliminating zygomatic superimposition over the apices of maxillary molars.