Panoramic radiographs: necessary for edentulous patients?

A study of the impact of screening or selective radiography on the treatment and postdelivery outcome for edentulous patients

OBJECTIVE

The purpose of this study was to assess the impact of radiographic findings on complete denture treatment and on the postdelivery course of those patients who had pretreatment radiographs (the screening group) and those who did not (the selection group).

METHOD

In total, 375 cases were randomly selected by systematic sampling. Data collected included patient demographic information and denture history, predenture fabrication radiographic findings, and postdenture delivery complaints.

RESULTS

Of the screening patients, 100% had pretreatment radiographs made; this compared with 13.5% of the selection patients. In the screening group, 68.3% of patients had one or more positive radiographic findings recorded. Of the screening patients, 8.3% received treatment before denture fabrication; this compared with 1.2% of the selection patients. Of the 375 cases, 2 screening patients had postdelivery complaints that required management other than denture adjustment.

CONCLUSION

The results indicate that there is weak scientific support for the guideline recommending routine pretreatment radiography for new denture patients.

An analysis of the scientific basis for the radiographic guideline for new edentulous patients

The FDA Radiology Guideline for the new edentulous patient recommends an initial survey of the arches. In the process of developing this recommendation, the expert panel reviewed the available literature and concluded that there was sufficient evidence to warrant screening radiography rather than selective radiography, which is the principle on which all the other recommendations are based. Our evaluation of the literature used by the panel for the edentulous recommendation identifies critical errors in the analysis of the data. Factors such as a vague definition of abnormality and a geographically diverse sample population might have led the expert panel to suggest a very conservative recommendation for this group of patients. The recommendation failed to consider the treatment impact of findings and was based simply on the large number of observations, regardless of their treatment or pathologic significance. However, in studies in which treatment is considered, it is clear that screening radiography for new edentulous patients does not yield sufficient clinically relevant information to support the guideline.

Common errors in panoramic radiography of edentulous patients

PURPOSE

Instructions for patient positioning during panoramic radiography usually describe positioning dentate patients, and errors in patient positioning are commonly identified by distortion of the dentition. The purposes of this study were to identify common errors in panoramic radiography of edentulous patients, describe the image distortions that can be expected with positioning errors in edentulous patients, and review quality assurance methods that improve the diagnostic value of panoramic films.

MATERIALS AND METHODS

Panoramic films were randomly selected from the inactive files of 75 edentulous patients seen at the dental school for complete denture construction. The radiographs were numbered and reviewed by a board-certified oral and maxillofacial radiologist trained to identify errors in panoramic radiography.

RESULTS

Of the 75 panoramic radiographs examined, only 6 films (8.0%) were free of errors, and 67 films (89.3%) had one or more errors in patient positioning and 33 films (44.0%) had one or more technical errors. The most common positioning errors were positioning the chin too high (32 films, 41.3%) and positioning the patient too far forward (26 films, 34.7%).

CONCLUSIONS

Without modification, manufacturer's instructions for positioning dentate patients during panoramic radiography may result in positioning errors on the panoramic radiographs of edentulous patients. Proper training and appropriate attention to detail while exposing and developing panoramic films are required to ensure maximum diagnostic benefits for edentulous patients.