Principle of the method and its capabilities
Orthopantomography is one of the most promising overview imaging methods for the maxillofacial region. Its main advantage is the ability to visualize the condition of both jaws, teeth, periodontium, and adjacent structures (e.g., maxillary sinuses) in a single image.
The following structures are well visualized on a panoramic tomogram:
- All parts of the mandible;
- Alveolar recess;
- Relationship of tooth roots to the floor of the maxillary sinus;
- Elements of the pterygopalatine fossa, including the posterior wall of the maxillary sinus and the pterygoid processes of the sphenoid bone.
Advantages and disadvantages
Pros of panoramic radiography:
- Excellent overview of the entire dentition and jaw system.
- Minimal radiation dose to the patient.
- High diagnostic value for initial assessment.
Cons and limitations (distortions): Like any 2D method for evaluating 3D objects, a panoramic image can yield inaccurate measurements due to geometric distortion and projection magnification (up to 30%).
- Distortions in root structure, bone architecture, and the positioning of anatomical structures are possible.
- Central teeth and the surrounding bone tissue are the least well visualized.
- Interesting fact: lateral panoramic radiographs show fewer distortions.
Indications
Due to its wide coverage, orthopantomography is prescribed for a wide variety of clinical situations. The main indications include:
- Inflammatory diseases of the jaws and teeth.
- Traumatic injuries to bone structures.
- Cysts and various neoplasms.
- Systemic bone lesions of the jaws.
- Periodontal diseases and planning for orthodontic or surgical treatment.
Role among other diagnostic methods
In modern dentistry, panoramic radiography is frequently used as a baseline examination. However, due to its inherent limitations involving 2D distortion, it is replaced or supplemented by cone-beam computed tomography (CBCT) for more complex tasks (such as precise measurements for implant placement or surgical navigation). CBCT eliminates the problem of structure superimposition and provides an accurate 3D image.
Additionally, to clarify pathologies of the jaws, nasal cavity, and orbits, the panoramic image can be supplemented with classical tomography or zonography.
Class and exam questions
What is the main advantage of orthopantomography?
It allows obtaining an overview image of the entire dentition and jaw system in a single short scan with a minimal radiation dose.
Which structures are least visible on a panoramic radiograph?
Due to projection specifics, the central teeth and the surrounding bone tissue are the least well visualized.
Can precise measurements be made using a panoramic radiograph?
No, the method provides approximately 30% projection magnification and is subject to geometric distortion, so for precise measurements (e.g., prior to dental implantation), it is better to use CBCT.
What else to study on this topic
- Dental cone-beam computed tomography (CBCT)
- Intraoral radiography methods (occlusal, interproximal, long-cone technique)
- Contrast imaging methods (sialography, temporomandibular joint arthrography)
- Low-dose 3D head CT for maxillofacial evaluation
- Digital radiography (visiodentistry) in dentistry
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