Root Canal Therapy Radiograph Woes
Taking a radiograph during a root canal can be such a challenge. Ensuring that you have proper isolation throughout the entire process is imperative. I always suggest leaving the rubber dam in place while taking the x-ray, too. This can be cumbersome, but it is better for the process in order to avoid any recontamination during your procedure.
As with anything else in dentistry, there are several different devices that can help stabilize your x-ray sensor while taking your radiographs. But my favorite is simple and very very thrifty. Simply use the patient’s finger! We call it “finger placement” in my practice, and it is hands-down the best tool I use to stabilize the x-ray sensor while getting a radiograph.
That being said, there are two things that can go wrong when you are taking x-rays. And this goes for any x-ray, for that matter, not just ones that you perform during root canals.
The first problem is when you have not obtained the entire tooth in your image.
The endo equivalent of this would be when you don’t grab the apex in your picture. So what do you do? How do you fix that? And how do you easily train your team members to fix it in the next x-ray so that they don’t subject your patients to a gazillion x-rays?
Well, if you miss the apex, then you need to adjust your SENSOR.
See, there are only two things that you will ever need to adjust — either the sensor or the x-ray tube position. The key is to know which one to adjust, and when.
In this situation, where the apex cannot be seen in the x-ray, adjust your sensor in the direction in which you need to extend your image— so, head in the direction of the apex.
For example, if you are doing a maxillary molar and you miss the palatal apex, then take that sensor and make sure it goes as high in the palatal vault as possible. If you are doing a mandibular tooth like in this tooth here…
…then make sure that the tongue is not getting in the way and that the sensor is able to slide closer to the floor of the mouth.
Quick tip for a lower tooth: Have the patient gently bite down on their finger that is holding that sensor in place. This will automatically push the tongue out of the way and open up the vault underneath the tongue, allowing the sensor to slide in place without pinching the patient. Don’t be scared, the patient is numb anyway!
The key is to NOT adjust your tube head higher or lower, because no matter how much you adjust it, you won’t get what you are looking for until you adjust your sensor FIRST!
The second issue is when you get a cone cut.
The cone cut happens when your sensor is not centered within your x-ray beam.
In this situation, you want to leave your sensor alone and adjust the position of the x-ray tube. And you always want to move the tube head in the direction of the cone cut.
So if you have white space on the mesial aspect of your x-ray, then you will want to move your x-ray tube head in a mesial direction to grab more of the mesial part of the sensor. Simply put, move your tube head in the direction of your cone cut!
When you move the tube head mesially, you can easily fix it. Voila!!
My radiograph rules
As an endodontist, my radiographs need to be perfect when I send my reports back to my referring dentist, so I am a bit of stickler when it comes to a good x-ray.
My team knows to follow these rules:
- The tooth in question must be in the center of the radiograph
- I need to see the apex and beyond
- There must never be a cone cut
- The final radiograph must show all the canals in the tooth
Try these tricks out and teach your team! They should be the ones taking your radiographs anyway. Marry these rules with your SLOB rule (watch my video tutorial on the SLOB Rule here) and you will be one mean x-ray taking machine!!
All the best,
Very useful article for everyday practice!
Thank you Seema!
thanks a lot ma’am these small tips are of lot importance in daily basis.
Glad to help! – Sonia
Explain very well each nd Every step.
Thank you – I’m so glad you’re following!
The article addresses the finer details in sensor and cone placement that I can’t believe I’ve been making it so hard on myself since undergrad till now. Thank you for pointing out the obvious in such a delicate and pleasant style.
Thank you Shamir – the difference I made for you is the reason I do this!!
I’m so glad you’re following, and stay tuned for more!
Have you made a post about handling bleeding canals? How to control it , what materials to use, how to avoid it in the first place, when to bring back for another appt?
Another idea could be a post about reference points. How to create an utilize them accurately.
Keep it up.
Thanks Matthew! I have not addressed that yet, but am adding it to the list!
Pls guide me I m unable to keep the concern upper post teeth in center of ray
What should the positionof pt head , and what should angulation of xray head to shoot
Hi! I recommend for the preop and postop radiograph to use a XCP (a positioning device) to help you. When you use this, pay attention to the angulation of your tube head as it will help you when you can’t use the XCP during treatment to take the x-ray. Making sure you sensor goes all the way into the palatal vault is key! Hope this helps!
Love reading your articles.
So glad you’re following!
I swear I always gain something from your blog! Thanks for sharing!
I always learn something from your blog! Thanks so much for sharing such great tips!
Thanks so much Rebekkah!
Great tips. I will be sharing this to my dental assistant.
Thanks Fortuna – definitely loop in your team!
Thank you mam
You’re welcome! – Sonia
Hi Dr. सोनिया.
I saw your xrays they are fantastic. Do you mind to tell me which company rvg sensor you are using..
I use many different sensors in my practice, so I don’t know which ones I used on this case. I have XDR, Carestream and Schick sensors in my office and we are considering shifting to XDR completely.
This is very useful. I will share it with my DAs. Thank you for sharing!
I’m so glad this is helpful.
Great tips! Thank you!
I am glad you are finding this helpful!
Very useful indeed, particularly the tip to ask the patient to ‘bite’ their fingers to position the sensor down in the floor of the mouth.
As per the comments above, I always learn something from your blogs. You have a very friendly and encouraging way in presenting. Thank you.
Thank you so much for reading doc!