Quality Resource Guide l Intraoral Bitewing Radiographic Technique 8th Edition 4 www.metdental.com Suggested Reading Mallya SM and Lam E. White and Pharoah’s Oral Radiology: Principles and Interpretation, 8th Ed. Elsevier Inc., St. Louis, Missouri. 2019. Chapters 5, 6, 7, and 16. 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 too 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) 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. Figure 6 Problem: The third molar is not imaged on the receptor. Solution: This error can be corrected by positioning the receptor more distal. Align the front edge of the receptor so that it is no further forward than the mesial of the mandibular first molar. If the tooth is still not imaged on the receptor, then a third molar disto-oblique projection should be exposed.