A 35-year-old male reported to our department with complaints of pain and swelling in maxillary left posterior region. On clinical examination, patient had masseteric space abscess secondary to caries on the maxillary left first and second molars. Patient also had a restricted mouth opening of 25 mm. In this patient, radiographs were obtained using both the conventional intraoral periapical radiographic technique and extraoral periapical technique. Figure 2 shows the comparison between standard intraoral periapical radiograph (A) and radiograph using extraoral technique (B). As seen, the radiograph obtained by extraoral technique has an adequate diagnostic value. Patient found the extraoral technique less painful and comfortable.

A 34-year-old male patient reported to our department with complaints of dull and aching pain in the upper left posterior region. Intraoral examination revealed a deep occlusal caries associated with the left maxillary second premolar. The tooth was tender on percussion. The patient had a severe gag reflex and it was impossible to obtain conventional intraoral periapical radiograph. A provisional diagnosis of apical periodontitis was made and endodontic treatment was recommended. The caries was excavated and adequate access cavity was prepared. Two root canals were located. However, it was impossible to obtain a radiograph to measure the working length. Therefore, it was decided to perform the extraoral periapical radiographic technique. The patient was positioned upright, with her mouth open as wide as possible. The sensor was placed on the external surface of the cheek, directly buccal to the left maxillary second premolar. A cotton roll was placed between the sensor and the cheek to parallel the sensor with the buccal surface of the tooth. The X-ray cone was angled approximately -25 degrees from the horizontal plane (Fig. 3A). The radiograph was taken with #15 K files (Fig. 3B). Cleaning and shaping of the root canals were performed and a radiograph with a master cone was obtained. The post-operative radiograph was obtained after obturation in similar way which provided the adequate diagnostic details (Figs. 3C and D). The added advantage of this technique was that it could be used in the patients with rubber dam in place making it applicable for all phases in endodontic therapy.

Pediatric patients are generally reluctant to intraoral film placement. A 7-year-old male patient reported with a complaint of severe pain in maxillary deciduous second molar region. On clinical examination the deciduous maxillary second molar was grossly carious. The patient was highly reluctant to intraoral placement of the sensor. Hence it was decided to use the extraoral technique. The technique for pediatric patients differed from that for adults. In pediatric patients we used lesser angulations i.e. -20 degrees for taking the radiographs of maxillary teeth and -10 degrees for taking the radiographs of mandibular teeth. The exposure time used over here was 0.35-0.40 second (Fig. 4A). The radiograph provided the essential diagnostic details (Fig. 4B) of the deep carious lesion extending into bifurcation, and it was decided to extract the tooth followed by placement of a space maintainer. Similarly, this technique was used in other non-cooperative pediatric patients (Figs. 4C and D). The patients found this technique less traumatic, and it was easier to obtain the patient cooperation.

Obtaining good intraoral radiographs of impacted third molar is often complicated by inadequate patient compliance and exaggerated gag reflex. Here we used this technique to obtain radiographs of impacted third molars in various patients. The technique used here was similar to the above mentioned technique. However, the sensor was placed more posteriorly and directly buccal to the third molars. The angulation used was -25 degrees for maxillary teeth and -10 degrees was used for mandibular teeth (Fig. 5A). The radiographs provided the essential diagnostic information (Figs. 5B and C). The patients preferred this technique compared with the conventional intraoral technique.