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?
5 Introduction Purpose Iannucci & Howerton (p. 211) To present basic conceptsTo describe patient preparation, equipment preparation, and receptor placement procedures used in the bite-wing techniqueTo 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 TabBite-Wing ReceptorsPosition-Indicating Device AngulationRules of Bite-Wing Technique
7 Basic Concepts Bite-wing technique A method used to examine the interproximal surfaces of teeth
9 Terminology Crestal bone Contact areas Contacts, open Iannucci & Howerton (pp ) (Figs through 19-5)Crestal boneContact areasContacts, openContacts, 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 DeviceA device used to position an intraoral receptor in the mouthBite-Wing TabA 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 dentitionSize 1For the posterior teeth of children with mixed dentitionsSize 2For posterior teeth of adults, placed horizontally or verticallySize 3For bite-wings, not recommended for adult patients
13 Position-Indicating Device Angulation Iannucci & Howerton (p. 213)AngulationThe alignment of the central ray of the x-ray beam in the horizontal and vertical planesIn the bisecting technique, the angulation of the PID is critical.
14 Horizontal Angulation Iannucci & Howerton (p. 214) (Figs. 19-4, 19-5)Correct horizontal angulationThe central ray is directed perpendicular to the curvature of the arch and through the contact areas of the teeth.Incorrect horizontal angulationThis 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 AngulationIannucci & Howerton (p. 214) (Figs. 19-9, 19-10)The positioning of the PID in a vertical or up- and-down planePositiveThe PID is positioned above the occlusal plane and the central ray is directed downward.NegativeThe 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.
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 )CMRSExpose all anterior periapical receptors first.Follow with posterior periapical receptor.Finish with bite-wing exposures.Bitewing onlyExpose 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 exposureDictated by the teeth and surrounding structuresRight 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 examinedAsk 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 bonePlaced with the long portion of the receptor in a vertical directionSeven 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 SpacesA cotton roll must be placed in the area of the missing tooth to support the bite-wing tab or beam alignment device.Bony GrowthsThe receptor must be placed between the tori and the tongue.