Академический Документы
Профессиональный Документы
Культура Документы
RADIOGRAPHY
ORAL RADIOLOGY LECTURE
panoramic periapical
A periapical or bitewing film is preferred
over a panoramic film for:
• Caries
• Periodontal involvement
• Early or limited periapical pathology
• Endo treatment
PRINCIPLES OF PANORAMIC
IMAGE FORMATION
A panoramic radiograph presents views from both
sides of the patients face as well as providing a frontal
perspective.
You can best
understand the relative
position of structures
shown in a panoramic
radiograph if you
imagine the image layer
to be bent around the
patient’s face
The lateral and more
posterior structures are
The anterior structures
projected to each side of
are shown in the midline
the panoramic radiograph.
of the standard
panoramic projection
Panoramic Machines
Obtained by rotating a
narrow beam of
radiation in the
horizontal plane.
R L
Patient Preparation
Head tipped up
Head tipped down
Head turned
Teeth in front of notch or behind notch
Teeth Too Anterior
If the teeth are positioned in front of the notches in the
bitestick (see diagram below left), the anterior teeth will
appear narrower and will be blurred (less sharp than
normal). If the teeth are in front of the notches, they are
closer to the film, resulting in less magnification
horizontally (narrowing). Being out of the focal trough
makes the images less sharp.
Teeth Too Anterior
This film shows the blurring and narrowing
of the anterior teeth.
R L
Teeth Too Anterior
R L
R L
Teeth Too Posterior
If the teeth are positioned behind the notches in the
bitestick (see diagram below left), the anterior teeth will
appear wider and will be blurred (less sharp than
normal). If the teeth are behind the notches, they are
farther from the film, resulting in more magnification
horizontally (widening). Being out of the focal trough
makes the images less sharp.
Teeth Too Posterior
R L
Teeth Too Posterior
R L
Head Turned
If the head is turned slightly to the side (not
centered on the bitestick), the structures on one
side will be closer to the film and the structures
on the other side will be farther from the film. In
the diagram below, the head was turned to the
right and the teeth are closer to the film on that
side.
Head Turned
The teeth are smaller on the side to which the head is
turned. (When the teeth are closer to the film, there is
less magnification horizontally). The teeth that are
farther from the film are wider because there is
increased magnification horizontally.
Head Turned
In this patient, the molars on the patient’s right side are
noticeably wider than the molars on the patient’s left.
Which way was the head turned?
To the left. Left side closer to film, less magnification.
R L
Head Turned
On this film, not only are the teeth wider on one side, but the
ramus is also wider on that side. (The black arrows are the
same length on both sides). Which side was farthest from the
film?
The patient’s right side; farther from the film, more
magnification.
R L
Head Turned
In this film, the patient’s head was turned to the right,
resulting in a widening of the teeth and ramus on the
patient’s left side.
R
Head Tipped Down
R L
Head Tipped Down
Again we see shortened mandibular incisors, V-
shaped mandible.
R
Head Tipped Up
If the Frankfort Plane is angled upward, the mandible
will be “squared-off” (angle of the mandible
approximately 90 degrees) and the hard palate will be
superimposed over the roots of the maxillary teeth. May
have the appearance of a “reverse” smile.
Head Tipped Up
In the film below, the hard palate (red arrows) is covering the
roots of the maxillary teeth. Note the reverse smile.
R L
Head Tipped Up
This film shows the reverse smile and it is difficult to
see the root areas of the maxillary teeth.
Lead Apron
If the lead apron is improperly positioned so that it is
located high on the back of the patient’s neck, it may
block part of the beam and result in a clear (appears
white on the viewbox) area on the film.
R
Static Electricity
Static electricity appears as black lines or dots on
the film, often having a tree-branch appearance. It
is caused by removing the film from the box or
cassette too quickly, creating static discharge.
Failure to Remove Appliances
As part of patient preparation, appliances should be removed
from the mouth. In this patient, the complete upper denture was
left in the mouth. This would not require a retake, since the acrylic
of the denture base allows x-rays to pass through and the bone is
clearly visible.
R L
Failure to Remove Appliances
In this patient, both upper and lower removable
partial dentures were left in the mouth. In this case
the metal frameworks obscure large areas of the teeth
and the film should be retaken.
R L
Glasses
Glasses should routinely be removed for panoramic
exposures. The bottom part of the frame/lenses may
obscure the periapical area of the maxillary anterior teeth.
What other error is evident on this film?
The head is tipped up too much. Notice the reverse
smile and the proximity of the hard palate to the roots
of the maxillary teeth.
R L
Patient Movement
It is important for the patient to remain still during
a panoramic exposure. This film shows excessive
patient movement (unknown cause) and must be
retaken.
R L
Patient Movement
This film shows much more subtle movement (arrow),
resulting in an uneven inferior border of the mandible.
This might be misinterpreted as being the result of a
fracture.
R
Incorrect Exposure Settings
If incorrect exposure factors are selected for a patient
(kVp, mA), a film that is too light (underexposed) or too
dark (over-exposed) may result. The film would
normally be retaken.
overexposure underexposure