Diagnostic Panoramic Images
DHY 202 Clinical Radiology I
Dental Hygiene Department
William Rainey Harper College
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.
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
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
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
Assessing The Diagnostic Quality of Panoramic
Radiographs
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•
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Zone 1:
Zone 2:
Zone 3:
Zone 4 & 6:
Zone 5:
Dentition
Nose-Sinus
Mandibular Body
Four corners, Condyles & Hyoid
Ramus-Spine
Zone 1: Dentition
The teeth should be separated and arranged with an
upward curve posteriorly, producing a smile-like
arrangement.
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
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
Zone 2: Nose-Sinus
The inferior turbinates within the nasal fossa & the hard
palate shadows above the root apices
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
Zone 3: Mandibular Body
The inferior cortex of the mandibular body should be
smooth & uninterrupted.
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
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.
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
Zone 5: Ramus-Spine
The ramus should be equal in width bilaterally & the
spine should not be superimposed on the ramus.
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.