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1. The Bitewing Technique
Reference reading: Chapter 19

2. Show interproximal caries
Show pulp changes
Show overhangs
Display improperly fitting crowns
Shows recurrent caries beneath restorations
Show resorption of alveolar bone
Objectives for Bitewings:

3. Alveolar Bone

4. Contact Areas

5. Diagnostic Image

6. Caries on #30 D

7. Crestal Bone Height

8. Alveolar Bone Loss

9. Crown Margins

10. Overhanging Amalgam and Crown

11. Recurrent Caries #29 M

12. Pulp Stone

13. Is a method used to examine the inter-proximal
surfaces of the teeth (where the explorer
doesn’t reach).
Considered a method of preventive dentistry.
Is a radiographic exam that is used the most
frequently in conjunction with dental exams
and cleanings.
The Bitewing Technique

14. X-ray beams pass through teeth at a 90 degree angle,
which creates a more accurate image of structures.
The use of paralleling technique creates the illusion
of open contacts, giving the appearance that there
are spaces between the teeth.
◦Appears radiolucent (BLACK)
Show the crowns of both upper and lower teeth, as
well as the supporting alveolar bone, on a single film.
How it works:

15. Vertical Angulation

16. The film is placed in the mouth parallel to the
crowns of both the upper and the lower teeth
The film is stabilized when the patient bites on
the bite-wing tab or film holding device.
The central ray of the x-ray beam is directed
through the contacts of the teeth, using vertical
angulation of +10 degrees
Principles of Bite-wing Technique:

17. The Bite-wing tab: this is a sticky tab that is
placed on the tube side of the film packet.
The patient bites directly on the tab, and
therefore establishes a better image because
the teeth are fully closed, and there is no bite-
block interference.
The Bite-wing Tab

18. Bite-wing Tab

19. Film Holding Devices - Rinn
Rinn XCP Bitewing
instrument:
◦Just like the Rinn for
periapical films, the
Rinn bite-wing holder
will position the film,
stabilize it, and align
the PID for a good
diagnostic film.

20. Premolar view:
◦angle the PID at +10 degrees vertically;
◦horizontally aim toward center of film, between the
premolars and the occlusal plane
◦Center tab on 2
nd
premolar
Molar view:
◦angle the PID at +10 degrees vertically,
◦ horizontally aim at contacts of 1
st
and 2
nd
molars
◦Center tab on 2
nd
molar
Bite-Wing Radiograph Views

21. Posterior Teeth

22. Premolar Curvature

23. Premolar Placement and
Image

24. Molar Area

25. Molar Placement and Image

26. Size 0 = pediatric patient with primary dentition
Size 1 = children with mixed dentition
Size 2 = teens and adult patients
Size 3 = horizontal bitewings only;
not recommended due to overlapped contact results
Four sizes of film are used for BWX

27. Vertical Bite-wings
Can be used to examine
the level of supporting
bone in the mouth.
The bite-wing is placed
in a vertical, up and
down, direction.
Mainly used for
periodontal patients.

28. A total of 7 projections are used to cover all
areas.
Modified CMRS using Vertical Bite-wings

29. Image of Anterior Vertical Bitewing

30. The whole purpose of the bitewing examination is
to see the interproximal areas of the teeth.
If horizontal angulation is incorrect, the contacts
will be overlapped, and produce a film of poor
diagnostic quality. To avoid overlap, direct the CR
through the interproximal areas of the teeth.
If the vertical angulation is incorrect, the image will
be distorted, and also of poor diagnostic quality
The importance of angulation:

31. Open Contacts: Desirable Image

32. Overlapping: non-diagnostic

33. Negative Angulation: non-diagnostic

34. Edentulous Areas
◦A cotton roll must be placed in the area of the missing
teeth to support the bite-wing tab.
◦Failure to support the BW tab results in a tipped
occlusal plane on the radiograph.
Bony Growths (tori)
◦Mandibular tori may cause a problem in film
placement.
◦The film must be placed between the tori and the
tongue, not on the tori.
Modifications to the BW Technique

35. BEFORE PLACING FILM IN PATIENT’S MOUTH:
Set exposure factors
◦(kVp, mA, exposure time)
Ask patient to remove all intraoral objects and
eyeglasses
Check the oral anatomy
◦Tori?Shallow or narrow palate?
◦Limited opening?
Attempt to retract cheeks and tongue to gauge
difficulty during film placement.
Helpful Hints