2. Panoramic Technique DHY 202 Clinical Dental Hygiene I Dental Hygiene Department William Rainey Harper College

3. Introduction All panoramic machines work essentially the same, although they vary in appearance.All panoramic machines work essentially the same, although they vary in appearance. Panoramic technique can be described in 5 generic steps.Panoramic technique can be described in 5 generic steps.

4. Steps in Panoramic Technique Stand the client uprightStand the client upright Position client’s chinPosition client’s chin Close client’s teeth on bite stick grooveClose client’s teeth on bite stick groove Close the side guidesClose the side guides Provide client instructionsProvide client instructions

5. Client Preparation Remove metallic & other objects from head & neck regionRemove metallic & other objects from head & neck region Place panoramic lead apron (no thyroid collar)Place panoramic lead apron (no thyroid collar) Check for interference from bulky clothingCheck for interference from bulky clothing

6. Exposure Considerations Use next highest kVp setting for any of the following client characteristics:Use next highest kVp setting for any of the following client characteristics: ObeseObese Large bone structureLarge bone structure Use next lowest kVp setting for any of the following client characteristics:Use next lowest kVp setting for any of the following client characteristics: Frail or small bone structuresFrail or small bone structures EdentulousEdentulous

7. Steps in Panoramic Technique Guide client with gentle hand pressure in small of backGuide client with gentle hand pressure in small of back Instruct client to:Instruct client to: –Stand erect with shoulders down & relaxed –Position feet as far forward as possible –Hold machine to avoid falling backward Adjust head planes:Adjust head planes: –Midsaggital perpendicular to floor –Frankfurt parallel to floor Purpose: straighten cervical spinePurpose: straighten cervical spine Step 1 : Stand Client Upright

8. Stand the Client Upright

9. Steps in Panoramic Technique Rest chin on chin restRest chin on chin rest Purpose:Purpose: Ensure chin is tilted down -4 to -7 degrees to counter upward angle of beamEnsure chin is tilted down -4 to -7 degrees to counter upward angle of beam Support & steady client headSupport & steady client head Step 2 : Position Client’s Chin

10. Position the Client’s Chin

11. Steps in Panoramic Technique Client bites end-to-end in bite stick grooveClient bites end-to-end in bite stick groove PurposePurpose Anterior teeth in anterior part of focal troughAnterior teeth in anterior part of focal trough Separate dentition in the imageSeparate dentition in the image Center client in machineCenter client in machine Step 3: Bite in Groove

12. Bite in the Groove

13. Focal Trough Known as the image layerKnown as the image layer A three-dimensional zone in which structures are reasonably well-definedA three-dimensional zone in which structures are reasonably well-defined Determines where dental arches must be positioned to achieve clearest imageDetermines where dental arches must be positioned to achieve clearest image

14. Steps in Panoramic Technique Close side guides against client’s templesClose side guides against client’s temples Purpose:Purpose: Position posterior teeth in middle of focal trough layer on both sidesPosition posterior teeth in middle of focal trough layer on both sides Stabilize client head positionStabilize client head position Step 4: Close Side Guides

15. Close Side Guides

16. Steps in Panoramic Technique Tongue on roof of mouth-swallow or suck cheeksTongue on roof of mouth-swallow or suck cheeks Hold still (22 secs.)Hold still (22 secs.) Warn about cassette rotationWarn about cassette rotation Don’t follow machine with eyesDon’t follow machine with eyes Step 5: Client Instruction s

17. Client Instructions Swallow, Hold Expose

18. Cassette Design 5-6” x 12” rigid or flexible5-6” x 12” rigid or flexible

19. Cassette Intensifying Screens Phosphor crystal on plastic basePhosphor crystal on plastic base Fluorescence reduces radiation to clientFluorescence reduces radiation to client Fast rare earth/Lanex screens emit green lightFast rare earth/Lanex screens emit green light Film and screen must be compatibleFilm and screen must be compatible

20. Infection Control Procedures Use clean, ungloved hands to handle cassette and filmUse clean, ungloved hands to handle cassette and film Use disposable bite stickUse disposable bite stick Other infection control procedures (draping, disinfecting) if deemed necessaryOther infection control procedures (draping, disinfecting) if deemed necessary

21. The End!