Panorex X-ray machines may be preferred by many dental professionals for their relatively low cost, reliability, relatively short learning curve, and the low radiation dose required to capture an image. 

However, no piece of equipment is immune to improper use or user error, and there are still many different types of artifacts that can manifest on a panoramic X-ray image. Here are some of the most common, as well as some methods to minimize their apparition. 

Dark Occlusion Over Maxillary Apices 

This is a relatively common artifact that makes it difficult to see the maxillary apices, and it has a few common causes. 

One cause is that the patient might not be holding their tongue against the roof of their mouth. This artifact may present if the occlusal plane is too flat, in which case the patient should be instructed to tilt their chin downward slightly. 

Dark Occlusion Around Anterior Teeth

A dark shadow around the anterior teeth may have been caused by the patient’s failure to close the mouth and lips; instructing them to do so may help prevent this issue. 

Central Cloud Artifact 

If there is a vertically-oriented, central cloudy artifact through the radiograph, the most likely cause is that your patient was “goosenecked”; that is, he or she was hunched forward during exposure, causing the spine to be captured in the back of the image.

Assisting the patient with standing erect so that the spine is as straight and vertical as possible, so that the X-rays don’t need to pass between it and the teeth, should help redress this artifact. 

Anteriors Look Too Wide or Too Narrow

If the anteriors look too narrow and bunched up, it might be because the patient is not biting the groove in the bite stick that aligns them appropriately. 

If they are wide and appear distorted, that could be for the same reason, and you should double check the laser positioning on the patient to make sure it is properly aligned.

Occusal Pointed Up (or Down) 

If the occlusal plane is sharply pointed either up or down, that is likely because the patient’s chin is angled accordingly. Check patient positioning before retaking the scan to make sure it is at the proper angle so as not to distort the image.

Jewelry Artifacts 

Jewelry, like earrings, can not only disrupt the scan where present, but can also present as a ghost artifact in another area of the image. Double check to make sure patients have removed all jewelry and all other radiodense objects before capturing a scan.

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These artifacts, though common in scans captured by panorex X-ray machines, may highlight another issue. It is possible that panoramic scans may not be capturing the details needed for you to render an accurate diagnosis or uphold a proper standard of care. 

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