Week 1 Radiology- Bitewing Techniques

Bitewings images

Shows crown of both Mand. and Maxi. teeth in one image

utilized for interproximal caries detection

also used to evaluate: crestal bone height, presence of tooth buds, restoration

Bitewing for adult

Usually 4 images

adjust according to number of teeth

Molar and premolar on each side

Bitewing for child

Usually, one image each side until 2nd molar errupts

Key term

Horizontal angulation- side to side positioning of x-ray tube

Vertical angulation- Movement up to down

Molar bitewing exposure

Must show distal of most mesial 2nd premolar

no overlapping on majority of contacts

Premolar bitewing exposure

Must show distal of most mesial canine

no overlapping on majority of contacts

Procedures for exposing bitewing images

Prepare - computer, machine, patient, package, sanitize and place PPE, prepare sensor

Check patients occlusion - which 2nd molar moves more forward + which canine is more forward

Assemble XCP-ORA

Molar image

Sensor placed parallel to molar, sensor should be positioned away from the teeth

Horizontal angulation - CR is directed at interproximal spaces of molar

Bitewing receptor sizes

Size 0- used w/ primary dentition, placed horizontally

Size 2 - Adult/older children, horizontally or vertically

Size 3 - used in adult, horizontally, not recommended

Tab bitewing

+10 angle used to compensate for slight bend in maxillary teeth/ palate

Precise cone placement is key

Vertical bitewing

Use to exam more alveolar bone

standard w/ periodontally involved patients

Placed vertically

cords toward palate

image 3 depends of # of teeth present

BWX modification

ALARA concept -As Low As Reasonably Achievable

• missing teeth

• open contact

• use of tab over XCP for patients w/ moderate to severe overbite

• (vertical BWX is better choice)

R

Rule of Horizontal Angulation (IDEAL)

To “open” a contact the CR(central ray) must be directed parallel to the space to be open