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  • 1. Diagnostic PanoramicDiagnostic Panoramic ImagesImages DHY 202 Clinical Radiology I Dental Hygiene Department William Rainey Harper College
  • 2. IntroductionIntroduction • Dental radiographers often taught toDental radiographers often taught to identify panoramic technique errorsidentify panoramic technique errors by viewing the teeth.by viewing the teeth. • Important to look at other anatomicalImportant to look at other anatomical features besides the teeth whenfeatures besides the teeth when assessing diagnostic quality of aassessing diagnostic quality of a panoramic radiograph.panoramic radiograph.
  • 3. Criteria for DiagnosticCriteria for Diagnostic Quality of PanoramicQuality of Panoramic RadiographsRadiographs • Entire maxilla & mandible recordedEntire maxilla & mandible recorded • Symmetrical display of structures right toSymmetrical display of structures right to leftleft • Slight smile/downward curvature of occlSlight smile/downward curvature of occl planeplane • Minimal over or under magnification ofMinimal over or under magnification of teethteeth
  • 4. Criteria for DiagnosticCriteria for Diagnostic Quality of PanoramicQuality of Panoramic RadiographsRadiographs • Tongue positioned against palate to avoidTongue positioned against palate to avoid palatoglossal air spacepalatoglossal air space • Minimal or no cervical spine shadowMinimal or no cervical spine shadow • Acceptable film density & contrastAcceptable film density & contrast • Free of technical, film handling &Free of technical, film handling & processing errorsprocessing errors
  • 5. Assessing The DiagnosticAssessing The Diagnostic Quality of PanoramicQuality of Panoramic RadiographsRadiographs • Divide the panoramic radiograph intoDivide the panoramic radiograph into six zones: three are in the midlinesix zones: three are in the midline and three are bilateraland three are bilateral Six zones
  • 6. Assessing The DiagnosticAssessing The Diagnostic Quality of PanoramicQuality of Panoramic RadiographsRadiographs • Zone 1: DentitionZone 1: Dentition • Zone 2: Nose-SinusZone 2: Nose-Sinus • Zone 3: Mandibular BodyZone 3: Mandibular Body • Zone 4Zone 4 && 6: Four corners, Condyles & Hyoid6: Four corners, Condyles & Hyoid • Zone 5: Ramus-SpineZone 5: Ramus-Spine
  • 7. Zone 1: DentitionZone 1: Dentition • Smile-like upward curvatureSmile-like upward curvature • Interocclusal space between archesInterocclusal space between arches • Anterior teeth neither too large or so narrowAnterior teeth neither too large or so narrow as to create “pseudospaces” between themas to create “pseudospaces” between them • Posterior teeth should not be larger or smallerPosterior teeth should not be larger or smaller on one side than the otheron one side than the other • No excessive overlap of the premolars on oneNo excessive overlap of the premolars on one side versus the otherside versus the other
  • 8. Zone 1: Dentition (cont)Zone 1: Dentition (cont) • Apices of max or mand teeth shouldn’t beApices of max or mand teeth shouldn’t be cut offcut off • Crowns of anterior teeth shouldn’t appearCrowns of anterior teeth shouldn’t appear fractured or obscuredfractured or obscured
  • 9. Zone 1: DentitionZone 1: Dentition The teeth should be separated and arranged with an upward curve posteriorly, producing a smile-like arrangement.
  • 10. Zone 2: Nose-SinusZone 2: Nose-Sinus • Images of inferior turbinates containedImages of inferior turbinates contained within the nasal cavitywithin the nasal cavity • No image of the soft tissue nose cartilageNo image of the soft tissue nose cartilage • The hard palate shadow (double image) andThe hard palate shadow (double image) and sometimes the ghost images of the palatesometimes the ghost images of the palate must be seen within the maxillary sinusesmust be seen within the maxillary sinuses (above apices of posterior teeth)(above apices of posterior teeth) • Tongue in contact with hard palate-noTongue in contact with hard palate-no intervening airintervening air
  • 11. Zone 2: Nose-SinusZone 2: Nose-Sinus The inferior turbinates within the nasal fossa & the hard palate shadows above the root apices
  • 12. Zone 3: MandibularZone 3: Mandibular BodyBody • Inferior cortex of mandible should beInferior cortex of mandible should be smooth & continuoussmooth & continuous • No ghost image of hyoidNo ghost image of hyoid • Midline area should not be overlyMidline area should not be overly enlarged superiorly-inferiorlyenlarged superiorly-inferiorly
  • 13. Zone 3: MandibularZone 3: Mandibular BodyBody The inferior cortex of the mandibular body should be smooth & uninterrupted.
  • 14. Zone 4 & 6: FourZone 4 & 6: Four Corners; Condyles &Corners; Condyles & HyoidHyoid • Condyles somewhat centered in zone 4Condyles somewhat centered in zone 4 & of equal size & on same horizontal& of equal size & on same horizontal planeplane • Body of hyoid bone in zone 6 shouldBody of hyoid bone in zone 6 should appear as a double image equal in sizeappear as a double image equal in size bilaterally & should not spread acrossbilaterally & should not spread across the mandible.the mandible.
  • 15. Zone 4 & 6: Four Corners;Zone 4 & 6: Four Corners; Condyles & HyoidCondyles & Hyoid Zone 4: The condyles are centered & equal in size & position bilaterally. Zone 6:The hyoid bone should remain in this zone
  • 16. Zone 5: Ramus-SpineZone 5: Ramus-Spine • Ramus should be same widthRamus should be same width bilaterallybilaterally • Spine can be present as long as itSpine can be present as long as it does not superimpose on the ramus;does not superimpose on the ramus; distance between the spine anddistance between the spine and ramus should be the sameramus should be the same bilaterallybilaterally.
  • 17. Zone 5: Ramus-SpineZone 5: Ramus-Spine The ramus should be equal in width bilaterally & the spine should not be superimposed on the ramus.