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Purpose: This study aimed to assess the interdental bone level in premolar bitewing radiographswhile retracting the cheeks. Methods: Seventy-two horizontal bone defects were created on dried mandibles and maxillae. The distance from the bone level to the cement-enamel junction of premolars wasdetected by a modified digital caliper (considered the gold standard). The reliability of allradiographs was assessed by intraclass correlation coefficient (ICC), and the validity wascompared to the gold standard using the analysis of variance test. P-values less than 0.05were considered statistically significant. Results: This study showed that the reliability of radiographs without a cheek simulatorand with 0.16 second exposure time was significantly higher than that of the two othergroups (ICC=0.96 compared to 0.93 and 0.88, respectively). The results from the radiographswithout a cheek simulator and with 0.16 second exposure time were more similar tothe gold standard measures than those of the two other groups, although the differencewas not statistically significant. Conclusions: Retracting the buccal soft tissue plays an important role in increasing the accuracyof radiographs in detecting the interdental alveolar bone level and produces moreaccurate results than increasing the exposure time, although it does not have a significantrole in reliability of results.

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