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Assessing Diagnostic Quality of Panoramic Radiographs in Dental Hygiene

This guide from the Clinical Radiology Department at William Rainey Harper College outlines the essential criteria for evaluating the diagnostic quality of panoramic radiographs. It emphasizes not only the proper positioning of teeth but also the importance of other anatomical features. The assessment is divided into six specific zones, each with distinct criteria, including visibility of the maxilla and mandible, symmetrical structure display, appropriate curvature of the occlusal plane, and minimizing technical errors. Understanding these parameters is crucial for accurate diagnostics in dental hygiene.

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Assessing Diagnostic Quality of Panoramic Radiographs in Dental Hygiene

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  1. Diagnostic Panoramic Images DHY 202 Clinical Radiology I Dental Hygiene Department William Rainey Harper College

  2. Introduction • Dental radiographers often taught to identify panoramic technique errors by viewing the teeth. • Important to look at other anatomical features besides the teeth when assessing diagnostic quality of a panoramic radiograph.

  3. Criteria for Diagnostic Quality of Panoramic Radiographs • Entire maxilla & mandible recorded • Symmetrical display of structures right to left • Slight smile/downward curvature of occl plane • Minimal over or under magnification of teeth

  4. Criteria for Diagnostic Quality of Panoramic Radiographs • Tongue positioned against palate to avoid palatoglossal air space • Minimal or no cervical spine shadow • Acceptable film density & contrast • Free of technical, film handling & processing errors

  5. Assessing The Diagnostic Quality of Panoramic Radiographs • Divide the panoramic radiograph into six zones: three are in the midline and three are bilateral Six zones

  6. Assessing The Diagnostic Quality of Panoramic Radiographs • Zone 1: Dentition • Zone 2: Nose-Sinus • Zone 3: Mandibular Body • Zone 4 & 6: Four corners, Condyles & Hyoid • Zone 5: Ramus-Spine

  7. Zone 1: Dentition The teeth should be separated and arranged with an upward curve posteriorly, producing a smile-like arrangement.

  8. Zone 1: Dentition • Smile-like upward curvature • Interocclusal space between arches • Anterior teeth neither too large or so narrow as to create “pseudospaces” between them • Posterior teeth should not be larger or smaller on one side than the other • No excessive overlap of the premolars on one side versus the other

  9. Zone 1: Dentition (cont) • Apices of max or mand teeth shouldn’t be cut off • Crowns of anterior teeth shouldn’t appear fractured or obscured

  10. Zone 2: Nose-Sinus The inferior turbinates within the nasal fossa & the hard palate shadows above the root apices

  11. Zone 2: Nose-Sinus • Images of inferior turbinates contained within the nasal cavity • No image of the soft tissue nose cartilage • The hard palate shadow (double image) and sometimes the ghost images of the palate must be seen within the maxillary sinuses (above apices of posterior teeth) • Tongue in contact with hard palate-no intervening air

  12. Zone 3: Mandibular Body The inferior cortex of the mandibular body should be smooth & uninterrupted.

  13. Zone 3: Mandibular Body • Inferior cortex of mandible should be smooth & continuous • No double or ghost image of hyoid • Midline area should not be overly enlarged superiorly-inferiorly

  14. Zone 4 & 6: Four Corners; Condyles & Hyoid • Condyles somewhat centered in zone 4 & of equal size & on same horizontal plane • Body of hyoid bone in zone 6 should appear as a double image equal in size bilaterally & should not spread across the mandible.

  15. Zone 4 & 6: Four Corners; Condyles & Hyoid Zone 4: The condyles are centered & equal in size 7 position bilaterally. Zone 6:The hyoid bone should remain in this zone

  16. Zone 5: Ramus-Spine The ramus should be equal in width bilaterally & the spine should not be superimposed on the ramus.

  17. Zone 5: Ramus-Spine • Ramus should be same width bilaterally • Spine can be present as long as it does not superimpose on the ramus; distance between the spine and ramus should be the same bilaterally.

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