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LEARNING OUTCOMES
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INTRODUCTION
• Extra oral radiography means that the source as well as film are placed
outside the mouth & an exposure is made in order to obtain the images on
an recording medium.
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• Paatero called this technique Pantomography, a contraction of the words
Panoramic radiography.
Panoramic meaning
Tomography meaning,
“a X ray technique for taking radiographs of layers of tissue in depth without the
interference of tissue above & below that level”
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PARTS OF A PANORAMIC MACHINE
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PRINCIPLES OF PANORAMIC IMAGE FORMATION
• Disk 1 is held stationary and the x-ray source is rotated so that the central ray
constantly passes through the center of rotation of disk 1 and,
simultaneously, both disk 2 and the lead collimator (Pb) rotate around the
center of disk 1.
Pb 6
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• Although disk 2 moves, the receptor on this disk also rotates past the slit.
• So the objects A through D move through the x-ray beam in the same
direction and at the same rate as the receptor.
• To obtain optimal image definition, it is crucial that the speed of the receptor
passing the collimator slit (Pb) be maintained equal to the speed at which
the x-ray beam sweeps through the objects of interest.
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• A patient in the place of disk 1, and objects A through D represent teeth and
surrounding bone.
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Structures near the x-ray
tube are distorted and
structure
closer X-ray or appear out of focus because
further
receptor blurer
the x-ray beam sweeps
through them in the direction
opposite that in which the
image receptor is moving
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sweep 2 times thats why object appear 2 times
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Only structures near
the receptor are
carefully captured on
the resultant image.
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FOCAL TROUGH (ZONE OF SHARPNESS)
• The focal trough is a three dimensional curved zone or image layer in
which the structures are reasonably well defined on panoramic
radiograph.
• Machines are designed to have zone, shaped like dental arch (HORSE
SHOE SHAPE)
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within : clear
out of : blurr FOCAL TROUGH
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FOCAL TROUGH
• When the object is positioned anterior to the FT (toward the film), the beam
passes at a rate faster than normal through the anterior structures, resulting in
decreased width of the structures on the film.
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ANTERIOR TO FOCAL TROUGH
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This film shows the blurring and narrowing
of the anterior teeth.
R L
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POSTERIOR TO FOCAL TROUGH
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This film shows the blurring and widening of the
anterior teeth.
R L
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INDICATIONS
Most useful clinically for diagnostic problems requiring broad coverage of
Prostho: the teeth.
Oral Pathology(cyst & tumors)
Orthodontics: alignment of teeth and jaw bones
Endodontics: multiple carious lesions
estimate age
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Impacted teeth
sequence of impaction
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Diseases & developmental anomalies
antero posterior dimension
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Eruption patterns
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Trauma
CBCT
(3D)
any fracture???
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when wana place more than one implant
Implants
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INDICATIONS
• Lesions such as cysts, tumors and developmental anomalies in the body and
rami of the mandible to established site and size.
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INDICATIONS
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CONTRAINDICATIONS
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MERITS OF PANORAMIC RADIOGRAPHY
16 periapical radiograph = 1 panaromic radiograph
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6. Patient’s ready understandability of panoramic film making it a useful
7. Both condylar heads are shown on one film allowing easy comparison.
8. The radiation dose (effective dose) is about 1/3rd of the dose from a full
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meant for hard tissue
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TECHNIQUE & PATIENT POSITIONING
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• The anteroposterior position radiograph of the patient is typically
achieved by having patients place the incisal edges of their maxillary and
mandibular incisors into a notched positioning device (the bite block).
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• The midsagittal plane must be centered within the image layer of the
particular X-ray unit.
• The patient's chin and occlusal plane must be properly positioned to avoid
distortion.
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• A general guide for chin positioning is to place the patient so that a line
from the tragus of the ear to the outer canthus of the eye is parallel with
the floor.
too up : reverse smile line
too low:e exaggerated smile line
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• Patients are positioned with their backs and spines as erect as possible and
their necks extended. This will help to straighten the spine, minimizing the
artifact produced by a shadow of the spine.
• Finally, after patients are positioned in the machine, they are instructed to
swallow and hold the tongue on the roof of the mouth.
• This raises the dorsum of the tongue to the hard palate eliminating the air
space and providing optimal visualization of the apices of the maxillary teeth.
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ANATOMICAL LANDMARKS
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SPINAL, NECK,
AND SOFT
TISSUE
ANATOMIC
STRUCTURES
1, Variant of normal 5, Hard palate (the lower line is the 9, Posterior pharyngeal wall.
Anatomy of the vertebral junction of the hard palate and the lateral
body wall of the nasal cavity on the tube
side, and the upper line is the junction of
the hard palate and lateral wall of the nasal
cavity on the receptor side).
2. Cervical vertebra. 6, Orbital rim. 10, Hyoid bone.
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