On

ORTHOPANTOMOGRAM
&
ITS INTERPRETATION
 CONTENTS:

1. INTRODUCTION
2. PRINCIPLES
3. NORMAL ANATOMICAL LANDMARKS
• THE MANDIBLE
• MAXILLARY/MID-FACIAL REGION
• SPINAL, NECK & SOFT TISSUE
• DENTITION
4. PATHOLOGICAL LANDMARKS
• RADIOLUCENCIES
• RADIO-OPACITIES
5. CONCLUSION
6. REFERENCES
INTRODUCTION
• Orthopantomography is a technique for producing a
single tomographic image of facial structures that
includes both the maxillary & mandibular dental
arches and their supporting structures.

• This is a curvilinear variant of conventional

tomography & it is also based on the principle of the
reciprocal movement of an x-ray source and an image
receptor around a central point or plane, called the
‘image layer’, in which the object of interest is
located.

• Object in front of or behind this image layer are not

clearly captured because of their movement relative
to the center of rotation of the receptor and x-ray
source.

• Panoramic image are most useful clinically for

diagnostic problems requiring broad coverage of the
jaw.
• Common examples include:
- Evaluation of trauma
- Location of third molar
- Extensive disease
- Known or suspected large lesions
- Tooth development (especially in mixed
dentition)
- Retained teeth or root tips (in edentulous
patient)
- Developmental anomalies

• These tasks do not require the high resolution &

sharp detail available on intraoral images.

• Panoramic imaging is often used as initial evaluation

image that can provide the required insight or assist
in determining the need for other projection.

• However, when a bull-mouth sevies of radiographs is

available for a patient receiving general dental care,
typically little or no additional useful information is
gained from a stimultaneous panoramic examination.
PRINCIPLES
• The first to describe the principles of panoramic
radiography were paatero and working independently,
Numata.
-The illustration in this section explains the
operation of a panoramic machine.

-Two adjacent disks rotate at the same speed in

opposite directions as an x-ray beam passes through
their centers of rotation.

-Radiopaque objects A, B, C stand upright on disk &

rotate past the slit, their images are recorded on the
receptor, which also moves past the slit at the same
time.

-Any object between the X-ray source and the

center of rotation of disk1 move in opposite direction
of the receptor, and their shadow are also blurred on
the receptor.
• In this situation, as before, the objects A, B, C & D
move through the X-ray beam in the same direction
& 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 be maintained equal to the speed at which the X-
ray beam sweeps through the objects of interest.

• In this situation, patient in the place of disk1, and

objects A through D represent teeth & surrounding
bone.

-The rate of movement of the receptor behind the

slit is regulated to be the same as that of the
central ray sweeping through the dental structures
on the side of the patient nearest the receptor
.
-Structures on the opposite side of the patient are
distorted and appear out of focus because the X-ray
beam sweeps through them in the direction opposite
that in which the image receptor is moving.
• Most panoramic machines now use a continuously
moving center of rotation rather than multiple fix
location.

-This feature optimizes the shape of the image layer

to reveal the teeth and supporting bone.

-This is accomplished through varying the shape of

moving center of rotation & allows better
representation of children, usually configured
patients, and specific anatomic sites of interest.
NORMAL ANATOMICAL LANDMARKS

THE MANDIBLE:

1. Mandibular condyle
2. Neck of mandibular condyle
3. Coronoid process of mandible
4. Ghost image-posterior aspect of inferior
border of left side of mandible
5. Inferior mandibular canal
6. Inferior border of mandible
7. Superimposed shadow of cervical vertebrae
8. Mental foramen
9. Submandibular fossa
10. Mandibular angle
11. External oblique ridge
12. Sigmoid notch
MAXILLARY/MID-FACIAL REGION:

1. Articular tubercle of the temporal bone

(articular eminence of TMJ)
2. Zygomatic arch
3. Zygomatic process of maxilla
4. Pterygomaxillry fissure
5. Orbital rim
6. Inferior nasal concha
7. Nasal septum
8. Anterior nasal spine
9. Floor of the maxillary sinus
10. Developing third molar
11. Ear lobe
12. Cervical vertebrae

SPINAL, NECK AND SOFT TISSUE:

 1. Schwall’s node (variant of normal anatomy of
vertebral body)
2. Cervical vertebra
3. Ear lobe
4. Soft palate & uvula
5. Hara palate
Lower line: palatal surface
Upper line: floor of the nasal cavity

6. Orbital rim
7. floor of nasopharynx (upper surface of soft
palate)
8. Posterior surface of tongue
9. Posterior pharyngeal wall
10. Hyoid bone

DENTITION:
o The panoramic image can be useful in
identifying the presence or absence, as well as
developmental status, of the permanent
dentition.
o In this patient (OPG),
The mandibular second premolar are
congenitally absent, and the mandibular
deciduous second molar are not undergoing root
resoption, indicating that they will be retained.

PATHOLOGICAL LANDMARKS
 In general, pathological changes in bone are
manifested radio graphically as any of the following
alterations:

1. Increased radiolucency
2. Increased radio-opacity
3. Combination of both
4. Alteration in the bone pattern of trabeculae &
haversian system

 Whenever radiolucent or radio-opaque lesions are seen,

(1) Site, (2) shape, (3) size, (4) margin, and (5) presence
of any internal structures are to be noted.

RADIOLUCENCIES:
 Radiolucencies

Unilocular

Well defined Ill defined

margin margin

* odontogenic cyst * giant cell lesion

* adenoameloblastoma * multiple myeloma
* static bone cyst * fissural cysts

Multilocular

Well defined Ill defined

margin margin

* ameloblastoma * osteomyelitis
* keratocyst * sarcoma
* fibrous dysplasia
* myxoma
* cherubism
* calcified odonto-
genic tumour

RADIO-OPACITIES:
 Radio-opacities

Well defined Mixed

* retained tooth root * unilocular with central radioopacity
* osteosclerosis * multilocular with central radioopacity
* ossifying fibroma * diffuse ground glass pattern
-fibrous displasia
-osteopetrosis

Cortical aberrations Antral opacities

* cortical redundancy - maxillary sinusitis
- Garre’s osteomyelitis - displaced tooth
- Ewing’s sarcoma - odontome
* osteophytic reaction - antral neoplasm
* cortical expansion - fibrous dysplasia
- aggressive odontogenic tumour - osteomas
- fibrous dysplasia
- odontogenic cysts
- paget’s disease
COMBINED RADIOLUCENCIES & RADIO-OPACITIES:

• Such an appearance is one of the most difficult lesions

for differential diagnosis.
• Shape is irregular with diffuse margins.
• This appearance may suggest any of the following
conditions:
- Osteomyelitis
- Malignancy
- Osteoradionecrosis
- Fibro osseous lesions.

CONCLUSION:

ADVANTAGES:
• Broad coverage of the facial bones & teeth.
• Low patient radiation dose.
• Convenience of the examination for the
patient.
• Ability to be use in patients unable to open
their mouth.
• Short time required to make a panoramic
image (3 to 4 min.)
 • Patient’s ready understandability of
panoramic films, making them a useful visual
aid in patient education and case
presentation.

DISADVANTAGES:
• The main disadvantage of OPG is that the image
do not display the fine anatomic detail available on IOPA
radiographs.
• Overlapping: the lower anterior region cannot
be properly visualized due to the overlapping and the ‘ghost
image’ of the spinal column.
• The cost is considerably greater than the
conventional radiographic equipment.
• It requires more space.
 REFERENCES:
• TEXBOOK OF ORAL RADIOLOGY-PRINCIPLES &
INTERPRETATION by WHITE & PHAROAH

• TEXBOOK OF ORAL & MAXILLOFACIAL

SURGERY by B.SRINIVASAN.