Bitewing film quality: A clinical comparison of the loop vs. holder techniques

Objective: To compare in vivo bitewing film quality using the holder versus the paper loop technique. Method and materials: Four bitewing films were taken from the right and left premolar and molar regions of 45 dental students using both the bitewing holder and paper loop techniques. A total of 360 films were taken and assessed by an experienced practitioner not apprised of the bitewing technique used. Of interest were: (1) the number of overlaps and the percentage of teeth showing the alveolar crest; (2) proper film positioning; and (3) the percentage of cone cutting. A Poisson regression using generalized estimating equations (GEEs) was used to estimate the difference in overlap between the two techniques. For proper positioning and cone cutting, logistic regressions using GEEs were used. Results: The average number of horizontal overlaps for the loop and holder techniques at the right premolar, right molar, left premolar, and left molar were 1.64, 2.11, 2.16, 2.78, and 1.64, 2.00, 2.00, 2.18, respectively. The loop technique was 1.11 times more likely to cause overlapping than the holder technique. The highest percentage of teeth showing the alveolar crest by the loop technique was 97.8% in the mandibular second premolar and first molar. With respect to film positioning, the loop technique was 1.12 times more likely to cause improper positioning than the holder technique. Both techniques demonstrated minimal cone cutting (1 in the loop versus 0 in the holder). Conclusion: The quality of bitewing films taken by the loop and holder techniques was not significantly different.