Ace Achievers

Dental Academy

PANORAMIC RADIOGRAPHY
• It is a radiographic technique that produces a single image of the facial structures,
including both maxillary and mandibular arches and their supporting structures. Also
called as ‘pantomography’ or ‘rotational radiography’.
• The term pantomography is derived from the word PANORAMA “an unobstructed
view of a region in every direction”.
• Numata of Japan (1933) and Paatero of Finland (1948-49) invented it.

Sharpness
• The sharpness or detail seen on a periapical film is much better. The images are
“fuzzier” on a panoramic film as compared. However, with a much larger field of
view, more structures can be displayed in the jaws. Also, with the advent of digital
imaging, panoramic radiography resolution and clarity has increased by leaps and
bounds.

Cassette/Screens/Film
• light-tight cassette is used to hold the x-ray film in tight contact with two intensifying
screens (one on each side of the film). The cassette can be either rigid metal or soft
vinyl, depending on the type of panoramic machine.

Principles of Panoramic Radiography

• The source of radiation and the image receptor are rotated around the patient’s head
at the same speed around a centre of rotation.
• A fan-shaped x-ray beam is directed towards the jaws through a slit collimator. The
image receptor too, passes in front of a slit collimator recording successive parts of
the structures exposed.
• The structures closer to the tube-head get unduly magnified and therefore, appear
blurred.
• The structures closer to the image receptor cast sharp shadows.

A. Collimation
• To limit the exposure of patient → x-ray beam is collimated.
• It produces a narrow, rectangular x-ray beam that exposes a small portion of film as
tube head and film rotate around the patient.

B. Centre of rotation
• The film cassette & tube head are connected & rotate simultaneously around the
patient during exposure.
• The pivotal point/axis around which they rotate is termed as ROTATION CENTRE.
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• Rotation center
- The tube head, angled slightly upward, rotates in an arc around the back of the
patient’s head.
- The center of this rotation varies as the tube head rotates, producing a sliding
rotation center.
- -4 to -7 negative angulation.
• Sliding rotation center
- At the starting point, with the tube head on the patient’s left, the rotation center
is located posteriorly on the same side as the tube head.
- As the tube head moves behind the patient, the rotation center “slides” toward
the front. As the tube head continues to move to the patient’s right, the rotation
center “slides” back posteriorly.

C. Focal Trough Or Image Layer

• The focal trough image layer is 3D curved zone in which the structures lined within
the layer are reasonably well defined on final panoramic image.
• Focal trough corresponds to the shape of the upper and lower jaws.
• The factors that affect its size are:
- Arc path
- SPEED of the receptor and x-ray tube head.
- Alignment of the x-ray beam.
- Collimator width.
• The shape and width of the focal trough is determined by the path of the sliding
rotation center.
• The three dimensions of the focal trough are:
1. Front-to-back (anterior-posterior).
2. Side-to-side (Buccolingual).
3. Up-and-down (Vertical).
• Increase in speed→ Increases image layer thickness
• Lesser the width of slit beam; more is thickness of image layer.
• The closer the rotation center is to the teeth, the narrower the focal trough in that
area.
D. Magnification
• Objects in the focal trough will be magnified in both the horizontal and vertical
dimensions. The overall magnification will be 20-30%.
Patient preparation
• Ask the patient to remove glasses, jewellery, dentures, hearing aids, bobby pins /
berets.
• Place the lead apron on the patient (no thyroid collar; it might block part of the x-ray
beam).
Patient positioning
• Four basic steps in patient positioning.
1. The maxillary and mandibular incisors are placed in the notch of the bite stick.
This positions the anterior teeth in the focal trough.
2. The Frankfort Plane should be parallel to the floor.
3. The Midsagittal Plane is perpendicular to the floor and centred on the bite stick.
4. The vertebral column should be straight.

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• The patient is encouraged to stand straight. Since the x-ray beam is angled upward,
it may pass through more of the vertebra if the patient is “slouched”, creating a white
shadow on the film.
• Advise the patient to swallow and feel the tongue contact the palate.
• Tell the patient to maintain this contact the entire time of the exposure
(approximately 20 seconds).
• Advise the patient to keep the head still during the entire exposure.
• CHIN REST: 4 -7 Degree downward: compensate negative angulation.
Characteristics of OPG
• Structures are flattened & spread out: Jaws & structure of maxillofacial complex as
well as spine are portrayed as if they were split vert in half down the mid-sagittal
plane.
• Midline Structures may project as single images or double images:
- Single real: Objects lie b/w Center of Rotation and film and X-ray beam only
passes through the structure once.
- Double real: Object intercepted TWICE by beam include:
▪ Hard and soft palate
▪ Hyoid
▪ Cervical spine
Ghost image
• Ghost images are formed by dense objects located between tube head and COR.
Caused due to external objects such as earrings; also can be produced by dense
anatomical structures such as the mandible.
- The ghost image has same general shape.
- Appears on the opp. Side.
- Higher up on the radiograph than its real position
- More blurred.
- Vertical comp is always larger.
- Structures which are ghost imaged are:
1. Hyoid bone
2. Cervical spine
3. Inferior border of mandible
4. Posterior border of mandible
5. The meatus
6. The turbinates
Air Spaces Seen on Panoramic Films
• Palatoglossal air space: The Palatoglossal Air Space is caused by failure to keep the
tongue against the palate during exposure.
• Nasopharyngeal air space
• Glossopharyngeal airspace
Patient positioning errors in OPG
• Chin Too far forward: Anterior teeth will appear narrower and blurred, Spine
superimposed on ramus.
• Chin Too far backward: Anterior teeth will appear wider and will be blurred. If the
teeth are behind the notches, they are farther from the film, resulting in more
magnification horizontally (widening).
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• Chin tipped too low: Exaggerated smile line, mand incisor blurred, apices cut, hyoid
ghost, Condyles cut, inter-condylar distance decreased.
• Chin tipped too high: hard palate, floor of nasal cavity superimposes on max root,
max incisors magnification, loss of condyles, reverse/flat smile line, inter-condylar
distance increased.
• HEAD TURNED to one side: 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

USES OF ERRORS:
• Too far forward: Nasal fossa and sinuses.
• Too far backward: Anterior maxilla and teeth.
• Chin high: Anterior mandible and teeth.
• Chin low: Anterior maxilla and teeth.

DOUBLE EXPOSURE
• It is preferable to process films immediately after exposure.
• If cassettes are laid aside for later processing, the operator may inadvertently pick
up a cassette that has already been exposed and use it again. This results in a
double exposure. The images may appear superimposed.

INDICATIONS OF PANORAMIC RADIOGRAPHY

• IOPA not possible due to trismus, gagging, loss of consciousness or uncooperative
patient.
• When large anatomic coverage is required to study lesions: cysts, benign or
malignant tumors, osteomyelitis, fibro-osseous lesions, multiple lesions,
generalized periodontitis, several carious teeth.
• To study growth and development and their disorders.
• To detect and study extent and nature of oral and maxillo-facial trauma (fractures).
• Pre-operative, intra-operative and post-operative assessment in implantology.
• To study temporo-mandibular joints and their disorders- initial survey
• As a part of FMRS (Full mouth radiographic survey).
• Identification and location of third molars.

Limitations of Panoramic Radiography

• Inadequate sharpness and detail due to rotational movement and use of intensifying
screens.
• Magnification of images and geometric distortion.
• Overlapping of images especially in the premolar region.
• Structures to be studied may lie outside the focal trough.
• High initial cost of the equipment.

A periapical or bitewing film is preferred over a panoramic film for:

• Caries
• Periodontal involvement
• Early or limited periapical pathology
• Endo treatment.