Evaluation of Panoramic Acquisition Errors by Predoctoral Dental Students

Panoramic radiography is commonly used in the management of dental-alveolar pathology. Novice clinicians are prone to technical errors that diminish the diagnostic quality of radiographs. The objective of this study was to analyze technical errors made during panoramic exposures by third-year (D3) dental students in order to enhance educational outcomes.

Four panoramic formative assessments (FAs) and one final summative assessment (SA) conducted by D3 students were evaluated. Technical errors-including misalignment of Frankfort plane, midsagittal plane, focal trough, tongue and spinal positioning, presence of foreign objects, and exposure errors-were recorded. Error counts and probabilities, as well as changes in error patterns across assessments, were analyzed using the Clopper-Pearson interval and the SCORE method, respectively.

The most common errors among D3 students were chin up (41.02%), head rotation (24.84%), tongue placement errors (17.19%), chin down (16.36%), head tilt (9.91%), and presence of foreign objects (9.14%). Students made up to four errors/exposure, with most making either one (37.93%) or two (36.12%) errors. The majority of images were diagnostic, with only three nondiagnostic images in FA2 and one in FA3. Although there was no statistically significant difference in error probabilities across assessments, an increasing trend in Frankfort plane, midsagittal plane, and spinal positioning errors was observed in SA.

All D3 students passed SA by producing diagnostic panoramic radiographs, demonstrating the effectiveness of clinical instruction. However, errors involving Frankfort plane, midsagittal plane, and spinal positioning persisted, suggesting that enhanced instructional focus on these areas is necessary to optimize the imaging performance of dental students.