Radiology- Chapter 21 Bitewing Technique

Bitewing technique

method used to examine the interproximal surfaces of teeth

-used to monitor the progression of dental caries, assess existing restorations, and examine the crestal bone levels between teeth

Interproximal

Between two adjacent surfaces

Interproximal examination

used to examine the crowns of both maxillary and mandibular teeth on a single image

Bitewing receptor

size 0, 1, 2 receptors with a bite tab or "wing"

Alveolar bone

the bone that surrounds the roots of the teeth. It forms the bony sockets that support and protect the roots of the teeth

Crestal bone

Coronal portion of alveolar bone found between the teeth

Contact areas

The area of a tooth that touches an adjacent tooth; the area where adjacent tooth surfaces contact each other

Opened contacts

appear as thin radiolucent lines between adjacent tooth surfaces

overlapped contacts

the area where the contact area of one tooth is superimposed over the contact area of an adjacent tooth.

horizontal bite-wing

The bite-wing receptor is placed in the mouth with the long portion of the receptor in a horizontal direction

Vertical bitewing

The bitewing receptor is placed in the mouth with the long portion of the receptor in a vertical direction.

Principles of bitewing technique

1. receptor placed in mouth parallel to the crowns of both the max and mand teeth

2. receptor stabilized when pt bites on bite wing tab or beam alignment device

3. when using bitewing tab, central ray is directed through contacts of teeth and vertical angulation of +10 degrees

Beam alignment device

Assists in the positioning of the position indicator device (PID)

Bitewing receptor

A receptor used to examine the crowns of the maxillary and mandibular teeth on a single image

Size 0

For posterior teeth of children with primary dentition

Size 2

For posterior teeth of older children and adults, placed horizontally or vertically

Size 3

For bitewings, not recommended

Horizontal angulation

Correct horizontal angulation:

-The central ray is directed perpendicular to the curvature of the arch and through the contact areas of the teeth.

incorrect horizontal angulation

results in overlapped contact areas

Vertical angulation

Correct vertical angulation

+10 degree

Incorrect vertical angulation

results in a distorted image

Exposure sequence for receptor placements

-two bite-wing receptors are typically exposed on each side of the arch

-one bite-wing receptor may be sufficient when posterior teeth are missing

Vertical Bite-Wings

Used to examine the level of alveolar bone

-Placed with the long portion of the receptor in a vertical direction

-Often used as post-treatment or follow-up films for patients with bone loss caused by periodontal disease

Modifications in bitewing technique

- Edentulous Spaces

- Bony Growths

Edentulous spaces

A cotton roll must be placed in the area of the missing tooth to support the bite-wing tab or beam alignment device.

Bony growths

Receptor must be placed between tori and tongue