PANORAMIC RADIOGRAPH

Dr Swarna Y M
 LEARNING OUTCOMES

At the end of lecture, student should have knowledge of

• Principles of panoramic radiography

• Indications of panoramic radiography

• Merits and demerits of panoramic radiography

• Technique of panoramic radiography

• Identification of anatomic landmarks on panoramic radiograph

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 INTRODUCTION
• Extra oral radiography means that the source as well as film are placed
outside the mouth & an exposure is made in order to obtain the images on
an recording medium.

• Panoramic imaging (pantomography) is a technique for producing a single

tomographic image of the facial structures that include, both the maxillary
and mandibular dental arches and their supporting structures.

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• Paatero called this technique Pantomography, a contraction of the words
Panoramic radiography.

Panoramic meaning

“an unobstructed or complete view of a region in every direction”

Tomography meaning,

“a X ray technique for taking radiographs of layers of tissue in depth without the
interference of tissue above & below that level”

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PARTS OF A PANORAMIC MACHINE

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 PRINCIPLES OF PANORAMIC IMAGE FORMATION
• Disk 1 is held stationary and the x-ray source is rotated so that the central ray
constantly passes through the center of rotation of disk 1 and,
simultaneously, both disk 2 and the lead collimator (Pb) rotate around the
center of disk 1.

Pb 6
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• Although disk 2 moves, the receptor on this disk also rotates past the slit.

• So the objects A through D move through the x-ray beam in the same
direction and at the same rate as the receptor.

• To obtain optimal image definition, it is crucial that the speed of the receptor
passing the collimator slit (Pb) be maintained equal to the speed at which
the x-ray beam sweeps through the objects of interest.

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• A patient in the place of disk 1, and objects A through D represent teeth and
surrounding bone.

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 Structures near the x-ray
tube are distorted and
structure
closer X-ray or appear out of focus because
further
receptor blurer
the x-ray beam sweeps
through them in the direction
opposite that in which the
image receptor is moving

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 sweep 2 times thats why object appear 2 times

Structures located more

centrally in the body relative
to the jaws, such as the hyoid
bone & epiglottis, appear on
the right, left & sometimes
central areas of the final
image

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 Only structures near
the receptor are
carefully captured on
the resultant image.

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 FOCAL TROUGH (ZONE OF SHARPNESS)
• The focal trough is a three dimensional curved zone or image layer in
which the structures are reasonably well defined on panoramic
radiograph.

• The shape of focal trough varies with the brand of equipment.

• Machines are designed to have zone, shaped like dental arch (HORSE
SHOE SHAPE)

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within : clear
out of : blurr FOCAL TROUGH

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 FOCAL TROUGH
• When the object is positioned anterior to the FT (toward the film), the beam
passes at a rate faster than normal through the anterior structures, resulting in
decreased width of the structures on the film.

• Alternatively, when the object is positioned posterior to FT the beam passes

through the anterior mandible slower than normal as a result the image of
structures is elongated horizontally on the film.

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ANTERIOR TO FOCAL TROUGH

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This film shows the blurring and narrowing
of the anterior teeth.

R L

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POSTERIOR TO FOCAL TROUGH

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This film shows the blurring and widening of the
anterior teeth.

R L

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 INDICATIONS
Most useful clinically for diagnostic problems requiring broad coverage of
Prostho: the teeth.
Oral Pathology(cyst & tumors)
Orthodontics: alignment of teeth and jaw bones
Endodontics: multiple carious lesions

estimate age

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Impacted teeth
sequence of impaction

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Diseases & developmental anomalies
antero posterior dimension

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Eruption patterns

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Trauma
CBCT
(3D)

any fracture???

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 when wana place more than one implant
Implants

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 INDICATIONS

• Lesions such as cysts, tumors and developmental anomalies in the body and
rami of the mandible to established site and size.

• To detect the presence of retained roots in edentulous patients.

• Assessment of any underlying disease before constructing complete or

partial dentures.

• Orthodontic assessment, to note the presence and position of the developing

permanent dentition.

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 INDICATIONS

• Antral disease- particularly to access the floor, posterior and anterior

walls of the antra.

• Investigation of the quality of the articular surfaces of the condylar

Text
heads in TMJ disorders.

• Periodontal disease- as an overall view of the alveolar bone levels.

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 CONTRAINDICATIONS

Panoramic films are not suitable for diagnostic examinations requiring

high image resolution, for example,

–Early alveolar bone loss bone loss , caries

–Detection of incipient dental caries

–Analysis of trabecular bone changes associated with early periapical

lesions.

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 MERITS OF PANORAMIC RADIOGRAPHY
16 periapical radiograph = 1 panaromic radiograph

1.Broad coverage of facial bones & teeth.

2.Low patient radiation dose.

3.Convenience of the examination for the patient. no need open mouth

4.Ability to be used in patients unable to open their mouth.

5.Short time period of the procedure.

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6. Patient’s ready understandability of panoramic film making it a useful

visual aid in patient education.

7. Both condylar heads are shown on one film allowing easy comparison.

8. The radiation dose (effective dose) is about 1/3rd of the dose from a full

mouth survey of intra oral films.

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 meant for hard tissue

DEMERITS OF PANORAMIC RADIOGRAPHY

1. Lack of fine anatomical detail, hence not useful for detecting small carious
lesions & fine structure of the periodontium.
2. Structures not in the focal trough may not be evident.
3. Soft tissue & air shadows may overlie & obscure hard tissue structures.
4. Distortion & magnification of the final image.
5. Formation of ghost images.
6. Technique is not suitable for children under 5 years of age or some disabled
patients. hard for them to stand in front of machine for 12s

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 TECHNIQUE & PATIENT POSITIONING

• Patients should be asked to remove any earrings, jewellery, hair pins,

spectacles, removable dentures or removable orthodontic appliances

• The procedures & equipment movements should be explained to

reassure patients.

• Patients should be placed accurately within the machines using the

various head-positioning devices and light-beam marker positioning
guides.

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• The anteroposterior position radiograph of the patient is typically
achieved by having patients place the incisal edges of their maxillary and
mandibular incisors into a notched positioning device (the bite block).

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• The midsagittal plane must be centered within the image layer of the
particular X-ray unit.

• The patient's chin and occlusal plane must be properly positioned to avoid
distortion.

• The occlusal plane is aligned so that it is lower anteriorly, angled 20 to 30

degrees below the horizontal palne. tilt near to X-ray Source: magnify

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• A general guide for chin positioning is to place the patient so that a line
from the tragus of the ear to the outer canthus of the eye is parallel with
the floor.
too up : reverse smile line
too low:e exaggerated smile line

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• Patients are positioned with their backs and spines as erect as possible and
their necks extended. This will help to straighten the spine, minimizing the
artifact produced by a shadow of the spine.

• Finally, after patients are positioned in the machine, they are instructed to
swallow and hold the tongue on the roof of the mouth.

• This raises the dorsum of the tongue to the hard palate eliminating the air
space and providing optimal visualization of the apices of the maxillary teeth.

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ANATOMICAL LANDMARKS

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 SPINAL, NECK,
AND SOFT
TISSUE
ANATOMIC
STRUCTURES

1, Variant of normal 5, Hard palate (the lower line is the 9, Posterior pharyngeal wall.
Anatomy of the vertebral junction of the hard palate and the lateral
body wall of the nasal cavity on the tube
side, and the upper line is the junction of
the hard palate and lateral wall of the nasal
cavity on the receptor side).
2. Cervical vertebra. 6, Orbital rim. 10, Hyoid bone.

3. Ear lobe. 7, Floor of nasopharynx (upper

surface of soft palate).
4, Soft palate and uvula 8, Posterior surface of tongue.
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 MAXILLARY,
OR MID-
FACIAL, BONY
ANATOMIC
STRUCTURES

1, Articular tubercle, 5, Floor of orbit. 9, Floor of maxillary sinus.

temporal
bone.

2. Zygoma. 6, Anterior 10Maxillary

aspect if inferior concha. left third molar (developing).

3. Zygomatic process of 7, Nasal septum. 11, Ear lobe.

maxilla.

4, Pterygomaxillary fi 8, Anterior 12, Cervical

ssure. nasal spine. vertebral body.
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 MANDIBULAR
BONY
ANATOMIC
STRUCTURES

1, Mandibular condyle 5, Inferior alveolar (mandibular) 9, Submandibular

canal fossa (lingual salivary gland
depression)

2, Neck of mandibularcondyle 6, Inferior 10, Mandibular angle.

border of mandible

3, Coronoid process of mandible. 7, Superimposed shadow of 11 , External oblique ridge.

cervical vertebrae

4, Ghost image, posterior aspect 8, Mental foramen. 12, Sigmoid notch.

of inferior border of left side of
mandible.
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 REFERENCES

1) ORAL RADIOLOGY: 5th edition: White & Pharoah

2) DENTAL & MAXILLOFACIAL RADIOLGY: Freny Kharodjkar

3) PRINCIPLES OF DENTAL IMAGING: Langland & Langalis

4) PRINCIPLES & PRACTISE OF PANORAMIC RADIOGRPAHY: Langland &

Langalis

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