Common errors in panoramic radiography of edentulous patients

PURPOSE: Instructions for patient positioning during panoramic radiography usually describe positioning dentate patients, and errors in patient positioning are commonly identified by distortion of the dentition. The purposes of this study were to identify common errors in panoramic radiography of edentulous patients, describe the image distortions that can be expected with positioning errors in edentulous patients, and review quality assurance methods that improve the diagnostic value of panoramic films. MATERIALS AND METHODS: Panoramic films were randomly selected from the inactive files of 75 edentulous patients seen at the dental school for complete denture construction. The radiographs were numbered and reviewed by a board-certified oral and maxillofacial radiologist trained to identify errors in panoramic radiography. RESULTS: Of the 75 panoramic radiographs examined, only 6 films (8.0%) were free of errors, and 67 films (89.3%) had one or more errors in patient positioning and 33 films (44.0%) had one or more technical errors. The most common positioning errors were positioning the chin too high (32 films, 41.3%) and positioning the patient too far forward (26 films, 34.7%). CONCLUSIONS: Without modification, manufacturer's instructions for positioning dentate patients during panoramic radiography may result in positioning errors on the panoramic radiographs of edentulous patients. Proper training and appropriate attention to detail while exposing and developing panoramic films are required to ensure maximum diagnostic benefits for edentulous patients.