slightly above (approximately 1/8 inch) the incisal edges of the lateral incisor and

cuspid teeth. The film's anterior border should be located lingual to the distal surface
of the opposite central incisor. Adjust the tube to an average angulation of -20º. Direct
the central ray straight through the bisecting plane. Follow the manufacturer's
instructions for exposure times.

MANDIBULAR INCISORS
Adjust the head as described for radiographs of mandibular teeth. Place the film
packet in the mouth with the long axis vertical. Both the long borders of the packet
should be placed under the tongue with the center of the film opposite the midline of
the arch and the upper border parallel to and slightly above (approximately 1/8 inch)
the incisal edges of the incisor teeth. Adjust the tube to an average angulation of -15º.
Direct the central ray straight through the interproximal spaces at the center of the
film and perpendicular to the bisecting plane. Follow the manufacturer’s instructions
for exposure times.

Bitewing Radiographic Technique:

Radiographs are an important part of dental diagnosis and treatment planning.
Patients may be prescribed radiographs that will be used along with a clinical
examination. Bitewing radiography is a commonly used dental x-ray technique and
may be a component of the radiologic examination. Bitewing radiographs provide
vital information to aid in the diagnosis of the most common dental diseases;
specifically tooth decay and periodontal bone loss or gum disease. Additional
important findings may be detected on bitewings, including the condition of fillings
and the presence of calculus or tartar.

Background
Bitewing radiographs provide an image of the crowns of the top and bottom teeth on a
single film.The type of film used for this examination provides a high resolution
image that is able to detect the subtle changes that occur with dental diseases.
Bitewings are usually prescribed in a series of 4 films, positioned on both sides of the
mouth, examining the structures from the eye teeth, or canines, back.

Bitewing Procedure

1)The patient is seated in an upright position in the dental chair.

2)The patient is covered with a lead apron and thyroid collar.

Accepted standards for infection control will be followed, with the operator wearing
gloves and some of the surfaces covered in a protective barrier.
3)A film is placed into the patient’s mouth using a cardboard film holding device.
This device holds the film in position while the patient bites his or her teeth together
onto a portion of the cardboard tab.It is important that the patient closes his or her
teeth completely in their natural bite.Sometimes a plastic film holder with an
attached ring may also be used.
4)Once the film is in position, the operator directs the cone of the x-ray unit toward
the film.
5)The patient is instructed to hold still while maintaining the correct position. The
operator leaves the room where he or she will press a button, to expose the film,
which produces an audible beep.
6)The operator re-enters the operatory and removes the film from the patient’s
mouth. This procedure may be repeated for different areas of the mouth as required.
7)Once the series of bitewing radiographs has been completed, the operator will
remove the thyroid collar and lead apron and ensure that the patient is comfortable,
while waiting for the films to be processed.
8)Following film processing, the films are examined. This initial assessment does
not examine the films for disease; rather, the films are assessed to determine whether
all areas can be visualized adequately.Anatomical variations, as well as local
restorations may obscure the image so that all the required areas cannot be clearly
seen, necessitating a re-take of that film.
The patient exposure dose of radiation is kept as low as possible in order to maximize
diagnostic value while minimizing risk.Radiation doses from dental radiography are
considered comparable to the levels of radiation that we are exposed to every day
from natural sources, such as the earth and space. Bitewing radiographs provide the
dental professional with important information that is vital in the diagnosis and
treatment planning for patients.
Paralleling TECHNIQUE The following procedures describe this technique:
1.Program the X-ray machine forhe discussed time, mA settings, and kVp settings.
2.Prepare theinter-proximalparallelingdevice. Fold the bitewing tab against the
film packet and insert the packet into the bite-block so that the printed side facesthe backing
support. Insert the end of the indicator rod into the holes in the bite-block.Slide the locator
ring onto the indicator rod. Look through the locator ring to see if thebite-block is centered in
the ring. If it is, the paralleling device is ready for
positioning in the patient's mouth.
3. Position the paralleling device with film in the patient’smouthsothatthe
anterioredgeofthefilm touches the distal surface of the mandibular cuspid. Have
the patient close gently but firmly on the bite-block to hold the film in position.
4. Slide the locator ring down the indicator rod until the ring almost touches the
surface of the patient's face. Then, align the tube head using the same technique as
previously described for the paralleling device.
5.Make the exposure. After making the exposure, put the exposed film in a lead
lined container or behind a protective screen. You are now ready to take the
radiograph on the opposite side of the patient's mouth.
BISECTING-ANGLE TECHNIQUE The following procedures describe this
technique:
1. Program the X-ray machine for the discussed time, mA settings, and kVp
settings.
2.Position the patient so that the ala-tragus line is parallelwiththefloor,andthe
midsagittal plane is perpendicular to the floor.
3. Position the film packet in the patient's mouth. Hold the wing of the packet
between your thumb and index finger. Place the lower edge of the packet between the
tongue and the lingual surfaces of the mandibular teeth.Positionthepacketsothat
itsanterioredge touches the distal surface of the mandibular cuspid. Rest the wing
of the packet on the occlusal surfaces of the mandibular teeth. Instruct the patient to
close slowly. As the patient's maxillary teeth contact your index finger, rollyour
fingeroutfacially,permittingthepatient's teeth to close on the wing. The film
packet is nowpositioned.
4. set the vertical angulation of the tube head at +5° to +l0°.
The occlusal packet contains two X-ray films. This allows different developing times
to be used for these films. The finished radiographs can then be compared for
diagnostic purposes. Occlusal radiographs are exposed using the bisected angle
technique.
MAXILLARY OCCLUSAL RADIOGRAPHS
Maxillary occlusal radiographs are taken by using the following procedures:
1.set the X-ray machine at 10 mA, 90 kVp, and 60 impulses (1 second). (Reducethe
kilovoltage 5 kVp if the arch is edentulous. Use 70 kVp if the patient is a child.)2. Position
the patient so that the ala-tragus line is parallelwiththefloor,andthemid-sagittalplaneis
perpendicular to the floor.
3. Place the film in the patient's mouth. Occlusal films are normally very
comfortable. Have the patient relax the muscles of the mouth and cheek as much aspossible.
The pebbled surface of the packet should be towardtheocclusalsurfacesof the maxillary teeth,
and the narrow side of the packet toward the patient’scheeks. To place the packet, retract one
corner of the patient’s mouth until the packetcan be inserted. Position the packet far enough in
the mouth so that it covers all theteeth. Special care must be taken to avoid gagging the
patient. Have the patient closegently but firmly on the packet to hold it in place.
4. Position the tube head. a.For maxillary anterior occlusal radiographs, set thevertical
angulation of the tube head at +65°. Center the tube head cylinder onthebridgeofthe.—
Projection of central ray (CR) for maxillary anterior occlusal

radiographs. patient's nose so that the central X-ray beam will be projected as
shown inFormaxillaryposteriorocclusal radiographs, set the vertical angulation
of the tube head at +75°. Center the tube head at the top of the patient's nose so that
the central X-ray beam will be projected as shown in.
5. Make the exposure.
MANDIBULAR OCCLUSAL RADIOGRAPHS
Mandibular occlusal radiographs are taken by using the following procedures:
1.Program the X-ray machine for 10 mA, 90 kVp, and 60 impulses (1 second).
(Reduce the kVp setting for edentulous patients and children as discussed earlier.).—
Projection of central ray (CR) for maxillary posterior occlusal radiographs.
2. Position the patient.
a.Formandibularanteriorocclusal radiographs, position the patient so that the
ala-tragus line is at a 45° angle with the floor, and the midsagittal plane is
perpendicular to the floor.
b.Formandibularposteriorocclusal radiographs, position the patient so that the
 ala-tragus line and mid-sagittal plane are perpendicular to the floor.
3.Place the film packet in the patient's mouth with the pebbled surface toward the
occlusal surfaces of the mandibular teeth, and the short sides of the packet are toward
thepatient'scheeks.Havethepatientclose gently on the packet to hold it in
place.
4. Position the tube head.
a. For mandibular anterior occlusal radio- graphs, set the vertical angulation ofthe tube head
at - 10°. Center the tube head cylinder on the tip of the patient’schin so that the central X-ray
beam will be projected as shown in.
b.Formandibularposteriorocclusal radiographs, set the vertical angulation of
the tube head at 0°. Center the tube head cylinder beneath the patient's chin so that the

central X-ray beam will be projected as shown in.

5. Make the exposures.

Extraoral radiographs example:

Panoramic X-ray:

Is one X-ray that provides a full picture of your whole mouth- complete upper and
lower jaw; sinuses and jaw joint. It is not as specific as the other X-rays because its
purpose is to show the general condition of all the teeth.It is used to help viewWhen

taking a full mouth series or an individual periapical radiograph, follow the given guidelines
for the
specific area listed:NOTE: After each exposure, put the exposed film inacleanpapercupor
disposable container. Then place the cup or disposable container in a lead container or
behind aprotective screen. 1. 2. 3. 4. 5. 6. 1. 2. 3. 4. Maxillary Incisor Area
Settheexposuretimeselectortomanufacturer's suggestedimpulses. Prepare the anterior
paralleling device. Position the parallelingdevice with film in the patient's mouth. Center the
film on the midline so that it is parallel with the longaxis of the incisors (fig. 1-14). Place a
cotton roll under the bite-block. Have the patient close gentlybut firmly. Adjust the locator
ring and align the tubehead cylinder as previously described. Make theexposure. Maxillary
Cuspid Area Set the exposure time selector to manufacturer's suggested
 impulses. Prepare the anterior paralleling device. Position the paralleling device with film in
the
patient's mouth. Center the film on the cuspid and parallel with the tooth's long axis (fig. 1-
15). Place a
cotton roll under the bite-block and have general tooth development; trauma; jaw joint pain;
wisdom teeth and certain abnormalities. It will give a broad view but does not provide
the fine detail that Bite-Wings or P.A.s provide.This X-ray is to be taken every 5-7
years