Technique Tips: The Post-operative Bitewing − a Solution to an Ambiguous Bitewing Radiographic Finding: is it Recurrent Caries or Partial Caries Removal?

Bitewing radiographs are commonly carried out for several reasons,¹ one of which is to detect recurrent caries underneath restorations, typically in proximal regions. Examples are given in Figures 1−4. Caries has the appearance of a radiolucency, which can be mimicked by several artefacts such as burnout or optical illusion.² The recent paradigm shift towards partial caries removal may add an additional phenomenon to be considered, namely deliberate retention of caries.

Many recent developments in cariology challenge the traditional view that all caries must be removed from a lesion.³ The current thinking is that, as long as a restoration's margins are sealed against bacterial and nutrient infiltration, the caries can be left in place, reducing the insult to the pulp and maintaining structural integrity. In an ideal world, the radiographic appearance of such a restoration would be fairly obvious, namely a clear caries-free margin. But detecting a large radiolucent area under an existing restoration may make us fear for the health of the pulp and lead us to assume recurrent caries and intervene. What if simply it was originally a deep lesion and a large amount of demineralized dentine was sealed under the restoration?