How to Comfortably Place Digital Intraoral Sensors
How to Comfortably Place
Digital Intraoral Sensors
Mary Ann Rupertus
An overview of working with digital X–ray sensor equipment
digital intraoral sensors
(See Figure 1) and this
has given me the opportunity to develop and hone a vast ar-
ray of tips and techniques to help make capturing images with
digital intraoral sensors more comfortable and more consis-
tent than ever before.
Before we get into specific sensor placement tips, here are
some general best practices dental professionals should know.
Positioning Devices: Holder sets help keep the sensor in
place and guarantee a good image every time. I recommend
using a paralleling device such as the arm and ring position-
ing system for accuracy and consistency in placement. Eye-
balling is not recommended.
Sensor Size: Patients’ mouths come in all different sizes.
Make sure to choose the correct sensor size for comfort and
maximum diagnostic imaging. We want to adhere to the
ALARA principal at all times.
Exposure Settings: Make sure the exposure settings are
correct on the X–ray source (65–70 KVP suggested). You
will need to adjust exposure times (or pulses), depending
on the X–ray source, the physical size of the patient, and the
region of the oral cavity to be imaged. Remember that maxil-
lary molar images need the most exposure time to penetrate
the zygomatic arch and mandibular anterior images need
’ll never forget the day the doctor I was working for an-
nounced “we’re getting digital X–ray sensors.” I had
mixed emotions about it; this was a progressive office
and I knew I had to give it my best shot. Little did I know that
this transition into technology would not only put the fun
back into dentistry for me, but that it would also change my
professional life forever.
I have been a clinical product trainer and sensor place-
ment specialist for 16 years and have had the unique opportu-
nity to watch digital imaging grow into an essential part of an
ever–increasing number of dental practices. More and more
dental professionals are discovering that digital radiography
offers better patient comfort, increases patient understand-
ing and acceptance, and is easier and faster to use than tak-
ing film X–rays. Today more than half of all general dentists
in the United States use digital imaging—and that number
is much higher in certain areas of the country. We are living
in a technology–oriented society and it is now expected in a
dental office as the standard of care.
I have experienced dentistry practiced in all possible
forms, including large group practices, small private practices,
prisons, hospitals, universities and all branches of the military.
I have taught doctors, dental staff and dental students in all
specialties across the dental field how to use Schick by Sirona
the least amount of time because we are
imaging above the mandible. Remember
to place the ring against the face and the
X–ray unit cone against the ring for con-
sistent radiation with every image.
Sensitive Patients: Everyone has
sensitive patients. I like to use the foamy
cushions called Edge–Ease for my pa-
tients with tori in the lower posterior
area. I have been successful using a tech-
nique with mouthwash for my patients
who gag easily. I fill a cup up with mouth-
wash and dip two gloved fingers into the
mouthwash and spread it on the covered
sensor. This technique seems to stop the
gag reflex every time.
Language: Eliminate the word “bite”
from your vocabulary; when you tell a pa-
tient to bite they chomp down and push
the sensor into the palate or sulcus. Tell
the patient to “close to pressure” in a soft
voice instead and you will have a much
more comfortable and happy patient.
Communicate: It always helps to
explain to the patient exactly what you
are doing and why in terms they can
understand. Remind the patient how
low dose the radiation is with the sen-
sor. Emphasize the positives and you
will get a positive response. Please do
not use negative words.
Visibility: Use the operatory light
and chair position for better visibility.
Follow these tips to learn optimal
sensor placement to take all intraoral
images, including vertical bitewings and
Maxillary Anterior: Use a rolling (ice
cream) scoop motion to place the sensor
into the patient’s mouth—it should go
Figure 2: Maxillary Anterior.
Figure 3: Mandibular Anterior.
Figure 1: Schick by Sirona modular platform, including AimRight autoclavable sensor
holder system and disposable sticky tab holders. Digital systems are available in multiple
configurations with several options for parallel positioning.
about halfway back with the distal edge
placed against the palate. Center the
bite block on the maxillary central inci-
sors and make sure the teeth are towards
the forward edge of the tab (away from
the sensor) to eliminate distortion. The
sensor should be parallel to the long axis
of the maxillary anterior teeth if placed
properly but not necessarily up against
the teeth. For added stability, you can use
a cotton roll under the tab or have the pa-
tient hold the metal positioning arm at
(see Figure 2)
Mandibular Anterior: Ask the patient
to touch the tip of their tongue to the lin-
gual of the mandibular anterior teeth. Take
control of the tongue by placing your in-
dex finger on top of it if necessary. Place
the sensor flat on top of the tongue so that
the distal edge of the sensor is even with
the mesial of the first molars. This is where
the lower jaw widens. Roll the sensor into
an upright position making sure the bend
in the metal bar is even with the center of
the nostrils. Think of a bird in a bird bath
and use the wrist firmly to push the tongue
down into place so the sensor is on top
of the tongue but parallel to the lower an-
terior teeth. The tongue acts as a cushion
and blocks out any tori and thin tissue is-
sues, such as with the frenum. My patients
have told me this is much more comfort-
able than placing under the tongue where
the tissue is very thin and something you
couldn’t do with film as it is too flexible.
(See Figure 3)
Maxillary Posterior: Retract the
cheek (fish hook) and guide the sensor
into the mouth between teeth #8 and #9.
This is where the vault is in the palate and
will give you plenty of room. Push the
sensor back until it is level with the de-
Figure 4: Maxillary Posterior.
Figure 5: Mandibular Posterior.
Figure 6: Horizontal Bitewing.
Mary Ann Rupertus has been with
Sirona Dental for 16 years as a clinical
specialist. She graduated from the dental
assisting program at Delaware Technical
Community College in 1985 and worked
chairside as a dental assistant for 13 years
in private practice. She is a current mem-
ber of the ADAA. She may be contacted at
These are the tricks and tips to make
every image more comfortable for your
patients—all you need is to master op-
timal sensor placement. A comfortable
patient will enable you to get a better
digital image. Remember to “think out-
side the box” when placing a digital sen-
sor and do whatever you need to do to
keep your patient comfortable but get
a good diagnostic digital image. Please
feel free to share any tricks or tips with
me you have discovered.
sired teeth (molars or pre–molars) and
have the patient close on the bite tab/
block, angling the sensor slightly past
the midline of the mouth. This will al-
low the rigid sensor to follow the curves
of the maxillary roots and ensure 2 mm
to 3 mm beyond the apices.
(See Figure 4)
Mandibular Posterior: Retract the
cheek so you can see what you are do-
ing. Place the front edge of the sensor
into the mouth between the tongue and
the teeth at a 45 degree downward angle
(dive into the swimming pool) for com-
fort and then slowly slide the sensor back
toward the molar area centering the sec-
ond molar on the center of the bite tab.
Use an Edge–Ease if the patient has tori.
(See Figure 5, page 20)
Horizontal Bitewing: The sensor
and aiming device for a horizontal bite-
wing image should be placed between
the tongue and the teeth, with the tab
resting on the teeth. Place the sensor
wire to the other side of the mouth for
comfort and visibility, and tell the patient
to close on their back teeth. As they do
so, “open the door,” swinging the front
edge of the aiming device toward the lat-
eral incisor, allowing the sensor to follow
the curve of the spee (lower jaw), which
will ensure contacts are open.
(See Figure 6)
Vertical Bitewing: Place the sensor
in the mouth horizontally, then roll it
into a vertical position once past the inci-
sors, using the ring of the aiming device
as a steering wheel. Make sure the cone
of the X–ray source is parallel to the arm
of the holder and directed at the center
of the aiming ring. I always use an Edge–
Ease taking my vertical bitewings.
(See Figure 7)
Figure 7: Vertical Bitewing.