[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Dentistry](https://durgical.com/en/dentistry/) › [The oral and dental exam](https://durgical.com/en/dentistry/areas/exam/) › Dental imaging: bitewing, periapical, panoramic and CBCT # Dental imaging: bitewing, periapical, panoramic and CBCT - Examination Each dental image answers a different question: decay between teeth, the root tip, the whole jaw, or a 3D view before surgery. Updated Nov 12, 2026 **See it in 3D:** [Mandible](https://durgical.com/en/anatomy/mandible/) · [Maxillae](https://durgical.com/en/anatomy/maxilla/) · [Maxillary sinus](https://durgical.com/en/anatomy/maxillary-sinus/) · [TMJ disc](https://durgical.com/en/anatomy/articular-disc-of-temporomandibular-joint/) ## Key points - Bitewing for interproximal caries; periapical for the root tip; panoramic for the whole jaw; CBCT for 3D. - Caries and infection look dark (radiolucent). - Deep neck infection needs contrast CT, not dental films. ## What it is Most dental radiographs are small intraoral films with a very low dose. Bitewings show the crowns of the upper and lower back teeth together and are best for decay between teeth and for the bone level. Periapical films show a whole tooth to the root tip and the surrounding bone. The panoramic radiograph (orthopantomogram) shows both jaws, all the teeth, the TMJs and the maxillary sinuses in one image. Cone-beam CT (CBCT) gives three-dimensional images of the jaws for implants, impacted teeth, cysts and nerve relations, at a higher dose. Ultrasound and medical CT or MRI are used for soft-tissue and deep-space infections. ## Findings and interpretation - Caries and periapical lesions appear radiolucent (dark) because mineral has been lost. - A periapical lesion becomes visible only after a substantial amount of bone has been lost, so early infection may not show. - Horizontal or vertical bone loss between teeth indicates periodontitis. - A well-defined radiolucency around the crown of an unerupted tooth suggests a dentigerous cyst. - Pregnancy is not a contraindication to necessary dental radiographs with a lead collar and thyroid shield; elective films can wait. ## How it is done - Ask what question the image must answer before choosing it. - Bitewing: caries between back teeth, early bone loss. - Periapical: root, periapical lesion, root fracture, length of a root canal. - Panoramic: overview of both jaws, development and eruption in children, fractures, cysts, third molars. - CBCT: 3D detail before implants or third-molar surgery, or to characterise a jaw lesion. - Contrast-enhanced medical CT: suspected deep neck infection or spread from a dental abscess. ## Common mistakes - Ordering a panoramic film to look for small caries misses them; bitewings are needed. - A normal radiograph does not exclude an acute abscess in its first days. - Mandibular condyle fractures are easily missed on a single view; a panoramic film or CT shows them better. ## Next step / Initial management - Choose the image by the clinical question and keep to the lowest dose that answers it. - Jaw radiolucency found by chance: refer to the dentist or oral surgeon; growing, painful or nerve-related lesions need prompt referral. - Suspected deep space infection: contrast CT of the neck rather than dental films, with urgent surgical referral. ## Test yourself Think of the answer, then tap the question to see it. ## Which dental radiograph is best for decay between back teeth? The bitewing radiograph. ## Why can a periapical abscess be invisible on an early radiograph? Because bone must lose a substantial amount of mineral before the lesion becomes radiolucent. ## What imaging is needed for a suspected deep neck infection of dental origin? Contrast-enhanced CT of the neck. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/dentistry/dental-imaging-bitewing-periapical-panoramic-and-cbct/) ## Connections ## See it in 3D 4 The structures of Durgical's 3D anatomy where it is found. - [Mandible](https://durgical.com/en/anatomy/mandible/) - [Maxillae](https://durgical.com/en/anatomy/maxilla/) - [Maxillary sinus](https://durgical.com/en/anatomy/maxillary-sinus/) - [TMJ disc](https://durgical.com/en/anatomy/articular-disc-of-temporomandibular-joint/) ## Related 4 - [Jaw cysts and odontogenic tumours](https://durgical.com/en/dentistry/jaw-cysts-and-odontogenic-tumours/) - [Pulp necrosis, apical periodontitis and the dental abscess](https://durgical.com/en/dentistry/pulp-necrosis-apical-periodontitis-and-the-dental-abscess/) - [Periodontitis: stages, grades and links with general health](https://durgical.com/en/dentistry/periodontitis-stages-grades-and-links-with-general-health/) - [Maxilla and mandible: applied anatomy for dentistry](https://durgical.com/en/dentistry/maxilla-and-mandible-applied-anatomy-for-dentistry/) ## Related conditions 1 - [Mandible fracture](https://durgical.com/en/conditions/mandible-fracture/) [← All of dentistry](https://durgical.com/en/dentistry/) Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once. Sources: [Dental Cone Beam Computed Tomography](https://www.ncbi.nlm.nih.gov/books/NBK592390/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Dental Caries Diagnostic Testing](https://www.ncbi.nlm.nih.gov/books/NBK574510/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Mandible Fracture](https://www.ncbi.nlm.nih.gov/books/NBK507705/) (StatPearls Publishing (NCBI Bookshelf), 2023). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/dentistry/dental-imaging-bitewing-periapical-panoramic-and-cbct/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/dentistry/dental-imaging-bitewing-periapical-panoramic-and-cbct/