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Caries: Panoramic radiographs demonstrate the highest positive predictive value (PPV) for the detection of caries in posterior teeth as compared to a full mouth survey including bitewing radiographs. Periodontal: PPVs for periodontal disease detection were almost exactly equal between low-dose single panoramic and higher dose full mouth survey. Bone loss: Panoramic radiographs more often indicate more severe bone loss than the periapical radiographs. Measurements of marginal bone loss made from panoramic radiographs are the most accurate when compared to truth. Periapical: Panoramic radiographs were shown to be as effective as periapical radiographs for the detection of lytic and sclerotic periapical disease.  Edentulous Patients Disease: Keur (1986) recommended that a panoramic radiograph be taken on all new edentulous patients. His study of 1,135 asymptomatic patients showed 34 percent had lesions that required surgical treatment. A further 29 percent had abnormalities that did not require surgical intervention. The panoramic radiograph demonstrates structures such as  the ramus, TMJ, styloid process, styloid ligament, upper parts of the maxillary antrum and lower orbit which are outside the anatomical limits of a full mouth survey. Some indications in panoramic radiographs should include: Hypodontia (congenitally missing), embedded and impacted, apical condensing osteitis, apical abscess and/or cysts, fibrous healing defects, apical resorption, recurrent (secondary) caries, cemental caries, drift and migration, attrition, regional odontodysplasia (ghost), dentinal dysplasia (type 1 A, B & C), congenital syphilis (enamel hypoplasia), taurodontism, mesiodens (supernumerary, supplemental and accessory), external resorption, localized and generalized prepubertal periodontitis, perio destructive process and many other types of cysts, tumors and lessions. Disease Trends: Panoramic carries about one tenth the risk of a full mouth in terms of fatal malignant disease per million persons exposed. Risk estimates of 13 to 18 fold exists between panoramic and full mouth survey using long, round cone and E-speed film.  The dentist will become more adept at diagnosting problems in adjacent anatomic regions such as the TMJ, salivary glands, styloid process, and maxillary sinus. Ohba and colleagues (1990) noted that panoramic radiography was the method of choice for the detection of problems associated with the floor and posterior wall of the antrum. In our aging population, the reasons for taking radiographs will shift away from the detection of previously common diseases such as caries and periodontal and periapical disease to include disorders that are more occult, and more life-threatening diagnoses such as malignant diseases within the jaws will be made. Additionally, the importance of recognizing the radiologic manifestation of systemic and metabolic diseases affecting the aging or aged such as osteoporosis will have more significance to a greater number of practitioners throughout the world.

All above statements are based on material found in Diagnostic Imaging of the Jaws by William and Wilkins, copyright 1995. Edited by Langlais, Langland, and Nortj=e. ISBN:0-683-04809-0

There are several factors that influence radiogrpahic image quality, which may be shifting your opinion of the above statements. Panoramic is much more sensitive to processing and dark room enviroments. Patient positioning, machine calibration both mechanically and electronically, film/screen combination and age, and view box lighting, all effect diagnostic value. If your panoramic results do not agree with the above statements, a service tech should be contacted to evaluate the problem. Older obsolete models may have non-repairable issues.

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DISCLOSURE

Always consult with your physician before using these products. The Buyamag Inc. does not make any diagnosis or give medical recommendations. These products are not intended to cure, heal, or prevent diseases.
Consulting with a Doctor is always recommended. The medical evaluation by your physician is advised at all times. Any self-help application is the responsibility of the user. Buyamag Inc. does not make or imply any medical claims on products described.

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