A method to reduce interproximal overlapping and improve reproducibility of bitewing radiographs for use in clinical trials

Abstract

To improve the quality of bitewing radiographs a Bite Registration Technique (BRT) was developed by modifying a commercially available Rinn XCP Instrument. The modification involved using a rubber impression material to register the subject's bite so that the subsequent replacement of the instrument in the mouth was guided by the registration indentations. A total of 240 radiographs were analysed to determine the frequency and severity of the overlapping and the degree of deviation in the horizontal angulation between the subsequent films. Approximately half the films were taken with BRT and the other half were taken with the unaltered Rinn SCP Instrument (without BRT). Two radiographs were taken of each side of the mouth. Only 11.6% of the proximal surfaces had more than half the enamel overlapped 'with BRT' compared with 33% 'without BRT'. In addition, when using the BRT, the initial and the subsequent radiographs of each child were more alike than 'without BRT'. Ninety percent were virtually identical; the mean difference in width of the largest overlap between the two films was 0.11 mm. To check the validity of these findings, 100 radiographs from a previously published clinical trial which used similar aged children and also used a Rinn SCP Instrument (modified), were analysed used the same criteria. The results obtained were similar to the 'without BRT' results; 30% of the proximal surfaces had more than half the enamel overlapped. Improved accuracy allowed a narrower X-ray beam to be used, thus reducing patient irradiation. The use of the Bite Registration Technique is recommended when a high degree of diagnostic accuracy is desired in clinical trials involving primary dentitions.

Can nonstandardized bitewing radiographs be used to assess the presence of alveolar bone loss in epidemiologic studies?

“…All the standardized radiographs were taken with the Rinn film holder (7). This device consists of film holder into which the dental radiograph fits, a plastic plate, which the patient bites on, and a rod connected to the film holder that protrudes from the patient's mouth to allow parallel alignment of the X‐ray tube (7).…”

“…All the standardized radiographs were taken with the Rinn film holder (7). This device consists of film holder into which the dental radiograph fits, a plastic plate, which the patient bites on, and a rod connected to the film holder that protrudes from the patient's mouth to allow parallel alignment of the X‐ray tube (7). To ensure that the patient's bite was reproducible in the standardized group of radiographs, the X‐ray technician placed an impression material (Henry Schein BLU‐BITE Vinyl Polysiloxane Derivative Registration Material: Henry Schein Inc., Melville, NY) on the plastic bite block.…”

“…Bringing the teeth together improperly can also cause misangulation and consequent distortion of the radiographic image (5). Several techniques have been proposed to minimize radiographic distortion from these sources (5, 7). All such techniques propose the use of a device to ensure that the radiographic film is held in the mouth in its correct position, the patient brings his or her teeth together in a reproducible manner, and the source of the X‐rays is aligned at 90° to the film.…”

Surface Tension and Contact Angle on Enamel of Surfactant Solutions for Caries Diagnosis with Dyes

“…Although only small areas of the body are irradiated, dental radiography uses relatively high exposures, and it is agreed that the radiation dose a patient receives during a clinical examination should be reduced as much as possible (Alcox, 1978). In an extensive study on common errors on bitewing radiographs, it was found that only 5% were without major errors (Nysether and Hansen, 1983), and in general, about 30% of the radiographs taken cannot be used because of the overlapping or blurring of images (Sewerin, 1981a;McDonald, 1983;Mitropoulos, 1985). Furthermore, it was found that misleading images occur frequently because of wrong angulation of the x-ray beam (Sewerin, 1981b).…”

Investigation into the relationship between deviations in X‐ray angulation and images of proximal overlapping on bite‐wing radiographs

“…This has been accomplished by taking an impression of the teeth using wax, aerylic resin or rubber itnpression material and good reprodueibility was reported in the studies that evaluated sueh methods. In a previous study (6) usitig a modified Bite Registration Technique (BRT), the author observed that the method not only improved reproducibility but also reduced the frequency of interproximal overlapping froni 30% to 11%. This was possible because the technique removed the guesswork in positioning the X-ray tube.…”