Which radiograph would be taken to obtain an extended view of posterior teeth from mid-roots of the maxilla to mid-roots of the mandible, assess periodontal bone levels, and detect true pockets?

• A. Panoramic radiograph
• B. Periapical radiograph of all teeth
• C. Vertical bitewing
• D. Cephalometric radiograph

Answer: (C)

For assessing periodontal bone levels and the presence of deep pockets, you need an image that shows the height of the alveolar bone around the posterior teeth across a wide span. A vertical bitewing radiograph provides an extended vertical view that captures the posterior teeth from the level of the mid-roots of the upper molars down to the mid-roots of the lower molars, giving clear visualization of interproximal bone height. This orientation highlights crestal bone levels and any bone loss patterns around multiple teeth in one image, which is essential for evaluating periodontal status. While radiographs cannot measure pocket depth clinically, they reveal bone loss that accompanies pockets, helping you gauge the extent of periodontal involvement. Panoramic images, cephalometric radiographs, or full-mouth periapicals each have limitations for this purpose: panoramics can distort bone levels and miss fine interproximal changes, cephalometrics serves skeletal assessment rather than periodontal bone detail, and taking periapicals of all teeth would require many images and still may not optimize the posterior bone height in a single view. The vertical bitewing thus offers the best balance of extended coverage and precise bone-level assessment for this purpose.