2. 1. Define the key terms associated with the bite-wing
technique.
2. Describe the purpose and use of the bite-wing image.
3. Describe the appearance of opened and overlapped
contact areas on a bite-wing image.
4.State the basic principles of the bite-wing technique.
2
Learning Objectives
Lesson 19.1: Bite-Wing Technique
3. 5. List the two ways a receptor can be stabilized in the bite-
wing technique and identify which one is recommended
for bite-wing exposures.
6.List the three receptor sizes that can be used in the bite-
wing technique and identify which size is recommended
for exposures in the adult patient.
7. Describe correct and incorrect horizontal angulation.
8.Describe the difference between positive and negative
vertical angulation.
3
Learning Objectives
Lesson 19.1: Bite-Wing Technique (Cont.)
4. 9.State the recommended vertical angulation for all bite-
wing exposures using a bite-wing tab.
10. State the basic rules for the bite-wing technique.
11. Describe patient and equipment preparations that are
necessary before using the bite-wing technique.
12. Discuss the exposure sequence for a complete mouth
series (CMS) that includes both periapical and bite-
wing exposures.
4
Learning Objectives
Lesson 19.1: Bite-Wing Technique (Cont.)
5. 13. Describe the correct premolar and molar bite-wing
receptor placements.
14. Describe the purpose and use of vertical bite-wing
images.
15. List the number of exposures and the size of receptor
used in the vertical bite-wing technique.
16. Discuss modifications in the bite-wing technique for
patients who have edentulous spaces or bony growths.
5
Learning Objectives
Lesson 19.1: Bite-Wing Technique (Cont.)
6. Purpose
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
The bite-wing image derives its name from the original
technique that required the patient to “bite” on a small
“wing” of paper attached to a film packet.
6
Introduction
7. 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
The bite-wing technique is also known as the interproximal
technique.
7
Basic Concepts
8. Bite-wing technique
A method used to examine the interproximal surfaces of
teeth
Useful to monitor the progression of dental caries, assess
existing restorations, and examine the crestal bone levels
between teeth
Knowledge of beam alignment devices, receptor sizes, and
angulations of the position-indicating device (PID) used
with the bite-wing technique is also required.
8
Basic Concepts
11. 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 bite-wing tab or
beam alignment device.
The central ray is
directed through the
contacts of the teeth,
using a +10 degree
vertical angulation. 11
Principles of Bite-Wing Technique
12. Bite-wing beam alignment device
A device used to position an intraoral receptor in the
mouth and maintain the receptor in position during
the imaging procedure
Bite-wing tab
An alternative to a beam alignment device
A heavy paperboard tab or loop fitted around a
periapical receptor and used to stabilize the receptor
during the exposure
12
Beam Alignment Device
and Bite-Wing Tab
13. Size 0
For posterior teeth of children with primary dentitions
Size 2
For posterior teeth of older children and adults,
placed horizontally or vertically
Size 3
For bite-wings, not recommended for adult patients
13
Bite-Wing Receptors
14. Angulation
The alignment of the central ray of the x-ray beam in
the horizontal and vertical planes
Can be varied by moving the PID in a horizontal or
vertical direction
In the bite-wing technique, the angulation of the PID
is critical.
14
Position-Indicating Device Angulation
15. 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. 15
Horizontal Angulation
16. 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.
16
Vertical Angulation
17. Correct vertical angulation
+10 degrees
Incorrect vertical angulation
Results in a distorted image
Negative VA
17
Vertical Angulation (Cont.)
18. Five basic rules must be followed when using the bite-wing
technique.
Receptor placement
Must be positioned to cover the prescribed area of teeth to be
examined
Receptor position
Must be positioned parallel to the crowns of both max. and mand.
teeth
Vertical angulation
+10 when tab is used
Horizontal angulation
CR directed through the contact areas
Receptor exposure
X-ray beam must be centered on the receptor to avoid what?18
Rules of Bite-Wing Technique
21. Explain the imaging procedure to the patient.
Position the patient upright in the chair.
Adjust the headrest.
Place and secure the lead apron with thyroid
collar.
Request that the patient remove eyeglasses
and all objectives from the mouth.
21
Patient Preparation
22. Set the exposure factors.
If a beam alignment device is used, open the
sterilized receptor package containing the beam
alignment device, and assemble the device on a
covered work area.
If a bite-wing tab is used, attach the tab to the
white side of the film, on the correct side of the
receptor.
22
Equipment Preparation
23. 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 on 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. 23
Exposure Sequence for
Receptor Placements
24. For bite-wings and periapicals
Expose all anterior periapical receptors first.
Follow with posterior periapical receptors.
Finish with bite-wing exposures.
Completing the FMX with bite-wing exposures may leave the
patient with a more positive feeling regarding the series.
Bite-wings only
Expose the premolar bite-wing receptor first.
Expose the molar bite-wing receptor next.
Repeat on opposite side of the mouth.
24
Exposure Sequence for
Receptor Placements (Cont.)
25. Receptor placement
The specific area where the receptor must be
positioned before exposure
Dictated by the teeth and surrounding structures
25
Receptor Placement
for Bite-Wing Images
26. If using film, the white side of the receptor faces the teeth.
If using film, the identification dot has no significance in bite-
wing receptor placement.
In the posterior bite-wing series, the receptors are placed
horizontally.
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.
26
Receptor Placement
for Bite-Wing Images (Cont.)
27. Placement for a four-receptor posterior bite-
wing series includes:
Right and left premolar exposures
Rights and left molar exposures
It is important to note that in the procedures for
premolar and molar bite-wing exposures, it is
recommended that the receptor be placed into the
patient’s mouth after both vertical and horizontal
angulations have been set.
27
Posterior Receptor Placement
28. Used to examine the
level of alveolar bone
Placed with the long
portion of the receptor
in a vertical direction
Often used as post-
treatment or follow-
up films for patients
with bone loss caused
by periodontal
disease 28
Vertical Bite-Wings
29. Modified FMX may be prescribed using vertical
bite-wing images.
Seven receptors are used to cover canine, midline,
premolar, and molar areas.
Three anterior and four posterior
Size 2 receptors use for all exposures or a
combination of size 1 (anterior) and size 2
(posterior)
29
Vertical Bite-Wings (Cont.)
30. 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.
What are “mandibular tori?”
30
Modifications in Bite-Wing Technique
The bite-wing image derives its name from the original technique that required the patient to “bite” on a small “wing” of paper attached to a film packet.
The bite-wing technique is also known as the interproximal technique.
Knowledge of beam alignment devices, receptor sizes, and angulations of the position-indicating device (PID) used with the bite-wing technique is also required.
Refer students to Figure 19-1.
Refer students to Figures 19-2 through 19-5.
What is an “overlapped contact area?” (On a dental image, the area where the contact area of one tooth is superimposed over the contact area of an adjacent tooth)
What is an “opened contact area?” (On a dental image, opened contacts appear as thin radiolucent lines between adjacent tooth surfaces.)
Refer students to Figure 19-6.
Refer students to Figures 19-7 and 19-8.
Beam alignment devices eliminate the need for the patient to stabilize the receptor with a bite-wing tab.
What bite-wing instrument is recommended for bite-wing projections? (The Rinn XCP system)
To reduce the amount of radiation exposure to the patient, both the ADA and the American Academy of Oral and Maxillofacial Radiology recommend the use of a rectangular collimator for all intraoral exposures.
Three sizes of bite-wing receptors: 0, 2, and 3.
In adult patients, a size 2 receptor is recommended for bite-wing exposures; size 3 is not recommended.
In the bite-wing technique, the angulation of the PID is critical.
Horizontal angulation refers to the positioning of the central ray in a horizontal, or side-to-side, plane.
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.
Refer students to Figures 19-9 and 19-10.
Refer students to Figures 19-11 and 19-12.
Five basic rules must be followed when using the bite-wing technique.
Before exposing any bite-wing images, infection control procedures must be completed.
Infection control procedures and preparation of the treatment area and supplies should be completed before seating the patient.
Refer students to Procedure 19-1.
Equipment must also be prepared before the dental image can expose any films.
Refer students to Procedure 19-2.
The number of bite-wings taken is dependent on 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.
Refer students to Figure 19-23.
Completing a CMS with bite-wing exposures may leave the patient with a more positive feeling regarding the series.
Right and left premolar exposures; right and left molar exposures: the receptor is placed after the vertical and the horizontal angulations have been set.
Refer students to Box 19-1.
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.
Refer students to Figures 19-14 through 19-24 and Procedures 19-3 and 19-4.
Refer students to Procedures 19-3 and 19-4.
It is important to note that in the procedures for premolar and molar bite-wing exposures, it is recommended that the receptor be placed into the patient’s mouth after both vertical and horizontal angulations have been set.
The vertical bite-wing examination uses one-half the number of exposures included in a complete series of periapical images.
Refer students to Figure 19-25.
Refer students to Figure 19-26.
An edentulous space is an area where teeth are no longer present.
What are “mandibular tori?” (Bony growths along the lingual aspect of the mandible)
