Reading X rays?

For those us us with just a pano and a PA . Why does a pano image show an implant about 2 or 3 mm mesial to the mental foramen than a PA ? I understand loops and branches and averages distances to avoid complications but I am wondering if panos have ANY value at all now in our 3D profession. I may put the pano in my barn!

DR KG comments:

There were 1000s of implants placed successfully pre- CBCT Era utilising Pano only. I hope this answers your question.

Dr. B comments:

As long as everything comes out fine. However, as an expert witness, trying to defend a 2D case when the opposing side will show 3D images, 3D models, guided surgery, robotic surgery, etc. it is hard to overcome. You're not judged by your professional peers, but your peers in the community. No matter what the content presented, the 3D imagery is a very hard obstacle to overcome. More and more literature, school teaching, continuing educational courses, etc. also lean to a standard of care that is beyond 2D. Standard of care will be the battle of the experts, but in the mind of juror, when the opposing side holds up a PA and compares it to a computer manipulated CT, it is a big uphill battle to win.

You would think the literature defines the standard, but it is ultimately shaped what happens in the legal arena.

AJM comments:

Put the pano in the barn. Time to move on.

Dale Gerke-Prosthodontist comments:

OPGs are still an excellent way to quickly and easily scan for possible dental and maxillo facial issues. however it has been a long time since an OPG would be considered an acceptable diagnostic tool in regards to implant placement. this is always the case when technology evolves and medical science progresses. it is all to do with standard of care and what is best for the patient. 3D radiographs have raised the standard of implant care considerably. irrespective of medical-legal issues (which of course are an important consideration for practitioners) we always need to place the patients' needs first. i doubt anyone with training and experience would argue that a 3d images is not a necessity before placing an implant. developing this point of view further, from a medico-legal aspect i think there is a strong argument in regards to surgical guides. although many with expertise might suggest they are not needed, i feel that they are necessary to deliver a reasonable standard of care. such is the natural progress of dentistry - especially over the last 30 years. Dr Dale Gerke - Prosthodontist