Which projection is used to visualize the crestal alveolar bone on patients with moderate to severe bone loss?

The vertical bitewing (BW) projection is specifically designed to visualize the crestal alveolar bone, particularly in cases of moderate to severe bone loss. This type of radiograph captures a larger vertical area of the dental arch, allowing for a more comprehensive view of the alveolar bone levels above the teeth.

In instances of significant bone loss, the vertical bitewing is advantageous as it can highlight changes in the height of crestal bone that might otherwise be missed with horizontal bites, which are limited in vertical coverage. The vertical orientation of the BW film allows clinicians to more accurately assess the contours and height of the alveolar ridge, which is crucial for diagnosing periodontal disease and planning appropriate treatment.

Other projections, such as periapical radiographs, primarily focus on the roots of the teeth and surrounding bone but may not adequately display the entire alveolar crest in detail. Occlusal views provide a broader view of the dental arch but are less effective at targeting specific areas of bone loss. Therefore, for detailed evaluation of crestal alveolar bone condition, particularly in cases of moderate to severe loss, the vertical bitewing is the most effective choice.