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Panoramic Radiograph A Valuable Diagnostic Tool in Dental Practice-Report of Three Cases
Panoramic Radiograph A Valuable Diagnostic Tool in Dental Practice-Report of Three Cases
CASE REPORT
Panoramic radiograph was advised which can obscure the image particularly in the incisor
revealed a very extensive multilocular radiolucent region.(6) Rushton et al suggested the following
lesion extending from second premolar till condyle. clinical factors as being the best predictors of a
Root resorption was noted on 35, 36 and 37. The diagnostic yield of significance to treatment.
38 was found close to the coronoid process. Clinical suspicion of teeth with periapical
Incisional biopsy revealed an ameloblastoma of pathology, presence of partially erupted teeth,
follicular type. clinically evident caries lesions swelling and
Discussion clinically suspected unerupted teeth.(7) Asaumi et
Panoramic images are useful clinically for al observed lesions in 12.8% among 1092 patients
those patients requiring broad coverage of the jaws, in a retrospective study in pediatric population and
such as evaluation of trauma, extensive dental or among this 47.1 % had different lesions from those
osseous disease, known or suspected large lesions, underlying the chief complaint.(1) Panoramic
location of third molars, evaluation of missing radiographs are a valuable tool in early
teeth, teeth development and eruption status, identification of problems in dental development
retained tooth and root tips in edentulous patients, during the mixed dentition stage. This gives
maxillary sinus and temporomandibular joint information regarding dental maturity, leeway
afflictions and developmental anomalies like space, the eruption of permanent teeth, anomalies
prognathism and retrognathism. Panoramic and developmental disturbances.(8)
imaging is often used as the initial evaluation Panoramic radiographs are used in
image that can provide the required insight and assessment of root length and tooth axis prior to
assist in determining need for other projections. orthodontic treatment. It has been observed that the
One of the strengths of the panoramic mean length measured were higher than the actual
image is the demonstration of the complete length by 22% for maxillary teeth and 1% by
dentition and allows diagnosing gross mandibular teeth.(9) There is a chance of
abnormalities in number, position and anatomy of overlooking significant dental abnormalities in the
the teeth. Panoramic radiographs reveal the premaxillary area in a panoramic radiograph even
proximity of impacted teeth with vital structures though the chance is 43%.(10) Panoramic
like inferior alveolar canal, floor and posterior wall radiographs are used in forensic age estimation of
of maxillary sinus, maxillary tuberosity and unaccompanied minors, but this should be
adjacent teeth. Above all patients readily combined with hand and collar bone radiographs
understand the image and are useful visual aid in for better accuracy.(11) Mucosal thickening and
patient education. mucosal antral cysts in the maxillary sinus are very
In all three cases patients have visited frequent incidental finding in panoramic
dental clinics for various dental problems and taken radiographs, dental infections are highly correlated
routine dental treatments like oral prophylaxis, with antral mucosal thickening.(12) Panoramic
restorations, root canal treatments and extractions. radiographs reveal calcified carotid artery
Number of visits ranged from three to more than atheromatous lesions in diabetic patients and help
ten. None of the cases was evaluated with the dentist for appropriate referral for diabetic
panoramic radiographs even in those patients with care.(13) Alteration of mandibular inferior cortical
missing wisdom teeth and over retained deciduous width and shape in panoramic radiographs in post-
teeth. menopausal women is an accepted predictor of
Panoramic radiographs cover a broad area spinal osteoporosis.(14) A reliable diagnostic
of facial bones and teeth with low radiation accuracy in panoramic radiographs is observed in
dose.(4) Relative exposures dose from panoramic preoperative evaluation of the relationship between
radiography has been estimated at 6.7 microSv and third molars and the inferior alveolar canal.(15)
26microSv carrying an associated risk of inducing Careful observation of panoramic radiographs
fatal cancer of 0.21 and 1.9 cases per million could reveal temporomandibular joint pathologies
examinations respectively.(5) like aneurismal bone cyst, traumatic bone cyst, and
The main disadvantage of panoramic synovial chondramatosis and TMJ arthrosis.(16)
radiology is that the images does not display the Conclusion
fine anatomic details and so it cannot replace Panoramic radiographs are indeed a
periapical radiograph or bite wing radiography in valuable tool in early detection of lesions in the
detecting small carious lesions or early periodontal maxillofacial area. Considering the radiation dose
and periapical lesions. Other problems include involved in the panoramic radiograph, and its
unequal magnification and geometric distortion diagnostic yield, routine examination by panoramic
across the image. The presence of cervical spine
radiograph on the initial clinical visit may be useful 10. Mattick CR, Carter NE, Gordon PH . The
in early detection of various pathologic conditions. diagnostic value of routine intra-oral premaxillary
Authors Affiliations: 1. Dr. Mathew Jose, Professor and radiographs in orthodontic assessment. Int J
Head, 2. Dr. Jomy Varghese, Senior Lecturer, Dept. of Paediatr dent1999: 9:161-8
OMFS, Sree Mookambika Institute of Dental Sciences, 11. Schmeling A, Reisinger W, Geserick G, Olze A.
Kulasekharam, Kanyakumari Dist, Kerala, India. Age estimation of unaccompanied minors. Forensic
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panoramic radiography of new adult Patients’ in Address for Correspondence
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yield to treatment and identification of radiographic Professor and Head,
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Oral Radiol Endod 2002;93:488-95 Sree Mookambika Institute of Dental Sciences,
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