Opening of Interproximal Contacts with a Modified Film Holder

Objective: Radiographic visualization of interproximal contacts is of primary importance.  Additionally, standardized viewing at reproducible horizontal and vertical angulation is desirable for measuring periodontal bone loss.  Four Rinn Flip-Ray holders were modified with a horizontal bar attached that would fit against the buccal surface of the maxillary posterior teeth at four different angles to allow for reproducible horizontal angulation at each radiographic exposure to identify the optimum angle for proximal contact visualization.  This is especially important between the first and second maxillary molars, which angle distally from buccal to lingual, as well as visualizing the other posterior contacts. 

Methods:   An unmodified device, a conventional bitewing tab, and the four modified devices with horizontal angles of 2,6,11,and 23° were evaluated in two manikin-head skulls with two sets of radiographs.  The radiographs were evaluated blindly via an adjusted Sewerin scale by two investigators.

Results: The bar at 2° angulation gave the best results with a mean score of 1.70.  The film tab had a score of 1.80 and the unmodified film holder had a score of 2.74.   There was no significant difference between the 2° bar and the film tab, but there was a significant difference between these two devices, the unmodified device, and the other bar angulated devices.   A Sewerin score of 1 to 2 in indicates openings between the contacts were well visualized radiographically.  A score of 4-5 indicates the contact was not opened.

Conclusions: The film holder with the 2° angled bar and film tab were superior to the other devices.  The film tab is more dependent on the skill of the operator.  Having a bar that contacts the buccal surface of the maxillary molar seems to standardize the horizontal angulation and the repeatability of the bitewing radiograph as compared to the unmodified device.