1. Diagnostic Panoramic Images
DHY 202 Clinical Radiology I
Dental Hygiene Department
William Rainey Harper College

2. Introduction
Dental radiographers often taught to identify panoramic technique errors by viewing the teeth.
Important to look at other anatomical features besides the teeth when assessing diagnostic quality of a panoramic radiograph.

3. Criteria for Diagnostic Quality of Panoramic Radiographs
Entire maxilla & mandible recorded
Symmetrical display of structures right to left
Slight smile/downward curvature of occl plane
Minimal over or under magnification of teeth

4. Criteria for Diagnostic Quality of Panoramic Radiographs
Tongue positioned against palate to avoid palatoglossal air space
Minimal or no cervical spine shadow
Acceptable film density & contrast
Free of technical, film handling & processing errors

5. Assessing The Diagnostic Quality of Panoramic Radiographs
Divide the panoramic radiograph into six zones: three are in the midline and three are bilateral
Six zones

6. Assessing The Diagnostic Quality of Panoramic Radiographs
Zone 1: Dentition
Zone 2: Nose-Sinus
Zone 3: Mandibular Body
Zone 4 & 6: Four corners, Condyles & Hyoid
Zone 5: Ramus-Spine

7. Zone 1: Dentition Smile-like upward curvature
Interocclusal space between arches
Anterior teeth neither too large or so narrow as to create “pseudospaces” between them
Posterior teeth should not be larger or smaller on one side than the other
No excessive overlap of the premolars on one side versus the other

8. Zone 1: Dentition (cont)
Apices of max or mand teeth shouldn’t be cut off
Crowns of anterior teeth shouldn’t appear fractured or obscured

9. Zone 1: Dentition
The teeth should be separated and arranged with an upward curve posteriorly, producing a smile-like arrangement.

10. Zone 2: Nose-Sinus
Images of inferior turbinates contained within the nasal cavity
No image of the soft tissue nose cartilage
The hard palate shadow (double image) and sometimes the ghost images of the palate must be seen within the maxillary sinuses (above apices of posterior teeth)
Tongue in contact with hard palate-no intervening air

11. Zone 2: Nose-Sinus
The inferior turbinates within the nasal fossa & the hard palate shadows above the root apices

12. Zone 3: Mandibular Body
Inferior cortex of mandible should be smooth & continuous
No ghost image of hyoid
Midline area should not be overly enlarged superiorly-inferiorly

13. Zone 3: Mandibular Body
The inferior cortex of the mandibular body should be smooth & uninterrupted.

14. Zone 4 & 6: Four Corners; Condyles & Hyoid
Condyles somewhat centered in zone 4 & of equal size & on same horizontal plane
Body of hyoid bone in zone 6 should appear as a double image equal in size bilaterally & should not spread across the mandible.

15. Zone 4 & 6: Four Corners; Condyles & Hyoid
Zone 4: The condyles are centered & equal in size & position bilaterally. Zone 6:The hyoid bone should remain in this zone

16. Zone 5: Ramus-Spine Ramus should be same width bilaterally
Spine can be present as long as it does not superimpose on the ramus; distance between the spine and ramus should be the same bilaterally.

17. Zone 5: Ramus-Spine
The ramus should be equal in width bilaterally & the spine should not be superimposed on the ramus.