UNIT 2

Bitewing Radiographic Technique

Types of intra oral radiographs
 • The bitewing radiograph
includes the crowns of the
maxillary and mandibular
teeth, the interproximal
areas and the area of crestal
bone on the same film.

Obj. 1 Define bitewings and state the purpose

and sizes of various types of bitewing
radiographs.
Uses:

01 02 03
Examining the Detecting caries Examining crestal
interproximal (root, recurrent and bone levels
surfaces of teeth interproximal)
(fit of restorations,
calculus)
Types of Bitewings

• Posterior – most common is horizontal

(but can be vertical)
• Usually take 4 – 2 on each side

• Anterior - vertical
Film Size

• Primary dentition – size 0

• Mixed dentition – size 1 or 2 depending
on age
• Permanent dentition – size 2 (may need 2
on each side) or size 3
Obj. 2 Compare the Advantages Disadvantages
advantages and • Only one film needed • Overlapping due to the
disadvantages of on each side curvature of the arch
size three (3) • Film is too narrow to
bitewings. reveal crestal bone
levels
Film Holding Devices

• RINN Instrument – film holding device

with aiming ring

• Bite tabs – foam or cardboard

• Stick on film as needed
• One size fits all
Film Holding
Devices
• Cardboard loops around film
• Comes in various sizes
 Obj. 4 State the Film is placed parallel to the
basic principles of crowns of the upper and lower
the bitewing teeth
technique.
Film is stabilized when the client
bites down

Central Ray is directed through

the interproximal/contacts of
the teeth
Obj 5. Describe
the basic film and
PID positions for
premolar and
molar bitewing
radiographs.
Film Positioning

• Client must bite down firmly on the tab,

otherwise there will be a large radiolucent area
between the occlusal surfaces of the teeth
Client Position

• Midsagittal plane perpendicular to the

floor
• Occlusal plane parallel to the floor
Vertical Angulation

• An angle of ~ +10º is used to

compensate for the slight bend of the
upper portion of the film and the slight
tilt of the maxillary teeth
Vertical Angulation
• Look at position guide to determine where 0° is

10°

position guide
Horizontal Angulation

• Film, teeth and open end of PID are

parallel
• CR is directed through the contacts
Premolar Bitewing

• Front edge of film should be aligned

with the midline of the mandibular
canine

• Middle of PID directed at occlusal plane

 Premolar
BW
The distal of the canines
as well as open contacts
between the premolars
should be evident.
Molar BW

Front edge of film

should be aligned
with the mandibular
second premolar
• The distal of the premolars as well as
open contacts between the molars
should be evident.
Obj. 6. Describe the basic film and
PID positions for vertical bitewing
radiographs

• Same principles as for horizontal BW

• Used to show more of the crestal bone level
(can also assess root caries)
Vertical BW
Obj 7. Summarize the
most critical bitewing
exposure errors and
discuss how to correct
them.
Common Error

•Horizontal overlapping (write this in you

notes!)
• Results from incorrect horizontal
angulation
Common Error

•Collimator cut off (AKA cone cut)

• CR not directed at the center of the film
packet
• Aim for the middle of the bite tab
Common Error

•Faulty film placement

• Too far forward for a molar BW
• Too far back for a premolar BW
Common Error

•Incorrect vertical angle

• Negative vertical angle used (note in
your notes that it is in respect to the
ppt radiograph)
Review

• The premolar bitewing radiograph should be placed to include which tooth

surface?
• What are the primary diagnostic uses of bitewing radiographs?
• How many standard-sized films are recommended to make the full adult
bitewing survey?
• What size BW film would you use on an average boy of ten years old?
• When would vertical bitewings be indicated?
Review Continued

• If you did not centre the beam on the film packet in the client’s mouth what
error would probably show up on the radiograph?
• If the position-indicating device is pointing downward through the apices of
the maxillary teeth is the vertical angulation positive or negative?
• Which way are anterior bitewing films placed?
 Complete Quiz #1 on DC Connect

Make sure to review chapter 19

(Bitewings)

Next Week
Unit 3 – Paralleling

Read Chapter 17 – pg. 152