bite-wing technique
the name of this technique comes from the tab (wing) being bit on by the patient to hold the image receptor in place
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· > this technique showcases the
anatomical structures pictured are the
dental crowns with associated alveolar
bone crest of the maxillary &
mandibular teeth of one side only
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Cardboard loop for
film & storage
phosphor plates
~ Plasticadhesivetoa
(infection control
(either right or left side) on single
image
> TYPES OF BITE-WING TECHNIQUES:
a) Anterior bite-wing technique: rarely used
b) Posterior bite-wing technique: for fully dentulous or partially edentulous patients only
• contraindicated for completely edentulous patient)
> Classification of bite-wings according to the long-axis of the image receptor:
a) Horizontal bite-wing technique: the standard, used for the initial periodontal disease detection
b) Vertical bite-wing technique: modified for use during:
• excessive interproximal alveolar bone loss (moderate to advanced perio disease)
• minimum 6mm P.D. pocket depth or more is present clinically
I
> Vertical BW is used for complete assessment (survey) of periodontal
status, and the total number of bite-wings required for each patients are:
> POSTERIOR BITE WING EXAMINATION: according to age
the classical bite-wing examination, includes:
• for adults: 2 horizontal posterior bitewing receptors (size 2), 1 for premolars and 1 for molars, for each side
• for children 12yrs & younger: 1 horizontal posterior bitewing receptor (size 2) for each side
> the number of image receptors used (whether 2 or 4), for the whole dental arch, depends on:
1) number of teeth present
2) size of teeth
3) size of dental arch
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4) size of image receptor used
> STRUCTURES VISIBLE IN AN IDEAL BITE-WING RADIOGRAPH:
• whole dental crowns of both maxillary & mandibular teeth of one side in a single image
• opened contact of the proximal surfaces of the teeth, no overlapping.
• level of interdental proximal alveolar bone (periodontal tissue status)
• no detection of periapical tissue (area) seen
> INDICATIONS FOR BITE-WING RADIOGRAPHS:
• detection of initial (incipient-early stage) inter-proximal dental caries
• detection of secondary or recurrent caries beneath dental restorations.
• assessment of existing restorations; detection of overhangs/over or under extended restorations
• detection of inter-proximal calculus (deposits)
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• assessment of inter-proximal alveolar bone level (periodontal tissue status)
• detection of horizontal tooth fracture
periodontal craters: osseous craters or bone defects,
a type of bone loss in which concavities in the crest of
the interdental bone are confined within the facial &
lingual walls
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> Different digital sensors (PSP) or X-ray film sizes used as bite-wing image receptors:
&
• Size 1 sensor: for children only sizes 1 & 2 digital sensors (CCD) are
• Size 2 sensor: for adults (is the standard) suitable for use as bite-wing receptors
• Size 3 sensor: for adults (shows all premolars & molars)
>
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> POSITIONING TECHNIQUE for bite-wing: can be performed using the following:
1) a cardboard (loop) bitewing tab is attached to the image receptor and then the X-ray tube-head
is aligned manually
2) an image receptor holder called the 'red Rinn XCP (Extension Cone Parallel)', which consists of:
a) a mechanism for holding the receptor parallel to the teeth (vertical component)
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b) a bite block/bite platform that replaces the original wing tab
c) an X-ray beam aiming device, which includes a metal rod & aiming/locating ring to facilitate
positioning and alignment of the X-ray tube-head
Left side exposure
Rightside exposure Chorizontal) Right side exposure (vertical
chorizontal
> Patient's position in bite-wing technique:
• patient should be seated in a comfortable upright position.
• the head is positioned so that the occlusal plane is parallel to the floor
and the midsagittal plane (MSP) is perpendicular to the floor X
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> X-ray beam angulation of bitewing technique:
• the vertical angulation should be adjusted within the range of 0 to 10 (maximum) degrees, with the
tube head slightly positioned downward; this serves 2 purposes:
1. to account for the natural curvature of palate
2. to prevent overlapping of cusps between occlusal surfaces of the same side upper & lower teeth
1) VERTICAL TUBE-HEAD (CONE) ANGULATION:
improper vertical angulation can lead to a distorted image and rendering, which is
impractical for diagnostic purposes
A) when the vertical tube angulation is excessive, greater than +10º (tube is being
positioned too steeply/aimed too far downward): more of the maxillary teeth and bone are
imaged, cutting off a portion of the mandibular structures
B) when the vertical angulation is inadequate: more of the mandibular teeth & bone is
imaged, cutting off a portion of the maxillary structures
>
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contrast for carries detection
~
high
You contrast for bone detection
2) HORIZONTAL TUBE-HEAD (CONE ANGULATION)
X-ray beam should pass through the inter-proximal spaces to prevent faulty horizontal angulation, which can
lead to proximal overlapping that may obscure significant diagnostic information
> Point of entry of X-ray beam:
• the X-ray beam should cover the image receptor antero-posteriorly and superio-inferiorly
• the tab attached to the bite-wing image receptor should ideally be positioned at the center of the image
receptor, ensuring it remains centered within the cone's view as well
• however there is an exception for the last molar exposure, the tab should be placed slightly more anteriorly
• the front edge of the cone (Beam Indicating Device/BID) should be 2 mm anterior the front
(
edge of the image receptor to avoid the occurrence of (partial image/cone cut/cone off) anteriorlv
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*
> the bite tab/bite-platform should be positioned in the
middle (center) of the sensor or film packet and parallel to
the superior and inferior edge of the sensor or X-ray film
(image receptor)
~ X
only placed anteriorly during
last molar exposure
~ X
light
> BITEWING IMAGE ARTIFACT: light & image noise due to: image
& noise
1) underexposure, or;
2) excessive exposure to the ambient light between image acquisition & image scanning of PSP sensor
> ANATOMICAL CONSIDERATIONS/LIMITATIONS (difficulties):
> Unable to always avoid overlap of contact points due to:
• crowded teeth, misaligned teeth
• curved arch form.
> Unable to always place image receptor very close to teeth due to:
• mandibular tori (can be solved by adding an extension to the tab)
• curved arch form
> Difficulty in maintaining the tab in correct position in partially edentulous patients:
to overcome this, a cotton roll is placed in the edentulous area (fill in gap)
> DIAGNOSIS OF DENTAL DISEASES AND RESTORATIONS
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