Panoramic should be a necessity for dental radiography
| 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. |
All above statements are based on material found in Diagnostic Imaging of the Jaws by William and Wilkins, copyright 1995. Edited by Langlais, Langland, and Nortj=e. ISBN:0-683-04809-0
There are several factors that influence radiogrpahic image quality, which may be shifting your opinion of the above statements. Panoramic is much more sensitive to processing and dark room enviroments. Patient positioning, machine calibration both mechanically and electronically, film/screen combination and age, and view box lighting, all effect diagnostic value. If your panoramic results do not agree with the above statements, a service tech should be contacted to evaluate the problem. Older obsolete models may have non-repairable issues.
Last updated: 08/02/2010 |
