How does the procedure work?
An orthopantomogram (abbreviated as OPTG) is an overview circular photograph of the teeth, which shows the entire jaw, unfolded in a plane. In addition to teeth, roots, canals, crowns and fillings, such an image can also be used to study the condition of periodontal tissues, maxillary sinuses, and sinuses.
A panoramic photograph of teeth also helps to identify hidden carious cavities, cysts, inflammations, periodontal pockets, abscesses, and to analyze the exact condition of the roots and periodontal tissues, the temporomandibular joint, and the maxillary sinuses. In addition, OPTG is indispensable if orthodontic treatment with aligners or braces is planned.
In the process of preparing for dental implantation, using a panoramic image, the doctor can determine whether there is enough bone tissue for implantation or a sinus lift is required, how many implants are needed and what their optimal sizes are, as well as what the dynamics of their engraftment will be.
It is extremely important to do an orthopantomogram to find out the position and condition of the wisdom teeth. That is why a competent doctor makes a decision whether to remove or cure the “eight” only after analyzing a panoramic image.
Edematous-proteinuric hypertensive gestosis (OPG-gestosis)
Edematous-proteinuric hypertensive gestosis (OPG-gestosis) develops more often at the 25th week of pregnancy or later, sometimes shortly before birth. Predominant in primiparous women. Risk factors are diabetes mellitus, kidney disease in the prenatal period, Rh incompatibility, the age of the pregnant woman is less than 18 and over 35 years, obesity, polyhydramnios, multiple pregnancies, etc. Characteristic of this pathology is high sensitivity to endogenous pressor peptides and amines.
Hypertension is nephrogenic in nature. Blood pressure level is one of the criteria for the severity of OPG-preeclampsia. So, with the first degree of severity, the blood pressure level reaches 150/90 mm Hg, with the second it reaches 170-180/100-110, and with the third it exceeds 180/110 mm Hg. An increase in diastolic blood pressure with a decrease in pulse pressure often predominates. Sometimes a complication such as eclampsia occurs. Preeclampsia, which develops against the background of previous hypertension, chronic glomerulonephritis and other diseases, has a more severe course.
OPG-gestosis must be distinguished from other variants of increased blood pressure in pregnant women, which are usually transient in nature. These include:
a) transient hypertension during hypercortisolism of pregnant women (physiological Cushing's syndrome) is caused by additional synthesis of ACTH in the placenta. Obesity, moon face, hirsutism, pink stretch marks and hypertension occur. After childbirth, a complete involution of symptoms is observed. No treatment required;
b) functional increase in GH during pregnancy: acromegaloid facial features appear, a moderate increase in blood pressure (it should be remembered that the criterion for hypertension in pregnant women is a blood pressure level > 130/80 mm Hg). Symptoms disappear after childbirth.
Diagnostics.
For OPG-preeclampsia: comprehensive examination of the kidneys. In the blood there is depression of all sterol and protein hormones, except prolactin. Total hyperlipidemia. Strengthening the adhesive properties of platelets, a chronic form of DIC syndrome is possible.
Treatment.
When treating hypertension in pregnant women, the safest first-line drugs are dopegit, long-acting nifedipine, hydralazine, labetolol. (beta-blockers can be used in the third trimester of pregnancy, and in earlier stages they cause fetal growth retardation. ACE inhibitors and AT1 receptor blockers are contraindicated (teratogenic effect, possibility of fetal death). Diuretics are not recommended due to the risk of reducing blood volume and reducing placental perfusion .
Digital or film orthopantomogram: what to choose?
Digital equipment today has practically replaced film analogues from practice. Although they cost clinics more, they do not require the costs of consumables and darkroom equipment.
In addition, film devices are characterized by a higher degree of radiation.
A panoramic image taken digitally is instantly transferred to the doctor’s computer and entered into the patient’s electronic record. If desired, the latter can receive the image on disk or in printed form.
Finally, the image quality with digital equipment is much higher than with film equipment. This means that the specialist receives better information for further work.
Why do you need a panoramic photo?
A panoramic photograph of the dentition is taken to diagnose the general condition of the oral cavity. The procedure is not painful. The only thing the patient faces in this case is the need to open his mouth wide while standing.
The procedure has its own indications, which are determined by the attending physician. Usually they are provided for in the future of any serious procedures and are as follows:
- dental implantation;
- its alignment;
- treatment of periodontal disease;
- inflammation of the soft tissues of the oral cavity;
- assessment of tooth growth rate;
- surgical intervention.
It is worth considering that before an orthopantogram you should remove all objects that interfere with the passage of x-rays (jewelry, etc.).
Patient protection is mandatory during the procedure. To carry it out, he wears an apron made with lead and a special collar on the neck area. This helps avoid radiation exposure and subsequent problems from the harmful effects of X-rays.
It is worth understanding that the safety of x-rays is achieved only when all necessary measures are followed. In addition, the better the device, the faster and better quality the picture will be. The X-ray of a digital orthopantomograph is better than that of a film one.
How is X-ray performed?
As already mentioned, the patient must stand. His chest should be pressed against the platform, which determines the correct position in space. The conditions of the procedure stipulate that he will need to bite a special plastic stick, after first pressing his tongue against the soft palate. Lips must be closed.
The doctor may ask you to change the position of the head so that the x-ray can cover the required area and the diagnosis is correct.
Currently, the procedure is performed using a safer PaX-i3d “Green” tomograph. Its main differences from devices of previous generations are that it is safer and scans an order of magnitude faster, protecting not only the patient, but also the clinic staff from exposure to X-rays.
What are the advantages and disadvantages of OPTG
An orthopantogram can significantly improve the quality of diagnosis, and today dental treatment is practically not carried out without radiography, except for minor problems. Among the undeniable advantages of the technique, experts highlight the following points:
- speed of the procedure - literally in a couple of minutes the image is ready for study;
- modern equipment makes it possible to adjust the height and trajectory of the emitter, which made diagnostics possible for children and wheelchair users;
- minimal radiation exposure and absolute safety for the body;
- high quality and accuracy of the obtained images;
- the ability to zoom in on the area under study and study it in detail on a computer monitor.
With an orthopantomogram, minimal radiation exposure is used. If we talk about the disadvantages, the main disadvantage of OPTG is obtaining a flat two-dimensional image. As a result, the image may slightly distort the dimensions of teeth, root canals and bone tissue. Such deviations can vary from 15 to 30%. To obtain a more accurate image, it is better to resort to computed tomography.
Acceptability during pregnancy
Panoramic tomography is extremely undesirable for patients during pregnancy - in such cases it is performed only if there is an urgent need. The procedure poses an increased risk during the first trimester. In later stages of pregnancy, X-ray radiation will not have such a severe effect, but can still cause certain disturbances in the functioning of internal systems. For example, the thyroid gland is especially sensitive to the effects of radiation.
When is it appointed?
An orthopantomogram is an indispensable diagnostic procedure in most clinical cases:
- For diagnosing pulpitis, carious lesions, periostitis - in diagnostic and treatment dentistry;
- To determine the condition of the dentition, bone tissue, TMJ - in orthopedic dentistry;
- To study the position of teeth, tooth germs, the presence of inflammation - in surgical dentistry;
- To determine the position of teeth, as well as jaws - in orthodontic dentistry;
- To determine the integrity of bone tissue, characteristics of the alveolar processes, TMJ and other specific features of the patient’s jaws - in implantology;
- For diagnostic monitoring of various pathologies, teething, identifying the reasons for the delay in this process - in pediatric dentistry;
- To identify abnormalities of the paranasal sinuses and nasal passages - in ENT therapy;
- To assess the severity of injuries - in case of traumatic phenomena of the maxillofacial zone.
Thanks to digital radiography technology, radiation exposure is minimized by up to 90% compared to conventional X-ray examinations.
Cost of dental examination
The cost of an orthopantomogram in clinics in Moscow and the regions starts from 700 rubles. But sometimes patients undergo it for free, for example, during turnkey implantation, when the total price of dental restoration already includes all the necessary diagnostic methods, consultations, implants, dentures and the work of specialists.
Chibisova M.A. Digital and film radiography in outpatient dentistry, 2004.
Author: Bespalov R. D. (Thank you for your help in writing the article and the information provided)
Information content of the image and reading (deciphering) technique
If you undergo an examination at a specialized diagnostic institution, the finished image is usually accompanied by an explanation from a specialist with a list of detected problems. Many people are interested in how to decipher an image on their own, how to read it correctly, and whether it can be understood at all. It should be noted here that in order to correctly explain the results of OPTG, you need to have a good understanding of the anatomy of the maxillofacial apparatus, and without the appropriate education, little can be understood. It is better to entrust this task to an experienced, qualified doctor.
Orthopantomogram 3D
A three-dimensional panoramic x-ray of the jaw can be performed with a computed tomograph. He takes many sequential photographs in different projections and then completes the image in a computer program. The result is a three-dimensional image of the jaw without distortions, which are inevitably present on a conventional otopantomogram, since it conveys a curved object in a flat form. Only with the help of computed tomography does it become possible to look at an object from a different angle or in a different projection without taking new pictures. Also, this method of examination allows the doctor, in the absence of the patient, to see an image of his jaw and examine it from any side and even at any depth.
Potential dangers and possible complications
Many patients in dental clinics are interested in quite natural questions regarding whether an orthopantomogram is harmful and how often it can be done so as not to cause harm to health. Let's start with the fact that if you follow the technology of the procedure, you should not be afraid of any problems. One of the potential complications may be excessive radiation exposure, however, with modern equipment this situation is excluded, even though OPTG will have to be performed at least 2-3 times during implantation, as well as several more times during the year after it to monitor the results of treatment .
Numerous studies on the safety of using an orthopantomograph have proven that with a single procedure, the patient receives a radiation dose corresponding to values in the range from 10 to 40 μSv . This is an acceptable and completely harmless dosage that does not pose any threat to the human body. For comparison: with a single fluorography procedure, the radiation dose is up to 500 μSv.
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