Tuxedo Imaging Sensor Positioning Checklist

For Bitewings & Full Mouth X-Rays (FMX)
Training Resource for Dental Teams

✅ General Sensor Setup

- Confirm sensor is connected and recognized by software
- Select correct patient & image type
- Apply disposable barrier sleeve
- Use correct sensor holder (e.g., bitewing tab, XCP ring)
- Sensor cord tip:
    • Drape cord forward and to the side of the mouth
    • Never let patient bite the cord – keep slack and direct around cheek

📸 Bitewing Positioning Checklist

- Seat patient upright; occlusal plane level with floor
- Place sensor horizontally; center on 2nd molar
- For anterior BW, include distal of canines
- Align sensor in the middle of the mouth – not buccal/lingual
- Cord tip: Tuck cord gently along cheek – avoid between teeth
- Say to patient: “Close gently on the tab for me, just until your teeth touch.” (Avoid saying “bite down”)
- Angle tube head at +10° vertically
- Align beam perpendicular to sensor and centered on contacts

🔍 Bitewing Image Quality

- Check for:
    • Open contacts
    • No cone cuts
    • No root tip cropping
    • Proper angulation
- Reposition if: Overlaps, patient moved, or if image is cut off

🦷 FMX Positioning Overview

- 18 total images:
    • 6 Anterior periapicals (PAs)
    • 8 Posterior PAs
    • 4 Bitewings
- Use same cord management rules for all images
- Reassure patient throughout: “You may feel some pressure – let me know if anything feels uncomfortable.”

📍 Anterior PAs (6 images)

- Sensor vertical, centered on centrals/laterals
- Use bite block and position midline
- Say to patient: “Close gently until your front teeth touch the holder.”
- Align X-ray tube with long axis of the tooth
- Check for full root visibility and proper image length

📍 Posterior PAs (8 images)

- Sensor placed parallel to long axis of molars/premolars
- Use cotton roll for bite stability if needed
- Cord routed out and down from corner of mouth
- Align beam to avoid cone cut and overlaps
- Patient instructions: “Close just until your teeth touch the holder – let me know if you feel anything poking.”

📸 FMX Bitewings (4 images)

- Follow standard bitewing positioning steps
- Use gentle verbal cues and maintain cord awareness
- Review all 4 bitewings for crestal bone and interproximal spaces

🛠 Troubleshooting Tips

- Image cut off? Move sensor slightly or adjust angle
- Overlapping contacts? Adjust horizontal beam angle
- Cord interference? Reroute cord along cheek, never between teeth
- Gagging?
    • Start with anterior images
    • Use distraction techniques
    • Try smaller bite block or pediatric holder

📁 Save & Quality Check

- Verify images saved to correct patient chart
- Review:
    • Root tips visible
    • Contacts open
    • No cone cuts or distortion
- Retake any suboptimal images
- Thank patient and remove all sensor components carefully