Dental Radiology 3nd stage

Lec.11 Panoramic Radiography ‫ حوراء الخزاعي‬.‫د‬

Introduction
Panoramic imaging is a standard procedure to survey the whole dental status. It shows a two-
dimensional view of a half-circle from ear to ear. Panoramic radiography is a form of tomography;
thus, images of multiple planes are taken to make up the panoramic image. In panoramic imaging
the patient’s jaws and facial bones are scanned with a narrow x-ray beam, which rotates around the
patient producing a sharp image layer.

(Focal trough)

A panoramic image shows a curved layer of the jaws including tempromandibular joints (TMJ).
Panoramic x-ray devices produce a wide range of two-dimensional clinical views e.g. adult pan,
pediatric pan, TMJs, segments (partial panoramic view of a selected region in the dentition),
sinuses, bitewing.
In panoramic imaging, the patient's dental arch must be positioned within a narrow zone of sharp
focus known as image layer. The image layer is a three-dimensional curved zone, or "focal trough"
where the structures lying within this layer are reasonably well defined on final panoramic image.
Objects outside the image layer are blurred, magnified or reduced in size and are sometimes
distorted to the extent of not being recognizable.

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Composition and types of panoramic radiography equipment

Dental panoramic radiography equipment consists of a horizontal rotating arm which holds an X-
ray source and a moving film mechanism (carrying a film) arranged at opposite side. The patient's
skull sits between the X-ray generator and the film. The X-ray source is collimated toward the
film, to give a beam shaped as a vertical blade having a width of 4-7mm when arriving on the film,
after crossing the patient's skull. Also the height of that beam covers the mandibles and the maxilla
regions. The arm moves and its movement may be described as a rotation around an instant center
which shifts on a dedicated trajectory.
The manufacturers propose different solutions for moving the arm, trying to maintain constant
distance between the teeth to the film and generator. Also those moving solutions try to project the
teeth arch as orthogonally as possible. It is impossible to select an ideal movement as the anatomy
varies very much from person to person. Finally a compromise is selected by each manufacturer
and results in magnification factors which vary strongly along the film (15%-30%). The patient
positioning is very critical in regard to both sharpness and distortions. Normally, the person bite on
a plastic spatula so that all the teeth, especially the crowns can be viewed individually. The whole
orthopantomogram process takes about one minute. The patient’s actual radiation exposure time
varies between 5.5 to 22 seconds.

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There are two kinds of film moving mechanisms, one using a sliding flat cassette which holds the
film, and another using a rotating cylinder around which the film is wound. There are two standard
sizes for dental panoramic films: 30 cm × 12 cm and 30 cm x 15 cm. The smaller size film
receives 8% less X-ray dosage on it compared to the bigger size.
Dental X-rays' radiology is moving from film technology (involving a chemical developing
process) to digital X-ray technology, which is based on electronic sensors and computers. One of
the principal advantages compared to film based systems is the much greater exposure latitude.
This means many fewer repeated scans, which reduces costs and also reduces patient exposure to
radiation. Lost X-ray can also be reprinted if the digital file is saved. Other significant advantages
include instantly viewable images, the ability to enhance images, the ability to email images to
practitioners and clients, no darkroom required and that no chemicals are used.

Panoramic images are valuable diagnostic tools in these clinical tasks

 Impacted wisdom teeth diagnosis and treatment planning

 Periodontal bone loss and periapical involvement.

 Assessment for the placement of dental implants
 Orthodontic assessment. pre and postoperative
 Diagnosis of developmental anomalies such as cherubism, cleidocranial dysplasia
 Carcinoma in relation to the jaws
 Temporomandibular joint dysfunctions and ankylosis.

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 Diagnosis, and pre- and post-surgical assessment of oral and maxillofacial trauma, e.g.
dentoalveolar fractures and mandibular fractures.
 Other diagnostic and treatment applications.

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Panoramic radiography by far is a very popular and widely accepted technique. A part from the
routine uses, it is also used for dimensional and angular measurements. One of the shortcomings of
panoramic radiographs is image distortion. Magnification or distortion is an inherent property of
panoramic machine. The position of an object between the x-ray source and the film is responsible
for magnification seen on radiograph.

Principal advantage of panoramic radiography

 Broad coverage of facial bones and teeth

 Low patient radiation dose
 Convenience of examination for the patient (films need not be placed inside the mouth)
 Ability to be used in patients who cannot open the mouth or when the opening is restricted
e.g.: due to trismus
 Short time required for making the image
 Patient's ready understandability of panoramic films, making them a useful visual aid in
patient education and case presentation.
 Easy to store compared to the large set of intra oral x-rays which are typically used.

Disadvantages

1. The resultant image does not resolve the fine anatomical structures (caries, periodontal
disease)
2. There is also some magnification and overlapped images of teeth in the molar region,
however the angular relationships are accurate.
3. The cost of a panoramic x-ray machine is 2-4 times the cost of an intraoral machine.