Panoramic X-rays. Comprehensive radiodiagnostics or radiation protection at all costs?

A case report is presented to examine the question of whether a panoramic x-ray in standard projection can be readily replaced by a radiation-reduced projection with shielding of the condylar processes.A female patient with juvenile idiopathic arthritis was examined by a panoramic x-ray and MRI prior to TMJ splinting. The panoramic x-ray in standard projection showed short, atypically-shaped condylar processes with cystic lesions and cortical erosion. The MRI confirmed the TMJ destruction. The condylar processes were shielded on the x-rays taken for a previous orthodontic treatment. Thus TMJ assessment was not done, though it is an integral part of orthodontic radiodiagnostics according to Hirschfelder and other authors. This example of juvenile idiopathic arthritis with TMJ involvement shows that visualization of the condylar processes is indispensable.