Panoramic and transcranial radiology in orthodontics and craniomandibular disorders

A good summary for the uses of TMJ radiographs was presented by Jeff Okeson in 1989 as follows: "Radiographs have limited use in the identification and treatment of TM disorders. Only through collaboration with clinical findings and history do they gain significance. When there is reason to believe that an organic joint pathosis exists, radiographs of the temporomandibular joints are obtained. Transcranial and panoramic views are used as screening devices for general assessment of bony abnormalities and osteoarthritic changes. Functional movements are also evaluated and correlated with clinical findings. Tomography is reserved for patients in whom the screening radiographs reveal a possible abnormality that needs closer visualization and investigation. Arthrography is a specialized diagnostic tool to be used only when significant doubt exists regarding the position of the articular disc. CT and MRI are reserved for when additional information will improve the adequacy of the diagnosis." I could not improve upon this summary but would like to point out that Jeff is labeling both panoramic imaging and transcranial imaging as screening devices to be later followed up with more definitive type imaging.