A panoramic radiograph shows a defect ABOVE the maxillary teeth. How would you correct this artifact?

Ask the patient to raise their tongue to the palate (A). The artifact above the maxillary teeth in a panoramic radiograph is the 'air shadow' or 'ghost image' caused by the patient's tongue NOT being in contact with the palate during exposure. When the tongue is down, an air space forms between the dorsum of the tongue and the palate, creating a radiolucent band that overlies (and obscures) the maxillary posterior root apices.

• Correction: instruct the patient to place tongue on the palate (swallow and hold) before and during the exposure.
• Other common panoramic errors: chin too high (smiling curve), chin too low (frowning/reversed curve), patient too far forward (blurry anterior teeth), ghost images from jewelry/restorations.