Chapter 19 Bite-Wing Technique

Dental Radiography Questions What is the purpose of bite-wing images? What are the recommended vertical and horizontal angulations for bite-wing exposures? What is the purpose of vertical bite-wing images?

Dental Radiography Chapter 19 Reading: Iannucci & Howerton (pp. 210-225)

Dental Radiography Chapter 19 Outline Bite-Wing Technique Basic concepts Step-by-step procedures Vertical bite-wings Bite-wing technique modifications

Introduction Purpose Iannucci & Howerton (p. 211) To present basic concepts To describe patient preparation, equipment preparation, and receptor placement procedures used in the bite-wing technique To outline the advantages and disadvantages of the bite-wing technique and review helpful hints

Basic Concepts Terminology Principles of Bite-Wing Technique Beam Alignment Device and Bite-Wing Tab Bite-Wing Receptors Position-Indicating Device Angulation Rules of Bite-Wing Technique

Basic Concepts Bite-wing technique A method used to examine the interproximal surfaces of teeth

Terminology Interproximal Interproximal examination Bite-wing receptor Iannucci & Howerton (pp. 211-212) (Fig. 19-1) Interproximal Interproximal examination Bite-wing receptor Alveolar bone

Terminology Crestal bone Contact areas Contacts, open Iannucci & Howerton (pp. 211-212) (Figs. 19-2 through 19-5) Crestal bone Contact areas Contacts, open Contacts, overlapped

Principles of Bite-wing Technique Iannucci (p. 212) (Fig. 19-6) The receptor is placed in the mouth parallel to the crowns of both the upper and lower teeth. The receptor is stabilized when the patient bites on the bitewing tab or beam alignment device. The central ray is directed through the contacts of the teeth, using a +10 degree vertical angulation.

Beam Alignment Device and Bite-Wing Tab Iannucci (pp. 212-213) (Figs. 19-7, 19-8) Bite-Wing Beam Alignment Device A device used to position an intraoral receptor in the mouth Bite-Wing Tab A heavy paperboard tab or loop fitted around a periapical receptor and used to stabilize the receptor during the exposure

Bite-Wing Receptors Size 0 Size 1 Size 2 Size 3 Iannucci (p. 213) For posterior teeth of children with primary dentition Size 1 For the posterior teeth of children with mixed dentitions Size 2 For posterior teeth of adults, placed horizontally or vertically Size 3 For bite-wings, not recommended for adult patients

Position-Indicating Device Angulation Iannucci & Howerton (p. 213) Angulation The alignment of the central ray of the x-ray beam in the horizontal and vertical planes In the bisecting technique, the angulation of the PID is critical.

Horizontal Angulation Iannucci & Howerton (p. 214) (Figs. 19-4, 19-5) Correct horizontal angulation The central ray is directed perpendicular to the curvature of the arch and through the contact areas of the teeth. Incorrect horizontal angulation This results in overlapped contact areas. What is the proper horizontal angulation for bite-wings? If the proper horizontal angulation is correct, what will be avoided?

Vertical Angulation Iannucci & Howerton (p. 214) (Figs. 19-9, 19-10) The positioning of the PID in a vertical or up- and-down plane Positive The PID is positioned above the occlusal plane and the central ray is directed downward. Negative The PID is positioned below the occlusal plane and the central ray is directed upward. Angulation is measured in degrees according to the markings on the outside of the tubehead. The vertical angulation is determined by the imaginary bisector; the central ray is directed perpendicular to the imaginary bisector.

Vertical Angulation Correct vertical angulation Iannucci & Howerton (p. 214) (Figs. 19-11, 19-12) Correct vertical angulation +10-degree Incorrect vertical angulation Results in a distorted image

Rules of Bite-wing Technique Iannucci & Howerton (p. 214) (Fig. 19-6) Receptor placement Receptor position Vertical angulation Horizontal angulation Receptor exposure

Step-by-Step Procedures Patient Preparation Equipment Preparation Exposure Sequence for Receptor Placements Receptor Placement

Patient Preparation Explain the radiographic procedure to the patient. Iannucci & Howerton (pp. 215-216) (Procedure 19-1) Explain the radiographic procedure to the patient. Position the patient upright in the chair. Adjust the headrest. Place and secure the lead apron with thyroid collar. Remove all objects from the mouth. Infection control procedures and preparation of the treatment area and supplies should be completed before seating the patient.

Equipment Preparation Iannucci & Howerton (pp. 215-216) (Procedure 19-2) Set the exposure factors. Open the sterilized receptor package containing the beam alignment device if a beam alignment device is used. Equipment must also be prepared before the dental radiograph can expose any films.

Exposure Sequence for Receptor Placements Iannucci & Howerton (pp. 215-216) (Fig. 19-13) Two bite-wing receptors are typically exposed on each side of the arch. One bite-wing receptor may be sufficient when posterior teeth are missing. The number of bite-wings taken is dependent upon the curvature of the teeth and the number of teeth present in the posterior areas. In adult patients, four bite-wings are taken: one right premolar, one right molar, one left premolar, and one left molar.

Exposure Sequence for Receptor Placements Iannucci & Howerton (pp. 215-216) CMRS Expose all anterior periapical receptors first. Follow with posterior periapical receptor. Finish with bite-wing exposures. Bitewing only Expose the premolar bite-wing receptor first. Expose the molar bitewing receptor last.

Bite-wing Receptor Placement Iannucci & Howerton (pp. 216-217) (Box 19-1) The specific area where the receptor must be positioned before exposure Dictated by the teeth and surrounding structures Right and left premolar exposures; right and left molar exposures: the receptor is placed after the vertical and the horizontal angulations have been set.

Bite-wing Receptor Placement Iannucci & Howerton (pp. 217-222) (Figs. 19-14 through 19-24) (Procedures 19-3, 19-4) The white side of the receptor faces the teeth. In the posterior bite-wing series, the receptors are placed horizontally. The identification dot has no significance in bitewing receptor placement. Center the receptor over the area to be examined Ask the patient to “slowly bite” on the bite-wing tab or bite-block of the beam alignment device. Bite-wing tab or loop should be centered on the receptor before placement. Premolar exposures are taken first because they are less likely to trigger the gag reflex. Remind patient to remain still and to not move film with tongue.

Vertical Bite-Wings Used to examine the level of alveolar bone Iannucci & Howerton (p. 222) (Figs. 19-25, 19-26) Used to examine the level of alveolar bone Placed with the long portion of the receptor in a vertical direction Seven receptors are used to cover canine, midline, premolar, and molar areas. Vertical bite-wings are often used as posttreatment or follow-up films for patients with bone loss due to periodontal disease. The vertical bite-wing examination uses one-half the number of exposures included in a complete series of periapical radiographs.

Modifications in Bitewing Technique Iannucci & Howerton (pp. 222-223) Edentulous Spaces A cotton roll must be placed in the area of the missing tooth to support the bite-wing tab or beam alignment device. Bony Growths The receptor must be placed between the tori and the tongue.