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Practical Panoramic Radiography

William C. Scarfe, BDS, FRACDS; Gail F. Williamson, RDH, MS

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Too far backward - Posterior positioning of the patient too far back usually occurs when the patient’s teeth are not biting on the bite block. The patient may suck the bite block rather than bite it.

Figure 109.

  • Prevention of this error, as with anterior positioning errors, necessitates that a bite block is used; secondly it requires that the patient’s anterior teeth are placed in an end-to-end position in the bite block.
  • The principle effect of positioning the patient too far back is to position structures that are normally within the focal trough, like the anterior dentition, further posteriorly and out of focus. The principal visual anatomic effects are widening of the entire image, ghosting of the mandible, and blurring of the turbinates (nasal conchae) across the sinus.
  • Another effect is to bring part of the molar dentition into the crossover region of the panoramic x-ray beam and increase the possibility of ghost artifacts from the mandibular angle and ramus.
  • The most obvious effects however are those on the dentition, which include:

 

  • Wide, unsharp image of the anterior teeth with the teeth more difficult to see
  • Widened crowns
  • Roots cut off (fuzzed out)
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