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15. Appendices
Green Smart User Manual 179
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<How to product error-free radiographic images for the pediatric patient>
(http://www.dimensionsofdentalhygiene.com/print.aspx?id=3612)
- By Evelyn M. Thomson, BSDH, MS
Panoramic radiographs are often recommended for assessing growth and development of
the pediatric patient and for evaluation of developing third molars during adolescence. 1-3
While the panoramic technique seems relatively straightforward, producing a diagnostic
quality image of the pediatric patient requires a mastery of technical skill.
4
Modern
panoramic x-ray equipment is designed for ease of use, yet studies continue to
demonstrate a high incidence of errors.
5-7 Positioning errors may occur at an even higher
rate in pediatric panoramic radiographs. 7 The goal of the dental hygienist is to maximize
the use of panoramic imagery in the assessment of the pediatric patient while minimizing
the occurrence of retakes that result from the radiographic error.
Producing A Quality Panoramic Image
A quality panoramic radiograph should image all of the teeth, erupted and unerupted, in
both the maxillary and mandibular arches from condyle to condyle in the horizontal
dimension, and from the superior third of the orbit in the superior region to the inferior
border of the mandible in the inferior region.
8,9 The arches should appear straight or
slightly U-shaped with the occlusal plane parallel to the horizontal edges of the film
(Figure 1) . The anterior teeth must not be magnified or diminished in size, and the
overlapping of adjacent posterior teeth should be kept to a minimum.
The most important component in producing a diagnostically acceptable panoramic image
is the patient positioning. All panoramic x-ray machines have guidelines to assist with
positioning the dental arches within the three dimensions of the focal trough, an area
where the anatomical structures will be imaged in relative clarity. Most panoramic x-ray