Conventional bitewing radiography
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Conventional bitewing radiography Falk Schwendicke1 · Gerd Göstemeyer2 Received: 6 August 2020 / Accepted: 9 September 2020 © The Author(s) 2020
Abstract Accurate detection and diagnosis of carious lesions is the prerequisite for application of the most effective caries management approach. However, the accuracy of proximal caries detection using visual-tactile assessment is limited. Additional diagnostic measures should therefore be performed to increase the validity of the diagnosis. Amongst various caries detection aids available, bitewing radiographs remain the gold standard for detection of proximal caries lesions. Here we describe a method for caries diagnosis using standardized bitewing holders. With this method the bitewing holders can be placed more precisely and reproducibly in the oral cavity. This approach increases accuracy of bitewing radiographs, which, due to the reproducible placement of the x-ray film, allows for monitoring of carious lesions long term. Keywords Bitewing · Caries detection · Caries diagnosis · Radiography
Quick reference/description Detection of carious lesions, especially on non-accessible (proximal) surfaces, is difficult through visual and tactile examination. Early detection of non-cavitated proximal carious lesions can be crucial, e.g., for non- or micro-invasive interventions. Bitewing radiography is an efficient imaging method that can be employed along with visual and tactile examination to increase the accuracy of the caries diagnosis.
Indications • Early detection of primary coronal carious lesions on occlusal and proximal sur-
faces.
* Gerd Göstemeyer [email protected] 1
Department of Oral Diagnostics, Digital Health and Health Services Research, CharitéUniversity, Berlin, Germany
2
Department of Operative and Preventive Dentistry, Charité-University, Berlin, Germany
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• Detection of proximal root caries. • Assessment of the quality of restorations and detection of secondary caries in the
proximal area.
• Detection of lesion extension in enamel and dentinal carious lesions. • Long-term monitoring of carious lesions.
Materials/instruments • Standardized or customizable bitewing holders (e.g., Icon X-ray Holder, DMG,
Hamburg).
• For customizable bitewing holders wax or hard-curing silicone. • Cow horn-ended instrument. • Orthodontic rings.
Procedure Early active interproximal carious lesions can be managed non- or micro-invasively, i.e., without the need of placing a restoration. However, once a lesion has reached a certain depth, loss of surface integrity is likely and the lesion requires invasive restorative interventions that are irreversible and with a limited longevity. Invasive restorations predispose the tooth to repeated and expensive re-interventions and result in substantial destruction of sound dental tissues to gain access to the lesion. Therefore, if indicated, non-invasive or micro-invasive methods are preferable to restorative measures. The main
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