| Caries |
Panoramic radiographs
demonstrate the highest
positive predictive value
(PPV) for the detection of
caries in posterior teeth
as compared to a full
mouth survey including
bitewing radiographs. |
| Periodontal |
PPVs for periodontal
disease detection were
almost exactly equal
between low-dose single
panoramic and higher dose
full mouth survey
Negative predictive value
(NPV) for periodontal
disease of a single
panoramic radiograph are
superior in all three
anatomic areas over the
full mouth survey |
| Bone loss |
Panoramic radiographs more
often indicate more severe
bone loss than the
periapical radiographs.
Measurements of marginal
bone loss made from
panoramic radiographs are
the most accurate when
compared to truth |
Periapical
Disease |
Panoramic radiographs were
shown to be as effective
as periapical radiographs
for the detection of lytic
and sclerotic periapical
disease
Full-mouth survey was
deficient in identifying
an osteosclerosis and
ectopic calcification when
compared to panoramic
radiographs. Early lytic
periapical changes may be
clearly seen in panoramic
radiographs when no change
is visible on a
corresponding periapical
radiograph taken at the
same time. Lesions clearly
depicted on the panoramic
radiographs are less
visible, if not totally
absent in the
corresponding periapical |
Edentulous
Patients |
Keur (1986) recommended
that a panoramic
radiograph be taken on all
new edentulous patients.
His study of 1,135
asymptomatic patients
showed 34 percent had
lesions that required
surgical treatment. A
further 29 percent had
abnormalities that did not
require surgical
intervention. |
| Scope |
The panoramic radiograph
demonstrates structures
such as the ramus, TMJ,
styloid process, styloid
ligament, upper parts of
the maxillary antrum and
lower orbit which are
outside the anatomical
limits of a full mouth
survey.
Some indications in
panoramic radiographs
should include: Hypodontia
(congenitally missing),
embedded and impacted,
apical condensing osteitis,
apical abscess and/or
cysts, fibrous healing
defects, apical resorption,
recurrent (secondary)
caries, cemental caries,
drift and migration,
attrition, regional
odontodysplasia (ghost),
dentinal dysplasia (type 1
A, B & C), congenital
syphilis (enamel
hypoplasia), taurodontism,
mesiodens (supernumerary,
supplemental and
accessory), external
resorption, localized and
generalized prepubertal
periodontitis, perio
destructive process and
many other types of cysts,
tumors and lessions. |
Dosimetry
and Risk
Comparisons |
Panoramic carries about
one tenth the risk of a
full mouth in terms of
fatal malignant disease
per million persons
exposed. Risk estimates of
13 to 18 fold exists
between panoramic and full
mouth survey using long,
round cone and E-speed
film |
Disease
Trends |
The dentist will become
more adept at diagnosting
problems in adjacent
anatomic regions such as
the TMJ, salivary glands,
styloid process, and
maxillary sinus. Ohba and
colleagues (1990) noted
that panoramic radiography
was the method of choice
for the detection of
problems associated with
the floor and posterior
wall of the antrum. In our
aging population, the
reasons for taking
radiographs will shift
away from the detection of
previously common diseases
such as caries and
periodontal and periapical
disease to include
disorders that are more
occult, and more
life-threatening diagnoses
such as malignant diseases
within the jaws will be
made. Additionally, the
importance of recognizing
the radiologic
manifestation of systemic
and metabolic diseases
affecting the aging or
aged such as osteoporosis
will have more
significance to a greater
number of practitioners
throughout the world. |
