PANORAMIC PATIENT POSITIONING ERRORS

Panoramic Patient Positioning Errors

Error and Cause Identifying Features Correction
Patient too far forward Narrow blurred anterior teeth with pseudospace Use incisal bite guide
Superimposition of spine on ramus Line up incisal edge of teeth with
Bicuspid overlap bilaterally notch
Edentulous patients should bite about
5 mm behind notch
Patient too far back Wide, blurred anterior teeth Use incisal bite guide
Ghosting of rami; spread-out turbinates, ears, and Line up incisal edge of teeth with
nose in image; condyles off lateral edges of film notch
Chin tipped too low Excessive curving of the occlusal plane Tip chin down, but ala-tragus line
Loss of image of the roots of the lower anterior should not exceed !5 to !7 degrees
teeth downward

Narrowing of the intercondylar distance and loss of Use chin rest

head of the condyles at the top of the film
Chin raised too high Flattening or reverse curvature of occlusal plane Tip chin down !5 to !7 degrees
Loss of image of the roots of the upper anterior Use chin rest
teeth
Lengthening of intercondylar distance and loss of
head of the condyles at the edges of the film
Hard palate shadow wider and superimposed on the
apices of the maxillary teeth
Head twisted Unequal right-left magnification, particularly teeth Line up patients midline with middle
and ramus of incisal bite guide
Severe overlap of contact points and blurring Close side guide
Head tilted Mandible appears tilted on film Position the chin firmly on both sides
Unequal distance between mandible and chin rest at of the chin rest
a given point on the right and left sides Close side guide
One condyle is higher and larger than the other

Slumped position Ghost image of cervical spine superimposed on the
anterior region
Chin not on the chin rest Sinus not visible on the film
Tops of condyles are cut off
Excessive distance between inferior border of the
mandible and the lower edge of the film
Bite guide not used Incisal and occlusal surfaces of the upper and lower
teeth overlapped
Tongue not on palate Relative radiolucency obscuring apices of the
maxillary teeth (palatoglossal air space)
Lips open Relative radiolucency on the coronal portion of the
upper and lower teeth
Stand-up machines: have the patient
step forward or place feet on markers
All machines: be certain the patient is
sitting or standing erect
Position the chin on the chin rest
Use bite guide
Compensate for missing anterior teeth
with cotton rolls
Place the tongue firmly against the
palate
Ask the patient to swallow, or to suck
on his or her tongue
Close lips
 PANORAMIC PATIENT POSITIONING ERRORS

Error and Cause Identifying Features Correction

Patient movement Wavy outline of the cortex of the interior border of
the mandible
Blurring of the image above wavy cortical outline
Prostheses Evidence of prostheses in the image
Acrylic denture teeth and bases do not show
Ask the patient to hold still and not
swallow
Explain the function of the machine to
avoid startling the patient
Be certain the patients clothing will
not interfere
Remove all complete and partial
dentures, eyeglasses, and jewelry

Adapted from Langland OE, Langlais RP, Preece JW. Principles of Dental Imaging, 2nd ed. Baltimore: Lippincott
Williams & Wilkins, 2002.