#Recall Part (6)

In the paralleling technique used to obtain periapical and bite-wing images, the receptor is
placed in the mouth parallel to the long axis of the tooth, and the central
ray is directed perpendicular to the receptor and the long axis of the tooth.
To achieve parallelism between the receptor and the tooth, the receptor must be
placed away from the tooth and toward the middle of the oral cavity.

In the paralleling technique, a beam alignment device must be used to position the receptor
parallel to the long axis of the tooth. A variety of beam alignment devices are commercially
available.
The sizes of intraoral receptors used in the paralleling technique depend on the
teeth being radiographed.
With anterior teeth, size 1 receptors are typically used;
with posterior teeth, size 2 receptors are typically used.

The five basic rules with regard to the paralleling technique are as follows:
(1) The receptor must cover the prescribed area of interest;
(2) the receptor must be positioned parallel to the long axis of the tooth;
(3) the central ray must be directed perpendicular to the receptor and the long
axis of the tooth;
(4) the central ray must be directed through the contact areas between teeth;
(5) the x-ray beam must be centered over the receptor to ensure that all areas
of the receptor are exposed.

Before the radiographic procedure using the paralleling technique begins, ensure that
you take all infection control measures, prepare the treatment area and the
supplies, seat the patient and explain the radiographic procedures to him or her,
make the necessary chair and headrest adjustments, place the lead apron on
the patient, remove any intraoral objects and eyeglasses, set the exposure
factors, and assemble the beam alignment devices.

When using the paralleling technique, always begin with anterior exposures (easier
for patient to tolerate, more comfortable, less likely to cause gagging), and then
move on to the posterior regions. In each quadrant, always expose the premolar
receptor first and then the molar receptor.

In a complete mouth radiographic series (CMRS) using paralleling technique, each
periapical exposure has a prescribed receptor placement (see Boxes 17-1 and 17-2
and Figures 17-11 and 17-12).

Modifications in paralleling technique may be necessary when a patient has a
low or shallow palate, bony growths, or a sensitive mandibular premolar region.

The advantages of the paralleling technique include the following:
(1) it produces images with dimensional accuracy,
(2) it is simple and easy to learn and use,
(3) it is easy to standardize, and
(4) it can be accurately repeated.

The disadvantages of the paralleling technique are as follows:
(1) placements of receptors may be difficult for the dental radiographer and
(2) the beam alignment device may cause patient discomfort.


Modifications:

A torus (plural, tori) is a bony growth seen in the oral cavity.
A maxillary torus (torus palatinus) is a nodular mass of bone seen along the
midline of the hard palate.
For maxillary torus, the receptor must be placed on the far side of the torus
(not on the torus) and then exposed.
Mandibular tori (singular, torus mandibularis) are bony growths along the lingual
aspect (tongue side) of the mandible
For mandibular tori, the receptor must be placed between the tori and the
tongue (not on the tori) and then exposed.

Shallow Palate
When the lack of parallelism is greater than 20 degrees, a modification in
technique is necessary, as follows:
Cotton rolls. To position the receptor parallel to the long axis of the tooth,
two cotton rolls can be placed, one on each side of the bite-block. As a
result, however, periapical coverage is reduced.
Vertical angulation. To compensate for the lack of parallelism, the vertical
angulation can be increased by 5 to 15 degrees more than the XCP
instrument indicates. However, image distortion occurs as a result.