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International Journal of Clinical Dentistry ISSN: 1939-5833
Volume 15, Number 4 © 2022 Nova Science Publishers, Inc.
PANORAMIC RADIOGRAPHS AND ITS IMPORTANCE IN
PEDIATRIC DENTISTRY – A RETROSPECTIVE STUDY
Sridhar M.1,
, Mebin George Mathew2, and Meenakshi3
1Postgraduate Student, Department of Oral Medicine and Radiology,
KAHERS KLE Vishwanath Katti Institute of Dental Sciences,
JNMC Campus, Nehru Nagar, Belagavi, Karnataka, India
2Department of Pediatric and Preventive Dentistry,
Saveetha Dental College and Hospitals,
Saveetha Institute of Medical and Technical Sciences,
Velappanchavadi, Chennai, India
3Private Practitioner
ABSTRACT
Aim and Objective: The aim of this study is to evaluate the importance of panoramic
radiographs in diagnosis and treatment planning for pediatric patients. The objective of
this study is to examine and determine the rate of incidentally observed oral pathologies,
associated lesions, dental anomalies and dentition status in pediatric patients.
Materials and Method: A total of 102 panoramic radiographs obtained from
Department of Oral Medicine, Saveetha Dental College. These radiographs were
randomly selected from pediatric patients with mixed dentition who came for their
regular dental check up. Panoramic radiographs were examined to detect the presence of
any lesions, pathologies, anomalies and also their dentition status. Results obtained were
tabulated and analyzed.
Results: Among the 102 radiographs, the most commonly observed finding was
decayed primary tooth (76.5%) with second commonest finding being eruption delay due
setback in exfoliation of primary tooth or retained deciduous tooth (20.4%). Hypodontia
accounted for about 15 in 102 radiographs (15.3%). Impacted tooth was found in about
6.12% of the OPG’s. Pulp therapy was done in 5.1% cases and Crown placement was
done without pulp therapy in 8.16% cases.
Clinical Significance: A dental professional must be able to differentiate between
normal and variation in normal panoramic radiographs which plays a key role in
diagnosing and treatment planning of these conditions accordingly.
Keywords: radiography, panoramic, tooth, impacted, supernumerary, dental caries
Corresponding Author: Dr. Sridhar M, Postgraduate Student, Department of Oral Medicine and Radiology
KAHERS KLE Vishwanath Katti Institute of Dental Sciences, JNMC Campus, Nehru Nagar, Belagavi,
Karnataka – 590010. E-mail: msridhar472@yahoo.com
Sridhar M, Mebin George Mathew, and Meenakshi
670
INTRODUCTION
Radiographs are important diagnostic tool in addition to routine chair side clinical
examination for dental professionals. Significant importance of radiographs irrelevant of its
type has made it a valuable possession in most of dental clinic practices. Radiographs help us
to visualize the anatomic structures which are missed out due to visibility underneath skin or
mucosa. These radiographs are used to confirm the clinical diagnosis and also in treatment
planning for certain cases.
Intra Oral Peri Apical Radiographs (IOPA) are most commonly used radiographs in
dental use as it consumes less time and it does not require any trained professionals to take
them. A single IOPA shows the tooth and its periapical region in a single x-ray film. Hence it
should be used multiple times to get a clear image of an arch. It does not show any structures
which are beyond boundaries of like sinus, body of mandible, condyle etc.
Panoramic radiograph, on the other hand is used to visualize entire maxilla, mandible and
other surrounding structures in a single film. Due to the vast coverage of both the jaws at a
single go, these are used to detect any abnormalities of developing structures, bone
pathologies, fractures etc. The patient also receives only less considerable amount of
excessive dosage in panoramic radiographs when compared to a radiographic film survey.
The aim of this study is to evaluate the importance of panoramic radiographs in diagnosis
and treatment planning for pediatric patients. The objective of this study is to examine and
determine the rate of incidentally observed oral pathologies, associated lesions, dental
anomalies and dentition status in pediatric patients.
MATERIALS AND METHODS
A total of 102 Panoramic Radiographs were obtained from Department of Oral Medicine,
Saveetha Dental College. These radiographs were randomly selected after meeting up with
exclusion and inclusion criteria. The radiographs from pediatric patients with mixed dentition
who came for their routine dental check up are evaluated. Panoramic radiographs were
examined to detect the presence of any lesions, anomalies, pathologies and also their dentition
status. Any deviation from normal condition was duly noted. Results obtained were tabulated
and then statistically analyzed.
Inclusion Criteria
• Pediatric patients of age 6-15 years.
• OPG’s of good diagnostic value.
• No extracted tooth and no loss of tooth due to caries.
Exclusion Criteria
• Radiographs of permanent dentition patients.
• OPG’s which is of imprecise or distorted quality.
• Extracted due to caries or trauma.
Panoramic Radiograph in Dentistry
671
Initially 350 OPG’s were collected from department for this study. As most of the OPG’s
were distorted and was faulty, they were omitted from this study thus restricting sample size
to 102. The X-rays were digitalized and the age groups from 4-15 years were included in this
study.
These 102 radiographs were analyzed for the presence of dental caries in both primary
and permanent, presence of any bone pathologies, cysts, fractures, periapical lesions, filling,
root canal treatments, crowns, supernumerary tooth, hypodontia, Mesiodens, condylar
morphology and maxillary sinus. The data obtained from each radiographs were tabulated.
This study was conducted in accordance with the 1964 Declaration of Helsinki and its
subsequent amendments.
RESULTS
Among the 102 radiographs, the most commonly observed finding was decayed primary
tooth (76.5%) with second commonest finding being eruption delay due setback in exfoliation
of primary tooth or retained deciduous tooth (20.4%). Hypodontia accounted for about 15 in
102 radiographs (15.3%). Impacted tooth was found in about 6.12% of the OPG’s. Pulp
therapy was done in 5.1% cases and Crown placement was done without pulp therapy in
8.16% cases. 5 supernumerary teeth were observed among 102 radiographs. There was a case
of condylar fracture. Crowding of lower anteriors was seen in some of the radiographs
(3.06%). Periapical lesions was found in same number of cases where crowding was present
(3.06%). Similarly, there were 2 reported cases of cystic lesion (2.04%).
Figure 1. Orthopantomogram showing flattening of left condyle.
Figure 2. Orthopantomogram revealing hypodontia.
Sridhar M, Mebin George Mathew, and Meenakshi
672
Figure 3. Orthopantomogram depicts presence of supernumerary teeth.
Figure 4. Orthopantomogram showing dentigerous cyst in lower left mandible.
Figure 5. Orthopantomogram reveals presence of impacted canine.
Panoramic Radiograph in Dentistry
673
Figure 6. Orthopantomogram depicts presence of mesiodens.
Table 1. Positive findings that were observed from 102 panoramic radiographs
FINDINGS
TOTAL NUMBER (N = 102)
PERCENTAGE (%)
Impacted
6
6.12
Crown
8
8.16
Root Canal Treatment
5
5.10
Filled
4
4.08
Supernumerary
5
5.10
Hypodontia
15
15.30
Crowding
3
3.60
Fracture
1
1.20
Delayed eruption
20
20.4
Cyst
2
2.40
Decayed primary tooth
75
76.5
Decayed permanent tooth
9
9.18
Periapical lesions
3
3.06
DISCUSSION
Orthopantomographs (OPG’s) are widely used in day to day practice in private clinic
because it is easy to explain to patient about their jaws and the problems associated with it on
a single film because it is quick and simple procedure [1,2]. In intra oral examination, OPG’s
can be used to detect the presence of oral lesions, dental anomalies or any other pathology so
that earlier detection of these conditions will help a clinician to have a better understanding
about the disease and its prognosis [3].
There are many factors which lead to pathological disturbances and dental anomalies.
One such factor is genetic factors like mutations, metabolic disturbances and inheritance.
Other factor is environmental which consists of physical, chemical and biological factors.
Sridhar M, Mebin George Mathew, and Meenakshi
674
Sometimes both environmental and genetic factors are involved in formation of certain
pathologies [4]. The commonest pathologies are cyst, supernumerary tooth, missing teeth,
dens in dente, dilacerations, taurodontism, malformations, alteration in size of teeth, etc [5].
Hence only clinical diagnosis does not help blindfold in differential diagnosis or
treatment of any such anomalies. So dentists must be well aware of to differentiate between
normal and abnormal structures in an OPG as it a reliable tool to assess the pathologies and
dental anomalies of their patients so that their treatment modality depends on the
identification of problem and devising a treatment plan accordingly [6].
Our study aims to detect any oral lesions, dental anomalies and pathologies at earlier
stages while the pediatric patient visits the dental clinic for their regular check-up. This was
found to be the commonest subject in most of the studies that were carries out in past. In the
present study, dental lesion as a whole was found in 30(30.2%) of the investigated
radiographs.
In a study conducted by Peckiner et al. [7], among 72 radiographs with oral lesions,
dental anomalies and pathologies, there was presence of 27 apical osteitis, 12 impacted teeth,
7 follicular cyst, 8 fractured teeth, 3 mesiodens, 2 taurodontism and 1 deformed tooth [7]. In a
similar study conducted by Cholitgul and Drummond et al. [8], 1608 children and adolescents
aged 10 to 15 years, dental anomalies were present in 21% of the radiograph (334
radiographs). Their study results revealed that most commonly found anomalies were
malpositioned teeth, missing teeth, misshaped teeth and teeth with hypoplastic appearance.
Hence these two studies prove the importance of panoramic radiographs in detecting and
confirming the diagnosis of such anomalies as stated earlier in our study.
Many studies have been conducted among school children of varying age to detect any
presence of anomalies at an early stage and to intervene them. In Taranaki, a study conducted
by Whittington and Durward where 1,680 children of age 5 years were examined for the
presence of dental anomalies. Among these children, 6 children had hypodontia, 3 children
had supernumerary tooth and on comparison, boys were more affected than girls. Similarly in
our study, presence of anomalies was present more in boys than that of girls [9]. Their study
correlated the presence of anomalies in primary dentition and its relationship with permanent
dentition which is the main aim of our study which is to interpret any abnormalities at
developing stage to prevent the further damage to dentition.
In another study where 1,092 panoramic radiographs were observed to identify the
presence of anomalies, 140 radiographs showed the presence of anomalies. Among those 140
panoramic radiographs, 39 radiographs showed missing teeth, 20 radiographs showed
mesiodens, 4 radiographs showed supernumerary teeth, 1 radiograph of odontoma, radicular
cyst and impacted tooth respectively. These results were contrary to our study where presence
of impacted tooth was higher than the above mentioned study by Asaumi et al. [10] where
Figure 5 depicts the presence of an impacted tooth. In a similar study where 480 panoramic
radiographs were analyzed, 40.8% of the radiographs were found to have dental anomalies.
The most common anomaly found in their study was dilacerated teeth (15%), followed by
impacted teeth (8.3%) and supernumerary tooth (3.5%). Ezzodini et al also concluded his
study stating the gender difference for the prevalence of these pathologies where males had
positive finding (49.1%) than that of females (33.8%) [11]. similarly in our study, the
anomalies were found more commonly in boys rather than girls.
Peltola et al. conducted a study where he observed radiographs of 14-17-year-old
children in Estonia. In those radiographs, the mean number of permanent teeth was found to
Panoramic Radiograph in Dentistry
675
be 31.5% [12]. In his study there was presence of hypodontia in 14% of radiographs and
supernumerary tooth was present in 3% of radiographs. This frequency of supernumerary
tooth occurrence is agreeable in terms of literature, but when compared to the results obtained
from our study, the frequency of occurrence is much higher (5.1%). Figure 3 and 6 shows the
presence of supernumerary tooth and mesiodens respectively.
Delayed tooth development has been reported as a chief cause in agenesis of tooth. Many
researchers have been done in order to bring a relationship between tooth development and
agenesis. One such study conducted by park et al. found that among 4611 patients, delayed
tooth development was present in 157 patients and tooth agenesis was present in 418 patients.
On contrary to their study, our study results yielded that there was presence of delayed
eruption in 20 patients and tooth agenesis was found in 15 patients [13]. Figure 2 shows the
presence of hypodontia or tooth agenesis.
Hence panoramic radiographs should be used as an additional aid to clinical examination
as it possess certain advantages like coverage of teeth, lower patient dose and short
development time for image of facial structure like both maxillary and mandibular dental
arches and its supporting structures [14, 15, 16]. But main drawback of using OPG’s is that
diagnostic accuracy in lower anterior region is questionable when compared to normal intra
oral periapical radiograph (IOPA). Hence in some cases, selective intra oral periapical
radiographs should be used along with panoramic radiographs to provide a better diagnostic
value [3].
CONCLUSION
Our study was carried out to detect dental anomalies, pathologies, and oral lesions in the
primary and permanent dentition. The clinical manifestations of oral lesion and any
maxillofacial deformity can be detected with this type of radiograph thus preventing any other
complications in later age. Hence a dental professional must be able to differentiate between
normal and variation in normal panoramic radiographs which plays a key role in diagnosing
and treatment planning of these conditions accordingly.
ETHICAL COMPLIANCE
The authors have stated all possible conflicts of interest within this work. The authors
have stated all sources of funding for this work. If this work involved human participants,
informed consent was received from each individual. If this work involved human
participants, it was conducted in accordance with the 1964 Declaration of Helsinki. If this
work involved experiments with humans or animals, it was conducted in accordance with the
related institutions’ research ethics guidelines.
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