Panoramic Radiograph (OPG)

What it does

Panoramic Radiograph reads the orthopantomogram (OPG), the screening image taken for new patients and before orthodontic or surgical treatment. Upload one panoramic X-ray; the run finds every tooth, numbers it with the FDI two-digit system, including deciduous and mixed dentitions, and builds an odontogram of the whole mouth.

Each tooth in the odontogram carries its restorative status (fillings, crowns, bridges, root-canal treatment, implants, or missing), caries with depth, periapical radiolucency and an estimated alveolar bone level. Impacted teeth and third molars get their Winter angulation, Pell & Gregory class, eruption level and the radiographic signs of proximity to the inferior alveolar canal. Guidance points to the next image where the panoramic view is not enough, such as a bitewing for early interproximal caries or a CBCT before a high-risk extraction.

Intended use

Decision support for the dentist who reads the OPG chair-side, usually without a radiologist's report: a complete chart and problem list to check against the clinical examination, and a second look at caries, apical lesions and third-molar risk. Every finding is linked to a tooth number.

Who it is for

General dentists, oral and maxillofacial surgeons, orthodontists, endodontists, periodontists and dental students. Developers bring the odontogram and findings into practice-management software or a dental imaging viewer.

Accepted input

• DICOM: panoramic images with modality PX, usually as Digital X-Ray objects.
• Image exports: JPEG or PNG exported from practice software, accepted with a calibration warning.
• One panoramic image per request; deciduous, mixed and permanent dentitions are all read.

Requirements

Requirement	Why
A panoramic projection	Bitewings, periapicals and cephalograms are read by their own models
Correct patient positioning	Positioning errors distort the teeth and are flagged
Left and right orientation	Tooth numbering depends on the side; orientation is normalised before charting
Pixel Spacing or Imager Pixel Spacing	Image exports without it carry a calibration warning

A panoramic image magnifies unevenly across its width, so bone loss is expressed as a percentage of root length and never in millimetres. Ghost images and overlapping premolar contacts are known limits and are flagged where they affect a tooth.

Optional context

Age (relevant for mixed dentition and third-molar development), the reason for the X-ray and known treatment history go in clinical_context.

The result

One JSON result with an FDI-numbered odontogram and one section per question; overlays reference the original image.

Section	Content
Tooth numbering	Tooth detection, instance outlines and FDI numbers, including deciduous teeth, and missing teeth
Restorative charting	Per tooth: fillings, crowns, bridges, root-canal treatment, implants
Caries	Carious lesions per tooth and surface with depth (enamel, dentine, deep or near the pulp)
Periapical lesions	Apical radiolucencies (apical periodontitis) per tooth
Impacted teeth	Winter angulation, Pell & Gregory class, eruption level and inferior alveolar canal proximity signs
Bone loss	Estimated alveolar bone level per tooth and sextant as a percentage of root length, horizontal or vertical pattern
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Standards

• Tooth numbering: FDI two-digit notation (ISO 3950), with Universal and Palmer conversions; teeth coded with DICOM CID 4018/4019 (permanent and deciduous).
• Findings: ICDAS/ICCMS radiographic caries depth; periapical index (PAI, Ørstavik); Winter and Pell & Gregory classifications; Rood & Shehab signs of canal proximity; AAP/EFP 2017 periodontitis staging, radiographic criterion.
• DICOM and exchange: overlays as GSPS or Segmentation, measurements in SR TID 1500, Encapsulated PDF, and FHIR R4 DiagnosticReport with one Observation per tooth (bodySite).