Quality Resource Guide
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Intraoral Bitewing Radiographic Technique 7th Edition
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www.metdental.com
Summary
Bitewing projections play an important role in
aiding the identification and treatment of dental
disease. Therefore, it is imperative that good
diagnostic bitewing radiographs be exposed. This
guide describes the desired characteristics of
posterior bitewings, problem-solving techniques
and common problems with associated solutions.
It was written based upon existing guidelines,
however, organizations such as NCRP often
provide periodic updates. Readers are encouraged
to source the appropriate agency or organization
for the most current recommendations.
Suggested Reading
Lam E. and Mallya SM.
White and Pharoah’s Oral
Radiology: Principles and Interpretation, 8th Ed.
Elsevier Inc., St. Louis, Missouri. 2019. Chapters 6,
7, and 17.
Dental Radiographic Examinations:
Recommendations for Patient Selection and
Limiting Radiation Exposure. American Dental
Association, Council on Scientific Affairs and US
Department of Health and Human Services, Public
Health Service, Food and Drug Administration,
2012.
Figure 7
Problem:
This premolar bitewing image is tipped and a
conecut is present.
Solution:
The packet placement error occurred due to
the receptor being placed to anterior in the
mouth. The tipped image can be corrected by
repositioning the biteblock so that the horizontal
plane of the biteblock is parallel to the occlusal
plane and the receptor is positioned in the
midline of the oral cavity. The conecut error can
be corrected by covering the entire receptor with
the beam.
A useful landmark is to align the front
edge of the positioning collimator with the front
edge of the receptor.
Figure 8
Problem:
The level of alveolar bone imaged in the
projection is unequal in the maxillary and
mandibular arches. This error could be due to
the receptor-holding device not centered on
the receptor, or incorrect vertical angulation
positioned too steep (tubehead positioned at an
angle greater than +10).
Solution:
Reposition the receptor so that it is centered
in the holder. The vertical angulation should
be positioned at +10 degrees (beam is angled
down). If the patient exhibits periodontal
pocketing of 5 mm or more, then a vertical
bitewing should be exposed to ensure that the
crestal bone is imaged on the projection.
Common Errors (continued)