1. Chapter 19
Bite-Wing Technique

2. 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?

3. Dental Radiography Chapter 19 Reading:
Iannucci & Howerton (pp )

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

5. 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

6. 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

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

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

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

10. 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.

11. Beam Alignment Device and Bite-Wing Tab
Iannucci (pp ) (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

12. 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

13. 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.

14. 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?

15. 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.

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

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

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

19. Patient Preparation Explain the radiographic procedure to the patient.
Iannucci & Howerton (pp ) (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.

20. Equipment Preparation
Iannucci & Howerton (pp ) (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.

21. Exposure Sequence for Receptor Placements
Iannucci & Howerton (pp ) (Fig )
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.

22. Exposure Sequence for Receptor Placements
Iannucci & Howerton (pp )
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.

23. Bite-wing Receptor Placement
Iannucci & Howerton (pp ) (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.

24. Bite-wing Receptor Placement
Iannucci & Howerton (pp ) (Figs 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.

25. Vertical Bite-Wings Used to examine the level of alveolar bone
Iannucci & Howerton (p. 222) (Figs , 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.

26. Modifications in Bitewing Technique
Iannucci & Howerton (pp )
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.