Panoramic Radiography

Robert A. Cederberg, MA, DDS

Professor, Dept. of Restorative Dentistry & Biomaterials
University of Texas HSC at Houston Dental Branch
Linear Tomography
Panoramic Radiography
 Radiographic technique for
producing a single image of both
maxillary and mandibular arches and
their supporting structures.
 Drs. Paatero and Numata were the
first to describe the principles of
panoramic radiography.
Historical Development
Panoramic radiographs can be made
using two different methods:
1. Use of an intraoral source of radiation
2. Use of an extraoral source of radiation
a. Film placement is intraoral
b. Film placement is extraoral
Panoramic Radiography
Intraoral Source of Radiation

Status-X, Siemens Co., Erlangen, Germany

Development of Extraoral
Source of Radiation
Dr. Numata was the first
to propose this method
in 1933. He placed a
curved film in the mouth
lingual to the teeth and
used a slit beam of
radiation which rotated
around the patient’s jaw
to expose the film. The
patient was stationary.
Parabolography
Dr. Paatero

Dr. Paatero in 1946

demonstrated a similar
method using a rotating chair.

Parabologram of maxillary teeth

Pantomography
(Linear Tomography)
 Dr. Blackman collaborated with Dr.
Paatero using a pantomographic
technique.
 Watson & Sons, Ltd. in collaboration
with Dr. Blackman developed the first
commercial model of the
pantomograph known as the
Rotograph.
Rotary Radiography

Watson & Sons, Ltd.,

Wembley, England Rotograph
Development of
Orthopantomographic Technique
 Limitations of Rotary panoramic
technique: rotation of patient and
film in circular paths (jaws are not
circular but elliptical), overlapping of
teeth posteriorly and streak artifacts.
 Orthopantomograph uses 3 rotation
centers producing an elliptical path
of rotation. Paatero – first prototype
1958.
Orthopantomograph
Panoramic Radiography
Advantages:
 Broad anatomic coverage
 Relatively low patient radiation dose
 Convenience and speed of the exam
 Easily tolerated by patients - Ex:
patients who are unable to open their
mouths
 Easy to explain treatment plans
Panoramic Radiography
Disadvantages:
 Does not resolve fine detail,
consequently additional images (PA,
BW) required
 Magnification
 Distortion and overlapping of teeth
 Objects located outside the image
layer are distorted, obscured or not
seen
Principles of Rotational
Panoramic Radiography
 Panoramic radiograph is unique in the
foci of projection
 Focus of projection is not the same in
the vertical and the horizontal plane
Horizontal plane - center of rotation
Vertical plane - x-ray source
 Central projection:
Principles of Rotational
Panoramic Radiography
 X-ray source placed intraorally and
curved film is placed extraorally, still
a central projection, although
magnified equally hor. & vert.
Principles of Rotational
Panoramic Radiography
 If you replace the stationary intraoral
x-ray source with an extraoral
rotating slit beam x-ray source,
magnification will be equal in the
rotation or horizontal plane but
different in the x-ray source or
vertical plane.
Principles of Rotational
Panoramic Radiography
Principles of Rotational
Panoramic Radiography
 The combination of a rotating beam
and a moving film changes the
horizontal dimension of the recorded
image, but the projection of the
object remains the same, so that the
proportions are restored in the
resultant image.
Principles of Rotational
Panoramic Radiography
Panoramic Cassettes

Screens
Panorex
Panelipse
Focal Trough
 The three-dimensional curved zone or
Image Layer in which structures are well
defined.

 Focal trough size affected by arc path,

velocity of the film and x-ray tube, beam
alignment, and collimator width.
Influence of Patient
Positioning on Image
Magnification
 As the position of the object is
moved within the focal trough the
size and shape of the resultant image
change.
Influence of Patient
Positioning on Image
Magnification
Correct Position

Forward Position

Backward Position
Correct Patient Positioning
and Head Alignment
 Occlusal plane 20 to 30 degrees
below horizontal
 Tragus to outer canthus is parallel to
the floor
 Back and spine erect and neck
extended
 Groove of bite block is positioned
inter-incisally and midline is centered
 Tongue placed in roof of the mouth
Correct Patient Position and
Head Alignment
Improper Patient
Positioning

Too Far Forward

Improper Patient
Positioning

Positioned Too Far Back

Improper Patient
Positioning

Chin Too Far Up

Improper Patient
Positioning

Chin Tilted Down

Improper Patient
Positioning

Slumped Correct

Patient placed in slumped position

Improper Patient
Positioning

Rotated Position
Ghost Images
 Superimposition of structures from the
contralateral side to the side being
viewed
Ghost Images
Improper Patient Positioning
and Patient Preparation
Improper Patient Positioning
and Patient Preparation
Improper Patient Positioning
and Patient Preparation
Improper Film and/or
Cassette Handling
Improper Film and/or
Cassette Handling
Improper Exposure
Techniques
hard palate tongue shadow
pterygomaxillary fissure infraorbital canal

hyoid bone infraorbital rim

maxillary sinus
Soft Palate & Uvula Floor of Nasopharynx

Inferior Alveolar Canal Cornoid Notch

Articular Tubercle Angle of the Mandible

condyle zygoma
coronoid process
zygomatic arch
nasal septum
lateral wall of nasal fossa
Panoramic Radiographic
Anatomy – Hard Tissues
Panoramic Radiographic
Anatomy – Soft Tissues