SmarterDA - Dental Assisting Boards Prep Courses
SmarterDA - Dental Assisting Boards Prep Courses
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7/31/2017 7:59:59 PM   |   Comments: 0   |   Views: 684


I often refer a radiographic exposure to a photoshoot session to our SmarterDA (Dental Assisting exam prep) users. The camera person is the clinician, and the model is the patient. To create the best effect, the photographer (clinician) should provide excellent instructions.

Panoramic radiography can be used in the following situations; for general surveys of oral health, to determine the best radiographic supplements for surgical procedures, for initial and progressive evaluations of orthodontic treatment, for information about pediatric growth and development, to review chronological dental eruptions and the axes of permanent tooth eruptions, to evaluate cystic or neoplastic lesions, to measure the dimensions for implantology, for historical documentation, to evaluate the temporomandibular joint, and to detect the presence of foreign bodies.1

According to the research conducted on positioning errors and published in Imaging Science in Dentistry, about 90% of panoramic images were presented with errors while only about 10% were error free. The ranking of positioning errors are as follows:2

1. Tongue not touching the palate during exposure (55.7%)

2. Slumped position (35%)

3. Patient positioned back (30%)

4. Patient positioned forward (18.3%)

5. Chin tipped high (17.9%)

6. Head is turned to one side (17.4%)

7. Chin tipped low (16.2%)

8. Head is tilted to the side (12.7%)

9. Patient movement during exposure (1.6%)


This article aims at summarizing how to detect the panoramic radiographic errors and to provide instructions on how to correct them. The goal is to successfully pass the dental assisting board exams and also to become the superstar dental assistant everyone wants on their team!

1. De Senna BR, Dos Santos Silva VK, França JP, Marques LS, Pereira LJ. Imaging diagnosis of the temporomandibular joint: critical review of indications and new perspectives. Oral Radiol. 2009; 25:86–98

2. Dhillon M, Raju SM, Verma S, Tomar D, Mohan RS, Lakhanpal M, et al. Positioning errors and quality assessment in panoramic radiography. Imaging Sci Dent. 2012; 42:207–212.


Panoramic Radiograph Errors + How to correct them [SUMMARY]



Error: Branch like marks, round clusters

Cause: Static electricity occurred when removing film from cassette

Correction: Avoid rapid removal of film from cassette


Error: White opacity at the bottom of film shaped like inverted “V” (also called “shark fin’ error)

Cause: Lead apron is above the collar line

Correction: Lower the apron

Note: The panoramic radiograph lead apron does NOT have a color


Error: Unwanted white opacity

Cause: Metal foreign object (tongue ring, piercing, braces, etc.) is present

Correction: Remove object prior to exposure if possible

Ghost image (magnified, blurry, and displayed on the opposite side of the radiographic image)

Note: Ghost image can also be of a body part such as the ramus


Error: White tapered opacity in middle of image (also called Washington Monument error)

Cause: Patient’s spine is slumped

Correction: Have patient take a step forward, straighten the back/neck, and lean slightly back


Error: Large, dark shadow over maxillary teeth between palate and dorsum of tongue

Cause: Patient’s tongue is not touching the roof of mouth

Correction: Instruct patient to place tongue in roof of mouth prior to exposure


Error: Thin and blurry anterior teeth, spine visible on sides of film

Cause: Patient is biting too far forward on the rod

Correction: Make sure anterior teeth are in grooves on the bite block


Error: Fat and blurry anterior teeth, condyles close to edge of film

Cause: Patient is biting too far back on rod

Correction: Make sure anterior teeth are in grooves on the bite block


Error: Exaggerated smile line, condyles at the top of film, spine forms arch

Cause: Patient’s chin is tipped too far down

Correction: Position the Frankfurt line (bottom of orbit to the middle of the ear) parallel to the floor


Error: Flat smile line, hard palate superimposed on roots, broad and flat mandible, condyles at edge of film

Cause: Patient’s chin is tipped too far up

Correction: Position the Frankfurt line (bottom of orbit to the middle of the ear) parallel to the floor


Error: Teeth and ramus are wider on one side

Cause: Patient’s head is twisted

Correction: Center the head’s midline, use the beam guides

Note: The side with the wider condyle is the side closer to the tubehead)


Error: Condyles are not equal in height

Cause: Patient’s is head tipped

Correction: Reposition head using proper guidelines for the machine


Error: Blurred portions of radiograph, large defects

Cause: Patient moved during exposure

Correction: Instruct patient to hold still prior to and during exposure


Error: Images of springs or rectangular radiolucencies visible on film

Cause: Cassette was placed in machine backward

Correction: Follow instructions on the cassette (e.g., this side faces the tubehead, right/left, this side up, etc.).

If instructions are not provided, create markings for future reference (e.g., write with a marker: This side tubehead, etc.)


As you can see, small details can make a difference. As a dental professional, it is important to minimize the exposure to radiograph, therefore, avoid re-takes.

Type: YouTube + SmarterDA

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