This article contains a literature review pertaining to panoramic radiographs and their use as investigative tools in orthodontic diagnoses and treatment planning. The objective was to evaluate the clinical necessity of panoramic radiograph in orthodontic diagnosis and treatment planning if it is to be applied as a pre-treatment. Five pieces of literature were selected after applying key words to internet search engines. Two pieces of literature projected procedure errors, which ought to be addressed in facilitating the process and enhancing accurate diagnoses. In the first study a sample of 1287 radiographs, 96% contained errors. According to the researchers criteria these errors ranged from 1-5 of their ratings in 24% of the images. These results were considered important to clinical decision making process. Displacement between the tongue and contact with hard palate was discovered to be the most recurring error. Five hundred and fifty eight pateints were diagnosed with anomalies were found in 558 patients. In the second study One thousand seven hundred and eighty two images were examined. Approximately 11% (196) contained errors. Positioning errors identified included tongue - palate inadequacies 55%; patient movement during diagnosis was the least 1.6%. In total, 64% of all images were acceptable and 24% unacceptable, while 11% were excellent. It was concluded that while this modern technology is useful in aiding several diagnoses and treatment application in-depth research regarding positioning errors must be addressed.
It is understood that radiographic investigations are often used when evaluating orthodontic patients. Researchers have found, however, that every exposure carries with it peculiar risks. Younger patients seem more vulnerable. In the United Kingdom Ionizing Radiation regulations insist that exposure be justified by first establishing benefits of conducting the procedure. Investigations prove that Dental panoramic tomography (DPT) is very useful in supplying data on a number of jaw abnormalities and dysfunctions.
As such, this literature review hopes to evaluate the clinical necessity of panoramic radiograph in orthodontic diagnosis and treatment planning if it is to be applied as a pre-treatment.
Method (Literature Review)
Literature 1: Frequency of errors and pathology in panoramic images of young orthodontic patients by Christina M. Granlund; Agneta Lith and Björn Molander.
It was discovered that from a sample of 1287 radiographs, 96% contained errors. According to the researchers criteria these errors ranged from 1-5 of their ratings in 24% of the images. These results were considered important to clinical decision making process. Displacement between the tongue and contact with hard palate was discovered to be the most recurring error. Five hundred and fifty eight pateints were diagnosed with anomalies were found in 558 patients. Ultimately, even though definite diagnoses could not have been made without further evaluations a total of one thousand two hundred and twenty-one findings relevant to orthodontic treatment were recorded from the study. Pathologies away from the dental arches were few. This in itself could be a reason for postponing starting radiation treatment in pateints with these diagnoses (Granlund et. al, 2012).
Major conclusions drawn from this study were that there are difficulties encountered in taking panoramic radiographs to eliminate positioning errors. Therefore, clinicians ought to be conscious of pathological incidences in young symptom free patients even though this is uncommon. Recommendations were that specialists ought to reconsider radiation treatment in limiting it only to dento-alveolar regions (Granlund et. al, 2012).
Literature 11: Panoramic radiographic Assessment in orthodontics by Siveria and Farman. This article is found in chapter 8 of the text.
In summarizing the authors advanced that panoramic radiography has a very significant place supporting orthodontic evaluation in relation to pre-treatment planning as well as post-treatment assessments of failure or success in execution of the procedure. Importantly they are essential to assessing the presence or absence peculiar types of teeth because it describes structure and morphology. Spatial relationships along with eruption sequences are also identified. Importantly, panoramic radiography is recommended by the American Board of Orthodontics as a treatment assessment strategy (Schulze, Krummenauer, Schalldach & d'Hoedt, 2000)
Many successful case studies have been tendered by members of the Diplomatic profession. Tooth root parallelism has been treated by panoramic radiographs. Further the authors explained how expedient it is imaging projection showing dental arches and supporting physical structures in the jaw such as bone. Precisely, the analysts provided evidence to prove that the technique is very effective in diagnosing dentition anomalies, bone morphology originating in the alveoli and abnormalities in the associating maxillofacial structures. The advantages include obtaining optimal treatment after a thorough examination of the jaw and teeth (Saglam, 2003).
Literature 111: Contemporary Orthodontics by Proffit, Fields and Sarver
These authors contend that protruding, crowding, irregular teeth have been a long standing problem for many. However, with the advent of panoramic radiography there is hope of resolving these dental issues. In evaluating the clinical necessity of panoramic radiograph in orthodontic diagnosis and treatment planning if it is to be applied as a pre-treatment, the author advanced that the focus of cosmetic and corrective dentistry is effectively aligning teeth to facial muscles enhancing face presentations and relieving discomfort. Therefore, panoramic orthography is mandatory. In fact it facilitates detection of facial non alignment during imaging and diagnosis. Consequently, strategies for correction of disproportions are designed (Oshagh, Shahidi, Najafi, & Saki, 2014).
Also, they continue to argue that for efficient prosthetic replacement panoramic orthographic is very useful. Other concepts such as occlusion identification have emerged. As such, it is imperative that proper imaging mechanisms be created to address angling of teeth and facial muscles. Further, in providing perfect angling accurate positioning is priority. Consequently, applications of panoramic imaging techniques in diagnostic procedures are mandatory (White & Pharoh, 2005).
Literature 1V: Positioning errors and quality assessment in panoramic radiography by Dhillion, Raju and Verma
The researchers focused their study on determining the relative frequency of positioning errors relating it to their diagnostic significance in creating inadequate images. Subsequently, these images could produce inconsistent diagnoses, which affect treatment interventions later. One thousand seven hundred and eighty two images were examined. Approximately 11% (196) contained errors (Dhillion, Raju & Verma, 2012).
Positioning errors identified included tongue - palate inadequacies 55%; patient movement during diagnosis was the least 1.6%. In total, 64% of all images were acceptable and 24% unacceptable, while 11% were excellent. The researchers concluded that with the increasing dependence of panosonic imaging for orthodontic diagnosis and treatment in the twenty first century improvement in positioning could enhance diagnosis and effective treatment (Elslande, Russett & Major, 2008).
Literature V: Practical Panoramic Radiography by Scarfe and Williamson
This expert opinion article outlined indications for panoramic imaging reiterating that criteria revisions were made in 2004. Suggestions included new indications for evaluating growth and development in children and adolescents tin examining mixed dentition and assessing third molars. In adults the procedure could be conducted as survey option in assessing dentate or partially edentulous. Specifically, periapicals and bitewings ought to be the focus of the panoramic viewing. The procedure is indicated also for diagnostic purposes in edentulous patient as well as facial trauma and for conducting extensive bony lesion evaluations (Scarfe & Williamson).
Next, panoramic radiography has a very significant place supporting orthodontic evaluation in relation to pre-treatment planning as well as post-treatment assessments of failure or success in execution of the procedure (Siveria & Farman, 2014). Third, panoramic radiography in contemporary orthodontics is very effective in diagnosis and treatment of orthodontic irregularities such as protruding, crowding, irregular teeth (Proffit et.al, 2013).
Subsequently, it was discovered that positioning errors affect quality of assessment in panoramic radiography and ought to be addressed when panoramic imaging is conducted in dentistry since it would enhance accuracy in diagnosis and treatment, ultimately (Dhillion et.al, 2012). Finally, guidelines criteria for panoramic orthography give clear indications pertaining to the specifics of the intervention (Scarfe &Williamson, 2014)
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