Introduction

A panoramic image displays the patient’s maxillary and mandibular oral and facial structures across a flat surface.¹ According to Iannucci & Howerton, "panoramic imaging is an extraoral technique that is used to examine the maxilla and mandible on a single projection." Panoramic imaging was first introduced in the 1930s, but became more popular as a diagnostic tool in the 1960s.^2,3 During the 1980s, panoramic imaging transitioned to a digital format, which had the advantage of less radiation as well as immediate viewing of the image for patient education.³ Panoramic imaging enables the dentist to diagnose the entire dentition and facial structures that are not visible in a full-mouth series.⁴ The technique is considered part of the standard of care and is popular due to the relative ease of use, wide scope of examination, and low radiation dose.⁵ The guidelines presented by the American Dental Association (ADA) indicate that a panoramic image and posterior bitewings are considered an acceptable full mouth series in certain cases.⁶

Dental professionals must understand the difference between normal anatomical landmarks and abnormal findings, such as artifacts or pathology, which may be present on a panoramic image when viewing both the mandible and maxilla in the one projection. It is recommended to review the image systematically in order not to overlook anything that might be a deviation from normal.⁴ The clinician may utilize the technique they are comfortable using; however, it must be consistent and ensure that all diagnostic information is read.² For instance, Perschbacher, recommends the following sequence: 1) review osseous structures and surrounding soft tissues, 2) review the alveolar process, and 3) review the teeth.⁴

It is important to evaluate the image bilaterally to look for symmetry, or asymmetry, which can indicate a pathological condition. For that reason, the methods suggested by Langland, Langlais, and Preece, which divides the image into 6 different zones (Figure 1), is a valuable tool for use during interpretation.³

Figure 1. Zones of Interpretation.³

Figure 1. Zones of Interpretation.³

Image source: MH & Dr. Iwata.