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UBC Theses and Dissertations

Panoramic radiographs prior to complete denture fabrication : a retrospective study of clinical significance and quality assurance Kratz, Richard John


Purpose. There are concerns about the burden of ionizing radiation from radiographs, and consequently about the benefits of radiographic screening of edentulous mandibles. The primary aim of this retrospective study was to identify findings on digital panoramic radiographs of edentulous patients to determine how such findings impacted patient management prior to fabrication of complete dentures. Secondarily, a quality assurance assessment of the panoramic radiographs was completed by comparing two groups of students, 2nd year Introduction to Prosthodontics (IPROS) and 3rd/4th year Integrated Clinical Care (ICC), regarding radiographic interpretations completed, positional errors detected, and radiographic interpretation errors made. Methods. Two hundred digital panoramic radiographs taken on edentulous patients were identified from UBC Dentistry clinics between 2006-2012, of which 31 were excluded (clinical crowns or implants present, no digital panoramic present or analog image scanned in). An Oral and Maxillofacial Radiologist provided training and interpretation assistance, and randomly audited 20 panoramic radiographs for an observed proportion of agreement. Results. There were 165 positive radiographic findings, of which 6 (3.6%) affected patient management. 301 positional errors were also identified, with 14 (8.3%) images free of error. There were significantly more (p<0.05) radiographic interpretations completed (p=0.00014) and positional errors correctly identified (p=0.002) in IPROS compared to ICC. No significant difference was observed for radiographic interpretation errors (p=0.059) between the two student groups. Conclusion. The positive radiographic findings (PRFs) identified in the panoramic radiographs of edentulous patients in this study offered minimal benefits, with only 3.6% of PRFs affecting patient management. We would therefore recommend that panoramic radiographic screening for this patient population be discontinued. The rate of positional errors for panoramic radiographs of edentulous patients was high, indicating a need for additional staff training to minimize errors and to maximize diagnostic benefits.

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