CHAPTER TWO
BITEWING RADIOGRAPHS
Objectives
Introduction
Definition
Purpose of bitewing images
Indication
Bitewing radiograph used for
Advantages / disadvantages
Bitewing Procedure
Errors of bitewing
What is the batwing radiograph?
Introduction
Bitewing radiographs take their name from the
original technique which required the patient to bite
on a small wing attached to an intraoral film packet.
Modern techniques use holders, as shown later,
which have eliminated the need for the wing (now
termed a tab), and digital image receptors (solid-
state or phosphor plate) can be used instead of film,
but the terminology and clinical indications have
remained the same.
An individual image is designed to show the crowns
of the premolar and molar teeth on one side of the
jaws.
What is the batwing radiograph?
What is bitewing x-rays?
Bitewing X-rays show
details of the upper and
lower teeth in one area of
the mouth.
Each bitewing shows a tooth
from its crown (the exposed
surface) to the level of the
supporting bone.
Bitewing X-rays detect decay
between teeth and changes
in the thickness of bone
caused by gum disease.
What is the purpose of bitewing
images?
What is the purpose of bitewing images?
The bitewing radiograph (BW) is an image
that depicts the maxillary and mandibular
crowns of the teeth, providing a clear
image of the interproximal surfaces of
the teeth and allowing for detection of
interproximal caries.
Cont.
Bitewing X-rays can also help determine the
proper fit of a crown (a cap that completely
encircles a tooth) or other restorations (such
as bridges). It can also see any wear or
breakdown of dental fillings.
What is the indication dental x rays?
MAIN INDICATIONS
Detection of lesions of caries
● Monitoring the progression of dental caries
Assessment of existing restorations
● Assessment of the periodontal status.
What is the bitewing radiograph used
for?
What is the bitewing radiograph used for?
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.
Advantages
Relatively simple and straightforward.
Adequate sensitivity, also for early proximal lesions
Image receptor is held firmly in position and cannot
be displaced by the tongue.
Position of X-ray tube head is determined by the
beam-aiming device so assisting the operator in
ensuring that the X-ray beam is always at right
angles to the image receptor.
Avoids coning off or cone cutting of the anterior part
of the image receptor.
Holders are autoclavable or disposable.
Disadvantages
● Position of the holder in the mouth is
operator dependent, therefore images are not
100% reproducible, so not absolutely ideal for
monitoring progression of caries.
● Positioning of the film holder and image
receptor can be uncomfortable for the patient
particularly when using solid-state digital
sensors.
● Some holders are relatively expensive.
● Holders not usually suitable for children
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 or
sensor is in position,
the operator directs the
cone of the x-ray unit
toward the film.
Conti.
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.
precaution
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 our patients.
What is the difference between a PA and
bitewing?
Bitewings are used to detect decay between teeth
and changes in bone loss caused by periodontal (gum
and bone) disease.
Periapical (PA) Radiographs show the whole tooth
from the crown to 2-‐3mm beyond the end of the root
to where the tooth is surrounded by alveolar bone.
Management of Maxillary Premolar with Pre-eruptive Intra-
coronal Resorptions
Gingival Disease in
Childhood
Bitewing radiograph showing the large carious lesion
(arrow) on the distal aspect of right maxillary first premolar.
Any question ??
