Orthopantomography (OPG) as the Recommended Jaw X-ray
Orthopantomography (OPG) is the recommended first-line diagnostic imaging tool for comprehensive jaw evaluation, providing a complete panoramic overview of the dentition, roots, maxilla, mandible, and surrounding anatomical structures. 1
Primary Indications for OPG
For orthodontic and dental diagnostic purposes, OPG should be obtained when evaluating:
- Suspected dental impaction (strength of recommendation A) - OPG is the first diagnostic examination after age 6 1
- Tooth anomalies including transpositions, numeric anomalies (missing or supernumerary teeth), and morphology abnormalities 1
- Treatment planning for third molar extraction in non-critical cases 1
- Root resorption and treatment progress monitoring during orthodontic treatment 1
Clinical Advantages
OPG provides several key benefits that make it the preferred initial imaging modality:
- Complete panoramic visualization of both jaws, all teeth, and adjacent structures in a single image 1
- Lower radiation exposure compared to multiple periapical radiographs or CBCT 1
- Efficient screening tool for detecting retained roots, impacted teeth, cysts, and jaw pathology 2, 3, 4
- Adequate for most diagnostic and treatment planning purposes without requiring advanced imaging 1
When OPG is NOT Indicated
Critical caveat: OPG should NOT be used for:
- Acute dental trauma - periapical intraoral radiography is the first-line examination for dentoalveolar trauma (strength of recommendation A) 1
- Post-treatment documentation - do not obtain OPG immediately before or after orthodontic appliance removal, as the most recent treatment OPG is sufficient 1
When to Escalate to Advanced Imaging
CBCT (cone beam computed tomography) should be reserved for specific situations where 2D imaging is insufficient:
- Complex third molar cases requiring assessment of mandibular canal proximity or maxillary sinus floor relationships (strength of recommendation A) 1
- Root resorption from impacted canines - OPG underestimates severity compared to CBCT 1
- Tooth transpositions with impaction requiring 3D anatomical clarification 1
- When 2D imaging cannot adequately define anatomical relationships or internal root structure (strength of recommendation A) 1
The Dutch Association of Orthodontists emphasizes that CBCT's higher radiation exposure must be justified by substantial diagnostic benefit that materially changes treatment planning 1
Age Considerations
Do not perform OPG before age 6 unless compelling clinical indications exist, as permanent tooth buds are inadequately visible and radiation exposure cannot be justified (strength of recommendation A) 1, 5
Supplementary Imaging Options
When OPG provides insufficient detail for specific regions: