Panoramic Radiography

Dr. Mohamed Khalifa

Professor – Oral & Maxillofacial Radiology
 Definition
• It is an extra-oral radiographic technique for
producing a single image of both the maxillary
and mandibular dental arches and their
supporting structures
Principles of panoramic radiography

• Scanography

• Tomography

• Focal trough
Indications
 Indications

1. Assessment of impacted teeth

2. Assessment of both jaws before implant

placement

3. Assessment of both jaws before planning

for dentures
 Indications

4. Demonstrating fractures of the mandible

5. Demonstrating pathological lesions

affecting both jaws

6. Demonstrating periodontal disease in

overall view
 Indications

7. Demonstrating of the sinuses and the

floor of the nasal cavity

8. Orthodontic assessment and evaluation of

the eruption patterns, growth and
development
Advantages
 Advantages

1. It allows examination of both jaws in

one radiograph

2. Its procedures are relatively simple to

perform and require minimal time

3. It requires minimal patient cooperation

 Advantages

4. It can be used with patient unable to open

their mouth

5. It delivers radiation dose less than full

mouth survey

6. It is useful in case presentation and patient

education
Limitations
 Limitations
1. Lack of fine details

Panoramic Periapical
 Limitations

• Caries

• Periodontal diseases

• Early periapical pathosis

• Root canal treatment

 Limitations

2. Magnification
 Limitations

3. Focal trough dependent

Sitting / Standing
Pan/Ceph/CBCT
Panoramic Projection

1- Patient preparation

2- Machine preparation

3- Patient positioning
1- Patient preparation
 Patient preparation
1. Explain the procedure to the patient

2. Ask the patient to remove any metallic

object in the head and neck region.
 Patient preparation

3. Ask the patient to wear a lead apron

without a thyroid collar
2-Machine preparation
 Machine preparation

Adjust the exposure factors according to

manufacturer’s recommendations to
accommodate the patient
3- Patient positioning
 Patient positioning

1. Ask the patient to sit/stand with the back

straight and erect

2. Position the mid sagittal plane perpendicular

to the floor
 Patient positioning
3. Instruct the patient to bite on the plastic bite-
block
 Patient positioning
4. Position the Frankfort plane parallel to
the floor

5. Ask the patient to close his lips and to

place the tongue against the hard palate
Role of Panoramic in
implantology
• Detection
• Determination
- Bone quantity
- Bone quality
 Measurements of
panoramic Radiography
1:1 Panorama
 Advances of Panoramic
radiography

• Automatic exposure control (AEC)

• Adjustable focal trough

• Multilayer panorama
Anatomical Landmarks
Panoramic Errors
 Errors
• Failure to Remove metallic objects

the metal frameworks obscure large

areas of the teeth
R L
 Errors
• Improper placement of the lead apron or
usage of one with thyroid collar

Radiopaque cone shaped artifact over the

midline.
 Errors
• Metallic object not removed

Ghost image is formed

 Ghost Image

actual image of earring

(between lines)

ghost image of earring

(between lines)
Ghost Image - Mandible
Ghost Image - Mandible
 Errors
• The back of the patient is not straight and erect
(slumped)

White shadow appears in the midline

(superimposition of the cervical spine).
 Errors
• Patient bites too far forward on the
bite-block

Anterior teeth appear blurred and

narrowed
 Errors
• Patient bites too far backward on the
bite-block

Anterior teeth appear blurred and

widened
 Errors
• Position the Frankfort plane downward
(Chin tipped too low)

The condyles may not be visible

The mandibular incisors appear blurred

Exaggerated smile line (curved upwards)

 Errors
• Position the Frankfort plane upward
(Chin tipped too high)
• The hard palate and the floor of the nasal
cavity appear superimposed over the roots
of the maxillary teeth.
• Squared or elongated mandible
• The maxillary incisors appear blurred.
• Reverse smile line (curved
downwards).
 Errors
• Improper adjustment of the mid sagittal
plane

Right and left sides are unequally

magnified in the horizontal direction (side
closer to the film is smaller).
 Errors
• Patient did not place the tongue against
the hard palate

Formation of an radiolucent area above

the apices of the upper teeth.
 Errors
• If the patient moves anytime during
exposure

The part of radiograph being exposed at

that time appears blurred
• Dental Radiography -Principles and Techniques
Joen Iannucci, Laura Jensen Howerton

• Textbook of Dental & Maxillofacial Radiology

Freny Karjodkar
Thank You