This document discusses the bitewing radiographic technique. It begins by describing what structures are visible on a bitewing film and how bitewing films are used to detect interproximal caries, bone levels, and restorations. It then discusses the basic principles of patient stabilization using a bite tab or film holder and directing the x-ray beam through tooth contacts. The document provides steps for patient preparation and recommendations for tab placement depending on the area being imaged. It discusses techniques for premolar and molar bitewings and common errors like improper patient biting, film placement, bending, angulation, and exposure issues.

1. Bitewing Technique,Bitewing Technique,
andand
Technique ErrorsTechnique Errors

2. Bitewing Film
Patient bites a “wing” or tab that
had been placed on the film.
Bitewing film

3. Anatomical structures found in aAnatomical structures found in a
bitewing filmbitewing film
Crestal bone
Crowns
Interproximal areas

4. Bitewing films usesBitewing films uses
Interproximal
caries
Crestal bone levels
Restorations contours

5. Bitewing holderBitewing holder Bitewing tabBitewing tab
Rinn XCP Bite-Wing
Instrument
Bite-Wing Tab

6. Basic principlesBasic principles
Stabilization: Patient
bites on the bite-wing
tab or film holder.
Film is
placed
parallel to the
crowns
X-ray beam: is
directed through
the contacts of
the teeth.

7. Patient preparationPatient preparation
1.1. Explain procedureExplain procedure
2.2. Position the patient upright in the chairPosition the patient upright in the chair
3.3. Adjust the headrestAdjust the headrest
4.4. Place and secure the lead apronPlace and secure the lead apron
5.5. Remove all objects from the mouthRemove all objects from the mouth

8. Bitewing Technique -TABSBitewing Technique -TABS
Not recommended. Film
slides easily within loop
and may end up out of
position antero-
posteriorly.
Recommended
Stick on

9. Molar - Toward front of film
Premolar - Centered A-P
Bitewing Technique -TABSBitewing Technique -TABS

10. Bite-wing technique - RinnBite-wing technique - Rinn

11. Bitewing TechniqueBitewing Technique
Head Position MSP
head supported by headrest
Horizontal Angulation

12. Bitewing TechniqueBitewing Technique
Film Placement
Position of dot doesn’t matter
Premolar
Molars with
3rd
molar
Molars without
3rd
molar

13. Premolar Bitewing:
covers the distal of
upper and lower canine,
both premolars, first
molar and at least a
portion of second
molar.
Molar Bitewing:
covers molars.

14. If third molars are not erupted into the mouth,
the film should be positioned more anteriorly.
Make sure ¼” of film extends posterior to
second molar.

15. Film PositionFilm Position
PID

16. Film PositionFilm Position
PID

17. Film PositionFilm Position

18. Bite-wing technique - RinnBite-wing technique - Rinn
Correct
Incorrect
Incorrect

21. 20º
0º
Vertical Angulation
Bitewing TechniqueBitewing Technique
ONLY WITH TABS!!!!!

22. Vertical AngulationVertical Angulation with TABSwith TABS

23. +10

24. cotton roll

25. If lingual tori are present, the
film must be placed lingual to
the torus
Make sure the film clears the
palatal gingiva as the patient
closes to keep film from being
pushed down into mandible

26. Vertical bite-wingsVertical bite-wings
Long axis of film vertical
Show advanced periodontitis
3 anterior, 4 posterior
+10 vertical angulation (tabs)

30. BITEWING
ERRORS

31. Bite-wing Technique ErrorsBite-wing Technique Errors
Patient is not biting on the bite block

32. Bite-wing Technique ErrorsBite-wing Technique Errors
Film placement

33. Bite-wing Technique ErrorsBite-wing Technique Errors
Film placement

34. Bite-wing Technique ErrorsBite-wing Technique Errors
Film placement

35. Bite-wing Technique ErrorsBite-wing Technique Errors
Film bending

36. Bite-wing Technique ErrorsBite-wing Technique Errors
Film bending

37. Bite-wing Technique ErrorsBite-wing Technique Errors
Horizontal angulation

38. Bite-wing Technique ErrorsBite-wing Technique Errors
Single overlap. Technique OK

39. Bite-wing Technique ErrorsBite-wing Technique Errors
Cone cut

40. Bite-wing Technique ErrorsBite-wing Technique Errors
Film Reverse