Frequency of errors and pathology in panoramic images of young orthodontic patients

The aims of this study were to evaluate the frequency of errors in panoramic radiographs in young orthodontic patients, to register pathologic and abnormal conditions, and to compare these findings with the patient's record. A total of 1287 panoramic radiographs of children and adolescents (530 boys and 757 girls; mean age 14.2 years) were analyzed. The radiographs were obtained of patients referred for orthodontic treatment during a 1 year period. Four observers evaluated the radiographs for 10 common errors, pathologies, and/or anomalies. Cohen's kappa was used for the calculations of inter- and intraobserver variability. Five of the errors were divided into clinically relevant or not clinically relevant errors, i.e. errors influencing diagnosis. Only those pathological findings with a possible influence on orthodontic treatment were compared with the patient's record. Of the 1287 radiographs, 96 per cent had errors. The number of errors in each image varied between 1 and 5, and in 24 per cent of these images, the errors could be of importance for clinical decision making. The most common error was that the tongue was not in contact with the hard palate. Pathologies or anomalies were found in 558 patients and a total of 1221 findings were recorded. Findings of possible relevance for orthodontic treatment were 63, and 12 of those were registered in the patient records. Pathological findings outside the dental arches were low and could be an argument for minimizing the radiation field.