Bitewing radiography

Main indications
Detection of interproximal caries

Monitoring the progression of dental caries

Assessment of existing restorations

Assessment of the periodontal status
Ideal technical requirements
The bite-platform should be positioned on
the middle of the film packet and parallel
to the upper and lower edges of the film
packet

The film packet should be positioned with
its long axis horizontally for a horizontal
bitewing or vertically for a vertical bitewing\


The posterior teeth and the film packet should be
in contact or as close as possible

The posterior teeth and the film packet should be
parallel- the shape of the dental arch may
necessitate two separate film positions to achieve
this requirement for the premolars and the molars

In the horizontal plane, the X-ray tubehead should
be aimed so that the beam meets the teeth and the
film packet at right angles, and passes directly
through all the contact areas

I
In the vertical plane, the X-ray tubehead
should be aimed downwards approximately
5 to 8 degrees to the horizontal to
compensate for the upwardly rising curve of
Spee

The positioning should be reproducible
Positioning techniques
Using a tab attached to the film packet and
aligning the X-ray tubehead by eye

Using a holder with beam-aiming device to
facilitate the positioning and alignment of
the X-ray tubehead
Film holders
Basic components of film holders
A mechanism for holding the film packet
parallel to the teeth

A bite platform that replaces the wing

An X-ray beam-aiming device
The appropriate size film is selected as
follows:
- Large film packets ( 31*41mm ) for adults

- Small film packets ( 22*35 mm ) for
children under 12 years. Once the second
permanent molars have erupted the adult
size film is required
The patient is positioned with the head supported and
occlusal plane horizontal

The operator holds the tab between thumb and
forefinger and inserts the film packet into the lingual
sulcus opposite the posterior teeth

The anterior edge of the film packet should be positioned
opposite the distal aspect of the lower canine- in this
position, the posterior edge of the film packet extends
usually just beyond the mesial aspect of the lower third
molar
The tab is placed on to the occlusal surfaces of
the lower teeth

The patient is asked to close the teeth firmly
together on to the tab

As the patient closes the teeth, the operator
pulls the tab firmly between the teeth to ensure
that the film packet and the teeth are in contact
The operator releases the tab

The X-ray beam is aimed directly through the
contact areas, at right angles to the teeth and
the film packet, with an approximate 5-8 degrees
downward vertical angulation

To ensure that the anterior part of the film is
exposed the front edge of the cone should be
positioned adjacent to the corner of the mouth
Advantages of using film packets
with tabs
Simple

Inexpensive

The tabs are disposable, so no extra cross-
infection control procedures required

Can be used easily in children
Disadvantages

Operator-dependent assessment of horizontal
and vertical angulation of the X-ray tubehead

Radiographs are not reproducible

Cone cutting is common

The tongue can easily displace the film packet
Advantages of film packet holders
Simple

Film packet held firmly in position and cannot be
displaced by the tongue

X-ray beam is always at right angles to the film
packet

Avoid cone cutting
Holders are autoclavable
Disadvantages
Positioning of the film holder can be
uncomfortable for the patient

Some holders are relatively expensive

Holders are not suitable for children
Ideal exposure factors
Assessment of caries and restoration-high kV
which ensures good contrast to allow
differentiation between enamel, dentin and allow
EDJ to be seen

Assessment of periodontal status- low kV to
avoid burn-out of the thin alveolar crestal bone

In the X-ray machines with fixed kV and mA
these results are achieved through exposure
time