Panoramic image of teeth, types, indications, where and how images are taken

The quality of dental treatment depends on the accuracy of the diagnosis. A panoramic photograph of teeth helps to find the cause of dental diseases. However, some patients are concerned about X-rays, fearing harm to their health. In the article we will consider the need for such images, harm to the health of the body and other issues related to this procedure.

What is an orthopantomogram?

A panoramic photograph of the teeth, or abbreviated as OPTG from the word “orthopantomogram”, is a two-dimensional cross-sectional image of the patient’s jaw. In fact, this is an ordinary x-ray, since it is x-ray radiation and an orthopantomograph x-ray machine that is used to take the picture. This is where patients begin to fear for their health, because X-ray radiation is harmful to the body.

What you can see in the image:

both jaws;
all teeth including roots;
condition of bone tissue;
jaw joints;
maxillary sinuses.

The doctor receives a panoramic picture of the patient’s skull and can make the most accurate diagnosis.

However, a panoramic image still differs from the usual x-ray and other hardware diagnostic methods: teleradiography, tomogram.

When an X-ray is taken, a visiograph works. With the help of such hardware research, you can see a maximum of two adjacent molars. That is, a targeted image is obtained in a two-dimensional plane. An x-ray can be taken at any public clinic.

Orthopantomogram

An orthopantomogram is done using a computed tomograph. The result is a panoramic image of the jaw in two dimensions. Diagnostics can be done in any public or private clinic. The price is several times more expensive: from 1000 rubles.

Teleradiography

Teleradiography is also performed on a computed tomograph. However, compared to an orthopantomogram, the doctor already sees the entire skull in front and profile. Accordingly, this is a more informative diagnosis than the first two. The examination method is used to resolve surgical and orthodontic issues. The procedure costs from 2000 rubles.

Tomogram

A tomogram (or computed tomography, CT) is also performed on a CT scanner. However, the doctor already sees a three-dimensional three-dimensional image: not only bone tissue, but also soft tissue. This examination is carried out to resolve issues regarding implantation and surgery. The photo is taken in private clinics, the price for the work starts from 1,500 rubles. You can do a segmental tomogram (a separate section of the jaw): it will be cheaper.

Which method is better

Which examination method is preferable? It depends on the issue that needs to be resolved. To place an implant, it is better to take a 3D image. If only one molar needs to be treated, a simple x-ray examination is sufficient.

In private clinics, patients are offered a panoramic photo at their first appointment. This is necessary to track the dynamics of changes in the condition of the jaw and teeth. The image will be stored along with the patient's record. Sometimes this service is provided free of charge, it all depends on the clinic.

Why is radiography performed?

Why do X-rays take place? Quite often, a visual examination and patient complaints are not enough to make an accurate diagnosis, and then errors cannot be ruled out. Modern dentistry strives to avoid any mistakes, and X-ray diagnostics are a great help for this. With the help of an examination, you can identify serious contraindications to certain treatment methods, monitor the treatment process, detect hidden pathological processes and injuries (for example, a root fracture or crack), and assess the condition of the bone tissue before implantation.

Radiography is prescribed in any field of dentistry: orthodontics, orthopedics, therapeutic and surgical areas. However, for each individual situation, different research methods based on the action of X-ray radiation will be considered the most effective. Let's look at all that exist today.

Minuses

Every medical procedure has its pros and cons. Let's consider them in relation to panoramic diagnostics:

OPTG does not always provide accurate information, since the image is not three-dimensional, but two-dimensional. In this regard, CT is still much more informative.
Sometimes image distortion reaches 30%, which negatively affects the diagnostic accuracy.
OPTG does not provide complete information about the three root teeth, as it produces a two-dimensional image in a slice. The roots of such teeth are located in three planes at once, and the image is only two-dimensional.

Accordingly, many dentists refer to OPTG as a rough diagnosis that only gives a general idea of the condition of the teeth and jaw. When it is necessary to see a crack in a root canal or to fill a curved root canal, they resort to other forms of examination.

Indications

In what cases is it necessary to do without an x-ray? There are several such situations:

before starting orthodontic treatment;
for detailed diagnostics of the maxillofacial apparatus and dentition;
before planning an operation;
to detect the localization of the focus of the inflammatory process;
when diagnosing periodontitis;
in implantology.

Orthodontic treatment

Orthodontic treatment is always preceded by an examination of the jaw apparatus. The image clearly shows the root system and its condition. Based on the information received, the orthodontist will select a bite correction method. A panoramic photograph of the teeth must be taken for children, since the doctor must see the anatomical features of the structure of the jaw system and the rudiments of unerupted molars. It is important to see in advance in which direction the teeth will grow, in what condition the root system is - its stability.

In what cases is a comprehensive diagnosis of the entire dental system performed? This examination method allows:

identify malocclusion pathologies in young children;
promptly detect hidden foci of the inflammatory process and unmanifested problems;
detect the beginnings of the formation of tumors and neoplasms;
control the quality of filled root canals;
check the condition of bone tissue;
see other hidden problems.

It is very important for adult patients to undergo annual examinations and take panoramic photographs in order to promptly identify pathology.

Hidden caries can also be seen on the x-ray.

Before surgery

Radiographs are extremely important before planning dental surgeries. The surgeon needs to see nearby molars, the condition of their roots, and the proximity of the nerve endings of neighboring molars. Also, before the operation, it is necessary to identify the presence of root fractures, foci of the inflammatory process and other nuances. Otherwise, the surgeon will operate “blindly”. So it is in the best interests of the patient to go and take a panoramic photo.

Tumor detection

Detection of the localization of the inflammatory process is of particular interest to the doctor and the patient himself. Because in most cases, patients complain not about a bad tooth, but about nearby healthy molars.

A panoramic photograph is also taken when wisdom teeth are difficult to erupt.

Periodontitis

Periodontitis is a dangerous gum disease that also destroys bone tissue. A panoramic (circular) image allows you to see the depth of tissue damage, the depth of periodontal pockets and make the correct diagnosis.

Implantation

Implantation is a modern method of restoring the smile line and functionality of the jaw system. Panoramic diagnostics (it is better to do a computed tomogram) before implantation will help identify pathology of the maxillary sinuses, in which implantation is strictly prohibited.

CT scans are also performed after implantation to monitor the quality of work. The image shows the condition of the bone tissue, which is especially important when implanting titanium elements.

Why do you need a dental x-ray?

Radiation diagnostics is needed in most cases during dental treatment. Without accurate photographs of the oral cavity, the doctor cannot determine the entire affected area and the spread of the disease. Many problems cannot be assessed visually alone, such as nerve damage. X-rays reflect bone tissue well, so this is a very effective technique for examining teeth. Soft tissues also cast a shadow on the photo; using them, the dentist can detect an abscess, cyst or tumor.

Content:

Why do you need a dental x-ray?
How it's made
In what cases is an x-ray needed?
Where can I do it?
Examination of children
X-ray for pregnant and lactating women
Frequently asked questions from patients

During a visual examination, the dentist can only guess the cause of pain, bleeding or other problems. For an accurate diagnosis, he needs an image of the internal structure of the oral cavity: gums, teeth, roots, canals. The procedure is always carried out before a diagnosis and treatment regimen are made. X-ray examination is necessary not only at the first stage; it is used to determine the effectiveness of therapy.

Be sure to take a series of photographs during cleaning and filling of the canals. They are used to determine the depth of each canal and the tactics for filling it. If the dental treatment is carried out incorrectly, for example, the canal is not completely sealed, this will lead to re-inflammation and various complications are possible, in the form of new dental problems. You cannot do without such technology after prosthetics, complex removal, or treatment of periodontal disease. That is, radiography of the jaw is needed to make a correct diagnosis and to monitor the progress of therapy.

How pictures are taken

The pantomograph diagnostic procedure does not take much time and is easy to perform. A special stick made of medical plastic is placed in the patient’s mouth, which he must squeeze with his teeth. Before the procedure, you must remove all metal accessories: rings, earrings, watches, necklaces. The patient is asked to wear a lead apron, which protects against harmful radiation.

After turning on the device, a digital sensor begins to rotate around the patient’s head, which scans the jaw and temporal area. The whole procedure takes no more than a minute. Then the doctor analyzes the data received, enters the information into a computer or onto a flash card, and takes a picture.

Other types of diagnostics

An image of the jaw is taken using a special device called an orthopantomograph. This device is an X-ray mechanism for scanning the entire jaw and temporal area. There are two types of pantomographs: digital and film (analog). Film mechanisms require a darkroom, while digital mechanisms require a computer. Digital pantomographs are more convenient to use, and their radiation dose is several times lower.

In modern dentistry, film orthopantomographs are used less and less often, since the pictures are unclear and quickly erased. The latest equipment is based on digital technology, and examination methods do not harm the body. The resulting digital image can be printed on photo paper or saved on any medium.

However, some public clinics still have old film-type equipment. If you take a panoramic photograph of your teeth under compulsory medical insurance, be prepared for such a turn of events.

The image can also be obtained using other hardware tools. Therefore, a panoramic test is also done using:

computed tomography;
teleroentgenograms.

CT scan

Cone beam tomographs allow you to take panoramic images of the jaw, which facilitates the work of dentists and orthodontists. A panoramic image of the entire oral cavity helps to make a correct diagnosis, prescribe bite correction and implant implants. However, this type of diagnosis is contraindicated for persons suffering from claustrophobia and pathological mobility (cannot sit quietly in one place). Pregnant women should refuse this procedure; breastfeeding women should refrain from breastfeeding for two days after the examination.

Teleradiogram

Teleradiography is prescribed when installing braces or implants, bridges. The procedure is also part of orthodontic treatment and surgery. The radiation exposure during this type of examination is minimal and does not pose a threat to the patient. This procedure is performed even on young children if there is a suspicion of an anomaly in the structure of the dental system.

Types of teleroentgenogram:

frontal;
lateral;
axial

In frontal diagnostics, images are taken from the front and back. A lateral teleroentgenogram is done in case of malocclusion; this procedure is mandatory when installing braces. The chin (axial) radiograph is clarifying (additional). It is necessary for a complete picture of the structure of the patient’s skull in a three-dimensional image. This procedure is mandatory when installing upper jaw implants.

Advantages of teleradiography:

the resulting image is as close as possible to the actual dimensions of the patient’s skull;
the result of the study is ready within a few minutes after the image;
The radiation dose to the patient is negligible.

This type of examination is preferable for patients with claustrophobia who are frightened by the appearance of the tomograph cabin. This type of diagnosis has virtually no disadvantages. However, the doctor’s literacy factor should also be taken into account: you need to be able to correctly decipher an x-ray.

Teleradiography (cephalometry or TRG)

Using this type of examination, doctors can obtain two-dimensional panoramic images of the entire skull in a lateral or frontal projection in real dimensions.

Lateral teleradiography is used in orthodontics, because with its help the doctor can very well assess the size of the upper and lower jaw, identify the inclination and position of the teeth, study the patient’s profile and determine the type of jaw growth.

This type of study allows you to obtain two-dimensional panoramic images of the entire skull

TRG in frontal projection can be used in orthopedics and implantology. The resulting images also allow you to assess the condition of the sinuses and mucous membranes.

The cost of 1 photo is from 700 rubles.

Common Questions

How safe is X-ray diagnostics?

Doctors responsibly declare that this diagnosis can be carried out several times a year without harm to health. A lead apron does not mean that the examination is mortally dangerous for the patient. The apron is worn to protect the thyroid gland from radiation. It is customary to wear aprons in dentistry, traumatology, etc., since the patient receives a dose of radiation annually during a fluorogram.

How often is irradiation allowed?

Since the radiation exposure to the body during an orthopantomogram is small, studies can be done as needed. That is, how much is needed for treatment. However, there is a limitation: no more than 80 images per year. This figure takes into account preventive fluorograms, and not just dental photographs.

How dangerous is x-ray for pregnant women?

X-rays are taken for pregnant women only as a last resort, if it is required to save the life of the woman and the fetus. However, in the first trimester, any manipulations with X-rays are prohibited: this will negatively affect the condition of the embryo. The second trimester is relatively safe, when all the internal organs and systems of the baby are formed. In the third trimester, taking an X-ray is very dangerous, as it can lead to premature birth.

Do children get x-rays?

In dental practice, photographs of baby teeth are taken if a cyst or a hidden source of inflammation is suspected. For diagnosis, a targeted image is sufficient, the radiation dose at which is extremely small. For the body to suffer harm, you need to make 100 such diagnostics in a year, or more than five in a day. Teenagers can already undergo OPTG, as they understand the requirement to stand still and not cry during the procedure.

Comments

How many times a year can dental x-rays be taken and how dangerous is it in terms of radiation exposure?

Timur (02/23/2020 at 11:21 pm) Reply to comment

Editorial staff of the portal UltraSmile.ru (02/27/2020 at 09:12) Reply to comment

Should the doctor take a second X-ray after cleaning the canals? The dentist only took the initial photo and that’s it. But after the treatment I feel discomfort, so I would like to know if a repeat scan was necessary? And wasn’t this the doctor’s mistake?

Galina (03/20/2020 at 10:07 am) Reply to comment

At 30 weeks of pregnancy, I was told that taking a spot image of a tooth would be almost harmless with modern equipment. Is it so? I don’t want to risk the baby’s health, but the tooth hurts very badly.

Maria (03/20/2020 at 10:52 am) Reply to comment

What should you do if the picture was taken poorly and the dentist asks you to take another one? Will a damaged photo need to be paid in full or is it the dentist’s fault?

Diana (03/20/2020 at 12:01 pm) Reply to comment

My child is 12 years old. His tooth hurt very much, he could not chew with it, although there were no visible changes in the tooth (no visible caries or anything else). We went to the municipal clinic. To fix the tooth, we went to the dentist twice in one week. The child also had dental x-rays taken twice a week. Tell me, how safe is it to have a child’s dental X-ray done in general and twice in one week?

Elena (03/20/2020 at 14:31) Reply to comment

About 3 years ago I finally decided to get all my teeth fixed. I went to the dentist for a month. At first she only filled, but when it came to 2 roots, which it was decided to build on... In general, I don’t know what dentists call it. I'll call it growing a tooth. So, before the extension of the first tooth, I was sent for an x-ray. Moreover, the picture didn’t work out the first time, only the second time. The doctor didn’t like the picture and she sent me for a repeat x-ray from a different angle. In total, I was “enlightened” 3 times. The root was fine, the tooth grew. However, when she sent me for an x-ray of the second tooth, or rather, its root, the x-ray room said that in a month they had given too much radiation through my head 3 times and advised me to come back in 3 weeks. As a result, I did not take an x-ray and have not treated the tooth until now. And you write in the comments about 100 pictures. So who is right?

Mikhail (03/20/2020 at 04:32 pm) Reply to comment

My wisdom tooth began to grow and displace the neighboring one, which was quite healthy and strong. The doctor said that it needed to be removed and sent him to take a picture. The tooth was removed on time, otherwise it would have grown in the second row. Probably, without a photo, such a procedure would not be easy to do.

Alla (03/20/2020 at 16:40) Reply to comment

Hello! Tell me, which method allows us to identify hidden tumor processes in the patient’s gums and jaws? I have a benign tumor of the salivary gland, is it possible to use sialography to analyze it, or is it better to have an ultrasound (I do it as planned once every six months)?

Eleanor (03/20/2020 at 5:51 pm) Reply to comment

I remember at an appointment at a dental clinic, the doctor removed a tooth without an x-ray. Another paid clinic sent me straight away for an x-ray. Does a doctor have the right to remove a tooth without sending the patient for a tomography?

Alexey (04/23/2020 at 07:39) Reply to comment

Any research methods that include x-rays carry a certain amount of radiation to the body. How safe are these devices described in the article for the patient?

Denis (04/23/2020 at 09:09) Reply to comment

Hello, can you write in more detail about multislice tomography? One more question: is it possible to get an appointment without a referral from a dentist? Can they tell right in the center with a tomograph what problems there are, or do they send this 3D image to the doctor?

Anita (04/23/2020 at 09:14) Reply to comment

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Bottom line

To properly treat teeth, you need to have an idea of the condition of the jaw and skeletal system. This information can be provided by an x-ray, which is taken with a special orthopantomograph or computed tomograph. The picture is taken in every private clinic and government institutions. The cost depends on the equipment and tariffs of private clinics. In a government institution, you can get an X-ray done free of charge upon referral or for a small fee of 300 rubles.

Orthopantomography is a panoramic image of both jaws in a section in a two-dimensional plane. The absence of a three-dimensional image is a common reason for an incorrect diagnosis. Also, a two-dimensional image does not allow one to see microcracks on the roots of teeth, and in three-rooted teeth only 2 roots are visible. The listed disadvantages speak in favor of computed tomography, although it costs several times more.

Panoramic diagnostics are recommended not only during dental treatment and implantation: it must be performed annually for preventive purposes. This will allow timely detection of hidden caries, internal foci of inflammation, cysts, tumors, and neoplasms.

Sources used:

Abolmasov N. G., Abolmasov N. N. Orthodontics. – 2008.
American Academy of Implant Dentistry (AAID)
Distel V. A. Dental anomalies and deformations. Omsk — 2004.
“Orthopedic dentistry. Textbook" (Trezubov V.N.)

In what cases is an x-ray needed?

During a visual examination, the dentist can see approximately 40% of the oral cavity. However, most problems lie inside: in the canals, roots, interdental space. Therefore, most patient complaints can be resolved only after X-ray diagnosis.

Indications for examination:

caries in any part of the jaw, including under the crown;
root destruction: fractures, cracks, bone depletion;
periodontitis - destruction of bone, while the gums become inflamed and bleed, teeth begin to loosen and hurt;
broken bite;
pathology of the dental joint;
abscesses and tumors, cysts;
periodontitis is an inflammation of the root, accompanied by the appearance of a cyst that enlarges.

Painful sensations do not always appear, so patients often delay treatment. Advanced periodontitis leads to gumboil and tooth loss.

In addition, canal cleaning, prosthetics and implantation, bone grafting, and orthodontic treatment are not performed without a detailed examination.