Put Patients at “Attention” for Better Panos

As an orthodontist, I use panoramic x-rays to determine eruption sequences, view impactions, or check the health of our patient’s teeth. Since going to our new Planmeca Promax Digital Imaging system, I’ve noticed a common theme in taking panos with the new equipment: The spinal column and menton will blur the information of the midsagittal plane (Figure 1). In the past, the patient would be positioned with his or her occlusal plane flattened and parallel to the floor. But because the new machine shoots the beam at an angle lower than the angle of the occlusal plane, a ghost image of the spinal column and menton will appear in the middle of the x-ray.  

To correct this, position the patient at “military attention” with the chin slightly below the cranial/cephalic junction and with a slight positive Curve of Spee to the occlusal plane. The result is a minimization of the ghost image of the spinal column and menton, making the apices of the incisors clearly visible (Figure 2).

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