CLARK TECHNIQUE

Other names

Localization technique
Oral object technique
Lost object technique

Oclusal Projections and

THEIR CORRESPONDENTS

VERTICAL ANGLES
OCCLUSAL PROJECTION VERTICAL ANGULATION
Maxillary topography +65
Maxillary lateral (right or left) +60
Pediatric maxilla +60
Mandibular topography -55
Mandibular cross-section 90
Pediatric mandibular -55

Described 100 years ago, this technique, also known as the Rule of

Oral Object and Technique of Eccentric Projections is based on

change of the relative positions of the radiographic images of the objects

when the angle of projection of the radiation beam changes.

For this technique, two periapical radiographs are required.

area to study: an orthoradial radiograph, which is achieved with the values of

correct horizontal and vertical angulation; and a mesioradial radiograph, in

which varies the horizontal angle by placing the base of the X-ray cone

toward the mesial; or a distoradial radiograph, which is obtained by placing the

base of the cone towards distal. Always in all cases the point of incidence

The radiation beam facial must remain in the same place 1,3,5.

This technique is useful during endodontic treatment for:

Dissociate images of roots and multiple canals.

Separate anatomical structures and periapical radiolucencies.

Determine the location of apical curvatures that are towards

the vestibular or palatine.

Description of the principles of the technique: there are two objects A and B, one

in front of the other (see figs. 1 and 2). If a beam of light is directed at both of

perpendicular manner, the resulting image will be of the overlapping objects,

without the possibility of distinguishing which is closer to the source of

radiation and which further away. By modifying the way the beam of light strikes.

about the objects, that is, by modifying the angle at which light strikes,

the resulting image will show the dissociated bodies. This is where it is used.

the premise of this technique: "The farthest object from the cone moves towards the
direction of the cone and the one that is closest moves in direction

opposite

This same principle is used in radiographic images, taking as

reference the point of incidence of the radiation beam to establish the

direction in which the relative position of the resulting image was recorded. If

is located on the same side where the base of the X-ray cone moved,

then the object will be further away from the radiation source and, if it

register on the opposite side from where the base of the cone was placed

X-rays, then the image will correspond to the object that is farthest.

near the radiation source, that is, towards vestibular. Using this

first, they can be dissociated and identify the corresponding images of

the conductors radicular.

In the following case (see fig.3), a lower first molar is shown.

Remember that the normal anatomy of this dental group is composed of two roots.

one mesial and another distal. The mesial root has two canals:

mesiovestibular and mesiolingual. Figure 3 corresponds to an X-ray.

ortorradial of that molar. In this radiograph, it can be seen that in the mesial root

two endodontic files are found, but the resulting image in the

conducts shows an overlap of both images, making it seem

it is about a single duct.

When taking an X-ray with variation of horizontal angulation, such as the

What is observed in figure 4 is that the image of the root canals is evident.

mesial is no longer a single one, but rather two radiopaque lines are observed.

corresponding to the mesiobuccal and mesiolingual canals. For

to identify each conduit, the rule formulated by Clark is used, which was

previously mentioned. The image of the object that is recorded to the side
the opposite direction to where the base of the X-ray cone was displaced corresponds

to the object farthest from the radiation source, in this case the duct

lingual. On the other hand, the image of the object that appears in the X-ray towards

the same side towards which the base of the X-ray cone moved is the

corresponding to the object that is closest to the source of

radiation. In the presented case, it would be the vestibular duct.

It is a method used to locate the position of a tooth or an object.

in the jaws. Before the dental radiologist can use techniques of

Localization requires a comprehensive understanding of the basics.

Additionally, step-by-step procedure knowledge is required.

Purpose and use

Dental X-ray is a two-dimensional image of a three-dimensional object.

dimensions. A radiographic image shows an object in its relationships

superior-inferior and anterior-posterior. The dental X-ray, however, does not

it represents the buccal-lingual relationship, or the depth, of an object. In

dentistry may be necessary to establish the buccal-lingual position of

a structure, such as a strange object or a tooth a jaw. The

Localization techniques can be used to obtain this information.

three-dimensional. With localization techniques, it is possible to locate it

next:

Foreign bodies
Impacted teeth
Impacted teeth
Retained roots
Root positions
Salivary calculations
Jaw fractures
Broken needles and instruments
Filling materials

Types of Clark techniques

Two techniques have been used to locate objects: (1) the object's norm

oral and (2) the right angle technique.

Oral object standard

The norm of the oral object governs the orientation of the represented structures.

in two X-rays taken at different angles. Using the technique and the

proper angulation, a periapical receptor or a bitewing receptor is exposed

by bite, next, after changing the beam direction

X, a second periapical receptor or bite wing is exposed by means of a

different angle, horizontal or vertical. For example, an angle

horizontal differences are used when it comes to locating images

vertically aligned (e.g., teeth treated with endodontic therapy,

while a different vertical angulation is used when it comes to

locate a horizontally aligned image (e.g., the mandibular canal).

After the two exhibitions have been completed, the images are

compared to each other. When the dental structure or the object seen in the second

The image seems to have moved in the same direction as the displacement.

of the device indication device (DIP), the structure or the object in

The issue is found in lingual (Fig-1).

For example, if the horizontal angle changes when changing the DIP

mesially, and the object in question moves mesially in the image, the

the object is in lingual (lingual=equal).

Conversely, when the dental structure or the object seen in the second

the image seems to have moved in the opposite direction of the displacement
DIP, the structure or the object in question is placed in the vestibular (Fig-2).

For example, if the horizontal angulation changes when changing the DIP distally,

and the object in question moves mesially in the image, the object

find in vestibular (vestibular=opposite).

The mnemonic 'ILOV' can be used to remember the object rule.

oral, in the following way:

Lingual

In other words, when the two images are compared, the object that is

find in Lingual seems to have moved in the same direction as the DIP, and

the object in the vestibular seems to have moved in the direction

opposite of the DIP.

PROCEDURE

Lateral Maxillary Occlusal Projection

1. Position the patient in such a way that the upper arch is parallel to the

soil.

2. Place a size 4 film with the white side facing the jaw.

the superior and the long edge in one direction from front to back.
Insert the receiver into the patient's mouth, subsequently placing it in the

as allowed by the patient's anatomy. Change the receiver on the side

right or left) of the area of interest. The long edge of the receiver must be

extend approximately 1/2 inch beyond the vestibular surfaces

of the back teeth.

3. Teach the patient to bite gently on the receiver, conversing the

position of the bitten receptor end to end.

4. Place the position indication device (DIP) in such a way that the

central ray is directed to +60 degrees in vertical angle towards the center of the

receptor. The top edge of the DIP is placed above the corner of the eyebrow

of the patient.

Pediatric Maxillary Occlusal Projection

1. The child's position should be such that the upper arch is

parallel to the ground.

2. Place a size 2 film with the white side toward the maxilla.

superior and the long edge in a side-to-side direction. Insert the

receptor in the child's mouth.

 3. Instruct the child to bite gently on the receiver, maintaining the

position of the receiver biting from end to end.

4. Place the position indication device (PID) in such a way

that the central ray is directed through the midline of the arc towards the

center of the receptor.

5. Position the DIP so that the central ray is directed at +60 degrees.

vertical angulation towards the center of the receptor. The upper edge of the

DIP is placed between the child's eyebrows on the bridge of the nose.

Topographic Occlusal Projection Mandibular

1. Position the patient in such a way that the mandibular arch is parallel to the

soil.

Place a size 4 film with the white side toward the jaw and the

wide edge in one direction from side to side. Insert the receiver into the mouth of the

patient, subsequently placing it as allowed by the anatomy

of the patient.

3. Instruct the patient to gently bite down on the receptor, maintaining the

position of the receiver biting from end to end.

4. Place the position indication device (DIP) in such a way that the

the central ray moves through the midpoint of the arch towards the center of the

receptor.
5. Place the (DIP) so that the central ray points to -55 degrees.

Vertical angulation towards the center of the receptor. The DIP must be centered.

on the patient's chin.

Occlusal Projection Cross Section Mandibular

1. Position the patient in such a way that the mandibular arch is parallel to the

soil.

2. Place a size 4 film with the white side facing the jaw and the

wide edge in one direction from side to side. Insert the receiver into the mouth of

patient, placing it later as allowed by the anatomy

of the patient.

3. Instruct the patient to gently bite down on the receiver, maintaining the

receiver position biting from end to end.

4. Place the position indicating device (PID) in such a way that the

central ray travels through the midline of the arch towards the center of the

receptor.

5. Position the DIP so that the central ray points at 90 degrees.

vertical angulation towards the center of the receptor. The DIP should be centered

approximately 1 inch below the patient's chin.

 Occlusal Projection Pediatric Mandibular Section

1. Position the child in such a way that the mandibular arch is parallel to

floor.

2. Place a size 2 film with the white side toward the maxilla and the

wide edge in one direction from side to side. Insert the receiver into the mouth of the

child.

3. Instruct the patient to bite gently on the receptor, maintaining the

position of the receiver biting from end to end.

4. Place the position indication device (PID) so that the

central ray is directed through the midline of the arch towards the center of the

receptor.

5. Place the DIP in such a way that the central ray is directed in

vertical angle of -55 degrees. The DIP must be centered over the chin

of the child.