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A pantomogram is a type of x-ray image that shows the teeth, jaws, mandible, and temporomandibular joints. Thanks to taking a panoramic (pantomographic) image, it is possible to evaluate the structures of the periodontium and jaw bones, which is helpful when starting dental treatment.
The pantomogram consists of x-rays of the jaw area with a special X-ray machine. The pantomographic image, which is also called a panoramic image, shows all teeth and other structures of the jaw, especially bones and mandibulo-temporal joints.
It allows to assess the condition of these parts of the craniofacial face and detect lesions located in bones and joints as well as abnormalities in the structure of the teeth and jaw.
Checkhow the lower jaw is built
The pantomographic image is taken primarily before putting on the orthodontic appliance. Based on this examination, the orthodontist can accurately determine the location of the teeth and their condition, and thus precisely adjust the appliance to the individual case.
Pantomogram wykonuje się również przy urazach szczęki (m.in. złamania wyrostka zębodołowego i złamania żuchwy), w chorobach przyzębia i w przypadku zaawansowanej próchnicy zębów. Wskazaniem do wykonania tego badania jest też kamica ślinianek.
Lekarz stomatolog często zaleca również pantomogram przed usunięciem zębów, szczególnie ósemek oraz przed zabiegiem wszczepienia implantów. Pantomogram pozwala dokładnie zobrazować położenie korzeni zębowych, stan kości i przyzębia oraz określić stopień mineralizacji zębów i kierunek ich wyrzynania, co jest istotne przed wykonaniem wyżej wymienionych zabiegów. Pantomogram wykonuje się także przed niektórymi zabiegami chirurgicznymi niedotyczącymi jamy ustnej, na przykład przed operacją zaćmy, aby wykluczyć stan zapalny w jamie ustnej.
The pantomogram is also used by doctors to:
- finding the source of toothache and making a tooth-by-tooth diagnosis;
- diagnosis of developmental anomalies, such as cherubism or clavicle-cranial dysplasia;
- jaw cancer diagnosis;
- diagnozy dysfunkcji i zesztywnienie stawów skroniowo-żuchwowych;
- diagnosis of osteosarcoma, enameloma, renal osteodystrophy affecting the jaws and hypophosphatemia.
See also: Which dental procedures should be performed at the National Health Fund? Here are the dentist’s recommendations
Types of pantomographs
Most radiology offices already use digital pantomograms, but it is worth remembering that there is another type of pantomogram, namely the analog pantomogram (intraoral – rarely used and extraoral – more often used).
Podczas badania wykorzystywana jest specjalna kaseta posiadająca światłoczułą błonę. Zanim można zobaczyć zdjęcie, musi ono zostać poddane procesom chemicznym, nie tak jak w przypadku pantomogramu cyfrowego, który dzięki czujnikom cyfrowym umożliwia podgląd na komputerze. Dodatkowym plusem jest możliwość powiększania wybranych partii.
The pantomographic examination is similar to any other examination that uses X-rays. The patient is asked to stand in front of the X-ray machine and not move for the time needed to take the picture.
The patient’s head is placed under the apparatus, and the teeth must be held by a special handle with a disposable insert, which allows the X-ray apparatus to be precisely positioned.
Before taking the photo, the patient puts on a special vest that protects the internal organs from radiation.
Podczas badania głowa pacjenta zostaje prześwietlona wiązką promieni RTG, które przebiegają wzdłuż łuków zębowych. Następnie obraz jest skanowany tak, by jego jakość była najlepsza przy jak najniższej dawce promieniowania.
The test is performed in the X-ray laboratory – in a room with walls specially insulated so that the radiation does not penetrate outside. The pantomographic image is a layered image, so it also shows the deeper structures of the jaw and joints. They are enlarged in the photo by a dozen or so percent. However, the panoramic radiograph does not clearly show all the elements of the X-rayed place.
Panoramic X-ray is painless, it lasts from a few to several seconds.
Checkfor what purpose X-ray examinations are performed
Before performing a pantomograph examination, remove metal objects, such as belts with metal buckles, bracelets, earrings, pendants, and a watch, and remove removable dentures.
This also applies to the earrings above the front teeth (the so-called smiley), which should be unscrewed before taking a panoramic photo of the teeth. The restrictions on metal objects do not apply to fixed appliances that cannot be removed.
You do not need to turn off your mobile phone while taking a photo.
A pantomogram is an image taken with an X-ray machine. Therefore, the main contraindication to its performance is pregnancy. Women who are expecting a baby cannot have a pantomogram of their jaws done.
The warnings also apply to women who suspect that they may be pregnant, as well as children. In special cases, it is possible to perform a pantomogram, but only in situations of dangerous jaw injuries.
Pantomogram powinno się wykonywać raz na dwa lata. Obecnie zalecane jest robienie zdjęcia RTG zębów każdemu dorosłemu, by sprawdzić stan szczęki. W większości wypadków jednak pacjenci wykonują go przed założeniem aparatu ortodontycznego czy skomplikowanym leczeniem próchnicy zębowej połączonej niekiedy z leczeniem kanałowym.
Pantomogram – interpretation of results
After performing an examination, which is a pantomogram, and obtaining the possibility of identifying the correct anatomy and pathology, the doctor can diagnose a given case. The specialist compares the right and left sides of the mouth to detect abnormalities, since normal anatomical changes often occur on both sides. Not only the location of the lesion is taken into account, but also its internal structure (X-ray impervious or almost invisible in the X-ray image), the size, shape and boundary of the lesion and its impact on surrounding structures.
After ruling out that the area of interest is not a variant of normal anatomy, the specialist categorizes the case as either a developmental or an acquired pathology. Several categories of disease include cysts, benign or malignant tumors, inflammation, bone dysplasia, vascular abnormalities, metabolic disorders, or injuries.
See also: 7 most promising neoplasms
Computed tomography and pantomogram
Computed tomography is a study that provides even more information about the examined structures and their topography. The examination shows the successive layers of the oral cavity. It allows you to obtain a 3D image and evaluate each tested plane. The pantomogram, on the other hand, is a classic image of all teeth in the maxilla and mandible. Thanks to this method, dentists can conveniently see everything on one X-ray and see, for example, emerging or damaged teeth or possible tumors.
Lekarz dentysta dobiera odpowiedni rodzaj badania w oparciu o stan zdrowia pacjenta. Tomografia komputerowa jest wykorzystywana w sytuacjach, gdy pantomogram jest niewystarczający, często w późniejszych etapach leczenia stomatologicznego.
Pantomogram – limitations
The pantomogram does not provide accurate and detailed information about each tooth or soft tissue such as muscle. It is commonly used as a preliminary assessment of bones and teeth. Because the mouth is curved, a panoramic X-ray can sometimes create a slightly blurry image where accurate measurements of the teeth and jaw are not possible. If your dentist or surgeon needs more information, you may order a computerized tomography (CT) or magnetic resonance imaging (MRI) scan.
See also: What does the surgeon do?
Pantomogram – side effects
Jak w przypadku każdego badania wykorzystującego promieniowanie jonizujące, występuje niewielki stopień bezpośrednich uszkodzeń jonizujących i pośrednich uszkodzeń spowodowanych przez wolne rodniki powstające podczas jonizacji cząsteczek wody w komórkach. Przyjmuje się, że ryzyko zachorowania na raka z powodu pantomogramu wynosi około 1 na 20 000 000. Nie bez znaczenia ma tutaj także wiek pacjenta i to osoby młodsze mają nieco większe ryzyko.
Is a pantomogram necessary?
It is not always necessary to perform a pantomogram. Occasionally an occlusal wing x-ray may be sufficient, especially if the dentist has to concentrate on just a few teeth. However, if the dentist needs to evaluate the entire oral cavity, including the jawbone, a pantomogram may be necessary. This is often the case when assessing the overall oral health of new patients or when planning implant treatment.
Promienie rentgenowskie są również ważnym narzędziem monitorowania wzrostu i rozwoju zębów i szczęk u dzieci. Dentysta zaleca odpowiednią radiologię w zależności od stanów, które musi ocenić.
Also check: Dental implants – how much do they cost? What does the price of dental implants depend on?
Panoramic radiograph and new diagnostic possibilities
The panoramic radiograph enables the visualization of a fragment of the neck and atherosclerotic lesions, which are an indicator of both local and systemic atherosclerosis. Coronary atherosclerosis leads to myocardial infarction (heart attack) and carotid atherosclerosis leads to stroke. Atherosclerosis has been attributed to risk factors that include cigarette smoking, hyperlipidemia, obesity, diabetes, and hypertension. However, these factors do not fully explain the risk of the disease.
See also: How do you recognize a heart attack?
Pantomogram – price
The price of a pantomogram is not high. Usually it ranges from 50 to 80 zlotys per photo. In some cases, an additional fee (approx. PLN 10) for the CD must be added. It is worth noting, however, that in order to take a panoramic photo of the teeth, you must have a referral from a dentist.
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