Panoramic and restrictive intraoral radiography in comprehensive oral radiographic diagnosis

It has been suggested that information from the panoramic radiograph makes it possible to appropriately select supplementary intraoral radiographs to achieve a comprehensive examination of teeth and surrounding bone with less patient dose but no significant information loss. Number of intraoral radiographs selected, information loss and monetary costs with such a procedure was evaluated in 40 patients. Results show that, on average, 5.1 intraoral radiographs were selected to supplement the panoramic radiograph. Of these, 3.1 contained information different from that in the panoramic radiograph but 2.0 did not. An additional 3.4 ought to have been taken to reach the result of the ‘gold standard’ achieved from a simultaneous evaluation by two expert observers of panoramic radiographs and full mouth surveys with intraoral radiographs. Sensitivity for the combined use of panoramic and supplementary intraoral radiographs was high (80–96%, depending on type of teeth) as regards periapical lesions and marginal bone loss but low for caries (42–96%). Specificity was high for periapical lesions and caries (95–97%) but low for marginal bone loss (50–92%). In Sweden, patient costs become almost the same for a combination of panoramic radiography and 8.5’intraoral radiographs as for a full mouth survey comprising 20 intraoral radiographs. The radiation dose reduction is 40–50% considering that the dose from a panoramic radiograph approximately corresponds to 2–4 intraoral radiographs. We conclude that using panoramic radiography in combination with selected intraoral radiographs is possible if the radiographic examination is preceded by a thorough clinical examination and the following parameters are correctly evaluated before the examination: patient category, radiation dose, information loss, patient discomfort, time consumption and monetary costs.