2 IntroductionDental 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 recordedSymmetrical display of structures right to leftSlight smile/downward curvature of occl planeMinimal over or under magnification of teeth
4 Criteria for Diagnostic Quality of Panoramic Radiographs Tongue positioned against palate to avoid palatoglossal air spaceMinimal or no cervical spine shadowAcceptable film density & contrastFree 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 bilateralSix zones
6 Assessing The Diagnostic Quality of Panoramic Radiographs Zone 1: DentitionZone 2: Nose-SinusZone 3: Mandibular BodyZone 4 & 6: Four corners, Condyles & HyoidZone 5: Ramus-Spine
7 Zone 1: Dentition Smile-like upward curvature Interocclusal space between archesAnterior teeth neither too large or so narrow as to create “pseudospaces” between themPosterior teeth should not be larger or smaller on one side than the otherNo 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 offCrowns of anterior teeth shouldn’t appear fractured or obscured
9 Zone 1: DentitionThe teeth should be separated and arranged with an upward curve posteriorly, producing a smile-like arrangement.
10 Zone 2: Nose-SinusImages of inferior turbinates contained within the nasal cavityNo image of the soft tissue nose cartilageThe 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-SinusThe inferior turbinates within the nasal fossa & the hard palate shadows above the root apices
12 Zone 3: Mandibular BodyInferior cortex of mandible should be smooth & continuousNo ghost image of hyoidMidline area should not be overly enlarged superiorly-inferiorly
13 Zone 3: Mandibular BodyThe 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 planeBody 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-SpineThe ramus should be equal in width bilaterally & the spine should not be superimposed on the ramus.