Bitewing Radiography
Bitewing Radiographic Examination · Also known as: bitewing X-ray, bitewings, posterior radiography
Bitewing radiography is a standard intraoral radiographic technique that captures the coronal portions of both maxillary and mandibular teeth in a single image, with the patient biting on a film holder or digital sensor. Introduced in the early 20th century and formalized as a diagnostic standard, bitewing radiographs are the primary image type for detecting approximal caries, monitoring alveolar bone level for periodontal disease assessment, and evaluating dental restorations and radiographic density changes. Digital bitewings have reduced radiation exposure and improved image quality and archiving.
Read the full method
Sign in with a free account to read this section.
Method map
The neighbourhood of related methods — select a node to explore.
When to use it
Use bitewing radiographs at initial examination for caries screening and periodontal assessment. Repeat at intervals based on risk: annually for low-risk patients, every 6 months for high-risk patients (frequent caries, poor oral hygiene, or active periodontal disease). Use for specific clinical questions: suspected approximal caries, monitoring periodontal disease progression, and evaluating restoration fit. Assume the patient can tolerate intraoral imaging without gagging or excessive movement.
Strengths & limitations
- Gold standard for detecting approximal caries before clinical visibility
- Enables assessment of alveolar bone level for periodontal disease staging
- Non-invasive, quick to acquire (< 1 minute for full-mouth series)
- Standardized positioning allows reproducible, longitudinal comparison across appointments
- Digital bitewings reduce radiation dose and allow image enhancement for diagnostic accuracy
- Cost-effective relative to advanced imaging modalities (CBCT)
- Two-dimensional imaging of three-dimensional anatomy introduces anatomical overlap and distortion
- Approximal caries at early stages (incipient lesions) may be invisible until demineralization exceeds 50% of lesion volume
- Cannot visualize buccal or lingual caries unless very advanced
- Alveolar bone crest position is visible only if the X-ray beam angles correctly; horizontal angulation errors obscure the interdental septum
- Cone-cut or partial image loss occurs with improper positioning, requiring re-exposure and additional radiation
Frequently asked
How often should bitewing radiographs be taken?
Guidelines vary by patient risk. Low-risk patients may have bitewings every 1–2 years; high-risk patients (frequent caries, poor oral hygiene, periodontal disease) every 6–12 months. Children and adolescents may be radiographed more frequently due to active eruption and development. Follow clinical guidelines (e.g., ADA, EAOO) and clinical judgement.
What is the difference between vertical and horizontal bitewings?
Vertical bitewings show greater craniocaudal (up-down) dimensions of the teeth, better visualizing the entire alveolar crest and vertical bone loss. Horizontal bitewings show greater mesiodistal (side-to-side) dimensions, ideal for approximal caries detection. Many clinicians use vertical bitewings for periodontal assessment and horizontal for caries screening.
Why do some radiographs show a cone-cut or partial image?
Improper positioning of the X-ray aiming ring or tubehead results in the X-ray beam partially missing the image receptor. Cone-cut images must be discarded and re-exposed, increasing patient radiation dose. Proper use of aiming devices prevents this.
Can digital bitewings be compared directly with film radiographs?
Generally, yes. Digital and film radiographs are radiologically similar, though digital images may show slight differences in contrast and grayscale due to sensor characteristics and processing algorithms. For longitudinal comparison within a patient, maintain consistency in imaging system (film or digital) and processing parameters.
Sources
- Ludlow, J. B., Davies-Ludlow, L. E., Brooks, S. L., & Howerton, W. B. (2006). Dosimetry of 3 intraoral digital imaging systems. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 101(2), 226-234. link ↗
- White, S. C., & Pharoah, M. J. (2014). Oral radiology: Principles and interpretation (7th ed.). Mosby Elsevier. link ↗
- Pitts, N. B., Ekstrand, K. R., Foundation, I. C. D. A., & Organization, W. H. (2013). International caries detection and assessment system (ICDAS) and its applications. Community Dentistry and Oral Epidemiology, 43(1), 41-49. link ↗
How to cite this page
ScholarGate. (2026, June 3). Bitewing Radiographic Examination. ScholarGate. https://scholargate.app/en/dentistry/bitewing-radiography
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
- DMFT IndexDentistry↔ compare
- Occlusal AnalysisDentistry↔ compare
- Orthodontic CephalometryDentistry↔ compare
- Root Canal Length DeterminationDentistry↔ compare