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

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

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

Criteria for Diagnostic Quality of Panoramic Radiographs Tongue positioned against palate to avoid palatoglossal air spaceTongue positioned against palate to avoid palatoglossal 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 & processing errorsFree of technical, film handling & processing errors

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

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

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

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

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

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

Zone 2: Nose-Sinus Images of inferior turbinates contained within the nasal cavityImages of inferior turbinates contained within the nasal cavity No image of the soft tissue nose cartilageNo 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)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 airTongue in contact with hard palate-no intervening air

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

Zone 3: Mandibular Body Inferior cortex of mandible should be smooth & continuousInferior cortex of mandible should be smooth & continuous No double or ghost image of hyoidNo double or ghost image of hyoid Midline area should not be overly enlarged superiorly-inferiorlyMidline area should not be overly enlarged superiorly-inferiorly

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

Zone 4 & 6: Four Corners; Condyles & Hyoid Zone 4: The condyles are centered & equal in size 7 position bilaterally. Zone 6:The hyoid bone should remain in this zone

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

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