The Power of Panoramic X-rays The Practice Benefits of Using Panoramic for Bitewings

Author : Dental Product Shopper
Published Date 07/25/2012
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The Power of Panoramic X-rays The Practice Benefits of Using Panoramic for Bitewings

Panoramic x-rays have come a long way since the US Army developed them in an effort to speed up the process of examining the oral health of soldiers. While these units helped soldiers move through the dental exam process quickly, they had limitations. At the time, panoramic x-rays were useful at detecting and localizing mandibular fractures and other pathologic entities of the mandible, but they had limited usefulness for assessing periodontal bone loss or tooth decay.

This history of the panoramic x-ray has followed it into the 21st century. I talk with many dentists who don?t believe that pan machines can take diagnostically reliable bitewings. However, with the advent of digital radiography and improvements in panoramic x-rays, they are important tools in the diagnostic armamentarium.

Misconceptions of Panoramic X-rays

Many dentists believe that the resolution of panoramic x-rays and the ability to open the contacts are not as good as traditional bitewings.

A typical panoramic image displays the interproximal contacts as overlapped or not open. Because the contact points cannot be seen clearly, many dentists believe that pans cannot properly display interproximal cavities. As part of the my research, I examined what angle the beam, or x-ray, should be pointed at to open the contacts and get an image of the interproximal area. One manufacturer used this research and engineered it into technology that allows the panoramic x-ray to be adjusted to the right angle to open the contacts.

Some dentists believe that because traditional bitewing x-rays are sharper, they will show cavities better than panoramic. However, it is not the resolution (sharpness) that makes interproximal caries detection good, but rather it is the imaging characteristics of the technology in use. In 1985, my research team first demonstrated that the ?fuzzy pan? images showed interproximal cavities as well as, or better than, the intraoral bitewings.1 In some cases no cavity was seen at all on the bitewing, but it was plainly visible on the pan taken the same day.

Benefits of Panoramic Bitewings

Using panoramic x-rays for bitewings can provide a dental practice and its patients with many benefits, including reduced costs for the practice, increased staff satisfaction, and improved patient care.2

Better patient acceptance.
Patients can easily stand or sit during a panoramic xray examination. They can be performed once, as opposed to a bitewing series of up to 4 exposures that take several steps.

Easier for the dentist and staff.
Dentists can consistently open up the contacts between the posterior teeth by adjusting the panoramic positioning light, rather than setting up a sensor in a holder, placing it in the patient?s mouth, aiming the xray unit, and repeating several of steps for each subsequent bitewing exposure.

The panoramic technique requires fewer steps. Dentists or staff can turn on the machine, instruct the patient to bite into the groove in the bite block, and have the images seconds later.

More diagnostic.
In my experience, more interproximal caries are missed with traditional bitewing x-rays than with panoramic x-rays. In addition, panoramic xrays provide more coverage for periodontal bone defects, periapical lesions, and pathological jaw lesions than bitewings.

Less radiation exposure.
A panoramic bitewing study can cut radiation dose by 40% compared with intraoral bitewing x-ray studies. A pan creates as little as 3 to 5 microsieverts versus 10 to 95 in various intraoral bitewing scenarios. In pediatric mode, the dose may be reduced up to 30% less than the adult dose.

Less infection control.
With traditional bitewings, dentists wrap and unwrap the sensor after each patient, disinfect the sensor and holder; disinfect the tube head, yolk, and cone; disinfect soiled countertop areas; and dispose of and change gloves. Using a panoramic machine requires no gloves and virtually no between procedure cleaning or maintenance. Only the bite block sleeve is replaced, which is removed by the patient. Traditional bitewings take much longer to acquire than panoramic xrays. By switching to panoramic, practices can achieve real time and cost savings.

The Power of Panoramic Imaging

The word is finally getting out about the power of panoramic imaging. According to a panoramic sales representative, dentists are more open-minded to gradually replacing bitewing x-rays with pans.

?I sold 28 pan units last April because dentists now understand that pans are superior to traditional x-ray units and have several other advantages such as cost, comfort, and ease of use,? the sales representative added.


1. Terezhalmy GT, Otis LL, Schiff TG, Langlais RP. A comparison with intraoral bitewing with panoramic radiographs for the detection of interproximal caries. Dentomaxillofac Radiol. 1985;7 (Suppl):Abstr 32.

2. Hamiddidadin A. A Comparison of Panoramic and Intraoral Bitewings for the Detection of Interproximal Caries [thesis]. San Antonio, TX. University of Texas Health Science Center at San Antonio; 2005.