How to take great vertical bitewings using digital radiography

Having served as a full-time dental hygienist prior to becoming a DEXIS Sales Manager, Lisa Brooks, RDH, gained extensive hands-on experience with both film and digital x-rays. In this article, Brooks will discuss the benefits of using digital radiography and DEXIS digital x-ray in particular. She also will share tips on how you can capture vertical bitewings for optimal diagnosis.

“The majority of doctors who take vertical bitewings versus horizontal are looking for interproximal bone loss. Comparing these radiographs over time is essential for checking bone levels, and DEXIS makes this a one-click function,” Brooks said.

A series of seven vertical bitewings allows for the capture of both anterior and posterior teeth. The usual protocol is to take three bitewings on each side and then one for the anterior. Properly taken vertical bitewings deliver better diagnostics by providing a comprehensive view of the full mouth.
Some would say this is a difficult series to take. “Utilizing the DEXIS sensor and its ergonomic design is a very simple procedure for the clinician and comfortable for the patient,” Brooks said.

“One of the things that’s nice about the DEXIS sensor design is the way that the cable exits the sensor as it allows you to comfortably take a bitewing image, both horizontally and vertically. Most other sensor cables exit the housing at a 90° angle from the rim while the DEXIS cord exits at a 45° angle from the rear so it doesn’t impinge on the actual tissue within the patient’s mouth, whether it is on the palate or the floor of the mouth,” Brooks said.

Tips for taking x-rays
Brooks points out some tips to taking the best bitewings with digital x-ray:

• Typically with film, we’ve been taught to keep the film as close to the teeth as possible, and to keep the x-ray head as close to the face as possible. That’s what’s going to result in the best image.

• With digital radiography, because of the enhanced comfort of the sensor, you can actually place the sensor more toward the midline of the mouth. But, you still want to have the x-ray head close to the face. “So, the closer that you have the x-ray head to the face, the more diagnostic the image is going to be,” she said.

• Techniques, devices, and accessories play an important role when taking clear and diagnostic vertical bitewings. Make sure you use the holders that are specifically designed for your sensor so that the cord can be securely attached to the holders and the patients can’t bite on the cord. Holders also stabilize the sensor in the cavity and help prevent accidental movement that would lead to compromised image quality.

Patient response
In Brooks’ experience, patients appreciate the fast workflow of taking digital x-rays and the instant viewing of images, but they rave most about the comfort.

“DEXIS is known to be the most comfortable sensor because of the beveled corners and rounded casing,” she said.

Film is thin, and therefore has a tendency to be more uncomfortable. The DEXIS sensor has a more rounded surface area, and is more gentle to the tissue. It’s not going to cut into tissue the way film can.