Positioning and preparation errors impacting dental panoramic radiographs in patients with mixed dentition.

Purpose: This study aimed to evaluate the quality of clinically indicated digital dental panoramic radiographs (DPRs) of children with mixed dentition. Despite the likely widespread use of this modality, recent research detailing errors on DPRs is scarce. Materials and Methods: A consecutive case series was performed, including 178 DPRs from patients aged 6 to 12 years. Each DPR was reviewed for 10 distinct errors. The findings were analyzed to identify potential solutions. Results: Nearly three-quarters of the DPRs contained multiple errors. Linear regression analysis indicated that the number of errors decreased with increasing patient age; however, this trend was not statistically significant. Notably, 3 groups of errors (2 errors each) frequently appeared together on the same DPR. When similar errors were grouped, the error incidence decreased significantly with age. Both leftward head tilting and rightward head rotation were observed, likely attributable to the design of the DPR room and the door location. The inter-rater and intra-rater reliability agreements were deemed "substantial" or "almost perfect, beyond chance" for the detection of most errors, particularly the most frequent types, which involved the "chin," "tongue," and "lips-open" positions. Conclusion: As a pediatric patient ages, the number of DPR errors decreases. The results suggest several pre-exposure strategies that could reduce the error rate. These include, monitoring for a "lips-open" position as an indicator of a potential "tongue" error (occluding the palate-glossal space), and implementing dry runs. Asymmetries observed on DPR must be documented and should prompt re-examination, as they may be genuine.