The Bitewing Technique

Reference reading: Chapter 19
Show interproximal caries
Show pulp changes
Show overhangs
Display improperly fitting crowns
Shows recurrent caries beneath restorations
Show resorption of alveolar bone
Is a method used to examine the interproximal 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.
X-ray beams pass through teeth at a 90 degree
angle, which creates a more accurate image of
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.
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
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.
Rinn XCP Bitewing
◦ 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
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 2nd premolar
Molar view:
◦ angle the PID at +10 degrees vertically,
◦ horizontally aim at contacts of 1st and 2nd molars
◦ Center tab on 2nd molar
Size 0 = pediatric patient with primary
Size 1 = children with mixed dentition
Size 2 = teens and adult patients
Size 3 = horizontal bitewings only;
 not recommended due to overlapped contact results
Can be used to
examine the level of
supporting bone in the
The bite-wing is
placed in a vertical, up
and down, direction.
Mainly used for
periodontal patients.
A total of 7 projections are used to cover all
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
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
◦ The film must be placed between the tori and the
tongue, not on the tori.
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.

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