Diagnostic Diagnostic Panoramic ImagesPanoramic Images

DHY 202 Clinical Radiology IDental Hygiene Department

William Rainey Harper College

IntroductionIntroduction

• Dental radiographers often taught to Dental radiographers often taught to identify panoramic technique errors identify panoramic technique errors by viewing the teeth.by viewing the teeth.

• Important to look at other anatomical Important to look at other anatomical features besides the teeth when features besides the teeth when assessing diagnostic quality of a assessing diagnostic quality of a panoramic radiograph.panoramic radiograph.

Criteria for Diagnostic Criteria for Diagnostic Quality of Panoramic Quality of Panoramic

RadiographsRadiographs

• Entire maxilla & mandible recordedEntire maxilla & mandible recorded• Symmetrical display of structures right to Symmetrical display of structures right to

leftleft• Slight smile/downward curvature of occl Slight smile/downward curvature of occl

planeplane• Minimal over or under magnification of Minimal over or under magnification of

teethteeth

Criteria for Diagnostic Criteria for Diagnostic Quality of Panoramic Quality of Panoramic

RadiographsRadiographs• Tongue positioned against palate to avoid Tongue positioned against palate to avoid

palatoglossal air spacepalatoglossal air space• Minimal or no cervical spine shadowMinimal or no cervical spine shadow• Acceptable film density & contrastAcceptable film density & contrast• Free of technical, film handling & Free of technical, film handling &

processing errorsprocessing errors

Assessing The Diagnostic Assessing The Diagnostic Quality of Panoramic Quality of Panoramic

RadiographsRadiographs

• Divide the panoramic radiograph into Divide the panoramic radiograph into six zones: three are in the midline six zones: three are in the midline and three are bilateraland three are bilateral

Six zones

Assessing The Diagnostic Assessing The Diagnostic Quality of Panoramic Quality of Panoramic

RadiographsRadiographs

• Zone 1: DentitionZone 1: Dentition• Zone 2: Nose-SinusZone 2: Nose-Sinus• Zone 3: Mandibular BodyZone 3: Mandibular Body• Zone 4 Zone 4 && 6: Four corners, Condyles & Hyoid 6: Four corners, Condyles & Hyoid• Zone 5: Ramus-SpineZone 5: Ramus-Spine

Zone 1: DentitionZone 1: Dentition• Smile-like upward curvatureSmile-like upward curvature• Interocclusal space between archesInterocclusal space between arches• Anterior teeth neither too large or so narrow Anterior teeth neither too large or so narrow

as to create “pseudospaces” between themas to create “pseudospaces” between them• Posterior teeth should not be larger or smaller Posterior teeth should not be larger or smaller

on one side than the otheron one side than the other• No excessive overlap of the premolars on one No excessive overlap of the premolars on one

side versus the otherside versus the other

Zone 1: Dentition Zone 1: Dentition (cont)(cont)

• Apices of max or mand teeth shouldn’t be Apices of max or mand teeth shouldn’t be cut offcut off

• Crowns of anterior teeth shouldn’t appear Crowns of anterior teeth shouldn’t appear fractured or obscuredfractured or obscured

Zone 1: DentitionZone 1: Dentition

The teeth should be separated and arranged with an upward curve posteriorly, producing a smile-like arrangement.

Zone 2: Nose-SinusZone 2: Nose-Sinus• Images of inferior turbinates contained Images of inferior turbinates contained

within the nasal cavitywithin the nasal cavity• No image of the soft tissue nose cartilage No image of the soft tissue nose cartilage • The hard palate shadow (double image) and The hard palate shadow (double image) and

sometimes the ghost images of the palate sometimes the ghost images of the palate must be seen within the maxillary sinuses must be seen within the maxillary sinuses (above apices of posterior teeth)(above apices of posterior teeth)

• Tongue in contact with hard palate-no Tongue in contact with hard palate-no intervening airintervening air

Zone 2: Nose-SinusZone 2: Nose-Sinus

The inferior turbinates within the nasal fossa & the hard palate shadows above the root apices

Zone 3: Mandibular Zone 3: Mandibular BodyBody

• Inferior cortex of mandible should be Inferior cortex of mandible should be smooth & continuoussmooth & continuous

• No ghost image of hyoidNo ghost image of hyoid

• Midline area should not be overly Midline area should not be overly enlarged superiorly-inferiorlyenlarged superiorly-inferiorly

Zone 3: Mandibular Zone 3: Mandibular BodyBody

The inferior cortex of the mandibular body should be smooth & uninterrupted.

Zone 4 & 6: Four Zone 4 & 6: Four Corners; Condyles & Corners; Condyles &

HyoidHyoid• Condyles somewhat centered in zone 4 Condyles somewhat centered in zone 4

& of equal size & on same horizontal & of equal size & on same horizontal planeplane

• Body of hyoid bone in zone 6 should Body of hyoid bone in zone 6 should appear as a double image equal in size appear as a double image equal in size bilaterally & should not spread across bilaterally & should not spread across the mandible.the mandible.

Zone 4 & 6: Four Zone 4 & 6: Four Corners; Condyles & Corners; Condyles &

HyoidHyoid

Zone 4: The condyles are centered & equal in size & position bilaterally. Zone 6:The hyoid bone should remain in this zone

Zone 5: Ramus-SpineZone 5: Ramus-Spine

• Ramus should be same width Ramus should be same width bilaterallybilaterally

• Spine can be present as long as it Spine can be present as long as it does not superimpose on the ramus; does not superimpose on the ramus; distance between the spine and distance between the spine and ramus should be the same bilaterallyramus should be the same bilaterally.

Zone 5: Ramus-SpineZone 5: Ramus-Spine

The ramus should be equal in width bilaterally & the spine should not be superimposed on the ramus.