Dental Panoramic imaging for dental students Part 2

1. 5/30/2021
Panoramic radiography
PAN, Pantomograph
OPG, Orthopantogram
Part 2
1
Osama El-Shall
Professor, Oral Radiology dept, Faculty of
Dental medicine, Al-Azhar University, Egypt
oelshall@hotmail.com

2. Panoramic Technique Errors

4. Positioning of teeth anterior to the focal
trough:
If the patient’s anterior teeth are not positioned in
the focal trough indicated by the groove in the bite-
block, the teeth appear blurred. If the patients
teeth are positioned too far forward on the bite
block or anterior to the focal trough the anterior
teeth appear skinny and out of focus on the
radiograph.
Solution:
the patient’s anterior teeth must be placed in
an end-to end position in the groove on the
bite-block.

5. teeth anterior to the focal trough

6. teeth anterior to the focal trough

7. Anterior teeth wider and blurred
Teeth too posterior

8. Positioning of teeth posterior to the focal
trough:
if the patient’s anterior teeth are not positioned in
the focal trough indicated by the groove in the
bite-block, the teeth appear blurred. If the
patients teeth are positioned too far back on the
bite-block or posterior to the focal trough the
anterior teeth appear fat and out of focus on the
radiograph.
Solution:
the patient’s anterior teeth must be placed in an
end-to end positioning the groove on the bite-block.

9. teeth posterior to the focal trough

10. Structures smaller on the side to which head is
turned; larger on opposite side.

11. Positioning of the midsagital plane:
If the patient’s midsagital plane is not perpendicular
to the floor, the ramus and posterior teeth appear
unequally magnified on the panoramic radiograph.
The side farthest from the film appears
magnified, and the side closest to the film appears
smaller .
Solution:
the patient’s midsagital plane is perpendicular to the floor.
The lateral head supports must then be adjusted to stabilize
the patient’s head position .

17. Mandibular incisors shortened, V-shaped mandible
HEAD TIPPED DOWN

18. Positioning of the Frankfort plane-downward:
If the patient’s chin is positioned too low or is tipped
down the Frankfort plane is angled downward, this
results:
– The mandibular incisors appear blurred .
– There is a loss of detail in the anterior apical
regions.
– The condyles may not be visible.
– An exaggerated smile line (curved up-ward) will
appear.
– Solution:
– the patient’s Frankfort plane must be parallel with
the floor.

19. Positioning of the Frankfort plane-downward

20. Positioning of the Frankfort plane-downward

21. HEAD TIPPED UP
Squared-off mandible, palate superimposed over maxillary teeth

22. Positioning of the Frankfort plane-upward:
If the patient’s chin is positioned too high or is tipped up the
Frankfort plane is angled upward, and the following
results:
The hard palate and floor of the nasal cavity appear
superimposed over the roots of the maxillary teeth.
There is a loss of detail in the maxillary incisor region.
The maxillary incisors appear blurred and magnified.
A reverse simile line (curved downward) is apparent on the
radiograph .
Solution:
The patient’s Frankfort plane must be parallel with the
floor.

23. Positioning of the Frankfort plane-upward

24. Positioning of the Frankfort plane-upward

25. ⚫a
⚫a - g
⚫b
⚫b - g
Ghost images of earrings

26. Ghost images of earrings

27. 5/30/2021 27

28. 5/30/2021 28

29. Ghost image of metal used to restore left angle of mandible

30. Lead apron shadow

31. Lead apron shadow

32. Lead apron shadow

33. Ghost image of thyroid collar

34. Shadow of vertebral column, usually from patient not standing
straight

36. Palatoglossal air space (black area above)
caused by failure to keep tongue against palate
during exposure. Makes it difficult to diagnose
periapical pathology in maxillary area.

37. Palatoglossal Air Space

38. Static electricity; caused by removing film from box or
cassette too quickly, creating static discharge

39. Partial dentures

40. Glasses

41. Patient movement

42. Double exposure

43. Ossama El-Shall
നന്ദി धन्यवाद
hvala ti
Salamat