Panoramic Panoramic TechniqueTechnique

DHY 202 Clinical Dental DHY 202 Clinical Dental Hygiene IHygiene I

Dental Hygiene Dental Hygiene DepartmentDepartment

William Rainey Harper William Rainey Harper CollegeCollege

IntroductionIntroduction

• All panoramic machines work All panoramic machines work essentially the same, although essentially the same, although they vary in appearance.they vary in appearance.

• Panoramic technique can be Panoramic technique can be described in 5 generic steps.described in 5 generic steps.

Steps in Panoramic TechniqueSteps in Panoramic Technique

• Stand the client uprightStand the client upright

• Position client’s chinPosition client’s chin

• Close client’s teeth on bite stick grooveClose client’s teeth on bite stick groove

• Close the side guidesClose the side guides

• Provide client instructionsProvide client instructions

Client PreparationClient Preparation

• Remove metallic & other objects Remove metallic & other objects from head & neck regionfrom head & neck region

• Place panoramic lead apron (no Place panoramic lead apron (no thyroid collar)thyroid collar)

• Check for interference from bulky Check for interference from bulky clothingclothing

Exposure ConsiderationsExposure Considerations

• Use Use next highestnext highest kVp setting for kVp setting for any of the any of the following client following client characteristics:characteristics:• ObeseObese• Large bone Large bone

structurestructure

• Use Use next lowestnext lowest kVp setting for kVp setting for any of the any of the following client following client characteristics:characteristics:• Frail or small bone Frail or small bone

structuresstructures• EdentulousEdentulous

Steps in Panoramic Technique Steps in Panoramic Technique

• Guide client with gentle hand Guide client with gentle hand pressure in small of back pressure in small of back

• Instruct client to:Instruct client to:– Stand erect with shoulders down Stand erect with shoulders down

& relaxed& relaxed– Position feet as far forward as Position feet as far forward as

possiblepossible– Hold machine to avoid falling Hold machine to avoid falling

backwardbackward

• Adjust head planes:Adjust head planes:– Midsaggital perpendicular to floorMidsaggital perpendicular to floor– Frankfurt parallel to floor Frankfurt parallel to floor

• Purpose: straighten cervical Purpose: straighten cervical spinespine

Step 1 : Step 1 : Stand Stand Client Client UprightUpright

Stand the Client UprightStand the Client Upright

Steps in Panoramic TechniqueSteps in Panoramic Technique

• Rest chin on chin restRest chin on chin rest• Purpose:Purpose:• Ensure chin is tilted Ensure chin is tilted

down -4 to -7 degrees to down -4 to -7 degrees to counter upward angle of counter upward angle of beambeam

• Support & steady client Support & steady client headhead

Step Step 2 : 2 : PositioPosition n Client’Client’s Chins Chin

Position the Client’s ChinPosition the Client’s Chin

Steps in Panoramic TechniqueSteps in Panoramic Technique

• Client bites end-to-end Client bites end-to-end in bite stick groovein bite stick groove

• PurposePurpose• Anterior teeth in anterior Anterior teeth in anterior

part of focal troughpart of focal trough• Separate dentition in the Separate dentition in the

imageimage• Center client in machineCenter client in machine

Step 3: Step 3: Bite in Bite in GrooveGroove

Bite in the GrooveBite in the Groove

Focal TroughFocal Trough

• Known as the Known as the image layerimage layer• A three-dimensional zone A three-dimensional zone

in which structures are in which structures are reasonably well-definedreasonably well-defined

• Determines where dental Determines where dental arches must be positioned arches must be positioned to achieve clearest imageto achieve clearest image

Steps in Panoramic TechniqueSteps in Panoramic Technique

• Close side guides Close side guides against client’s templesagainst client’s temples

• Purpose: Purpose: • Position posterior teeth Position posterior teeth

in middle of focal trough in middle of focal trough layer on both sideslayer on both sides

• Stabilize client head Stabilize client head positionposition

Step 4: Step 4: Close Close Side Side GuidesGuides

Close Side GuidesClose Side Guides

Steps in Panoramic TechniqueSteps in Panoramic Technique

• Tongue on roof of Tongue on roof of mouth-swallow or suck mouth-swallow or suck cheekscheeks

• Hold still (22 secs.) Hold still (22 secs.) • Warn about cassette Warn about cassette

rotation rotation • Don’t follow machine Don’t follow machine

with eyeswith eyes

Step 5: Step 5: Client Client InstructioInstructionsns

Client InstructionsClient Instructions

• Swallow, Swallow,

• Hold Hold

• ExposeExpose

Cassette DesignCassette Design

• 5-6” x 12” 5-6” x 12” rigid or rigid or flexibleflexible

Cassette Intensifying ScreensCassette Intensifying Screens

• Phosphor crystal on plastic basePhosphor crystal on plastic base

• Fluorescence reduces radiation to Fluorescence reduces radiation to clientclient

• Fast rare earth/Lanex screens emit Fast rare earth/Lanex screens emit green lightgreen light

• Film and screen must be compatibleFilm and screen must be compatible

Infection Control ProceduresInfection Control Procedures

• Use clean, ungloved hands to handle Use clean, ungloved hands to handle cassette and filmcassette and film

• Use disposable bite stickUse disposable bite stick

• Other infection control procedures Other infection control procedures (draping, disinfecting) if deemed (draping, disinfecting) if deemed necessarynecessary

The End!