HUMAN SKULL STUDY REGARDING PANORAMIC X-RAY DEFORMATIONS DUE TO ANTERIOR-POSTERIOR INCLINATION OF THE HEAD WITH POSSIBLE MEDICO-LEGAL IMPLICATIONS

Panoramic radiography is widely used as a general screening method at the beginning of dental treatment and can be used in personal identification after disasters. Often, the patient's position was a poor one during the x-ray procedure, which changes the doctor's perception of the actual distances. This study used a human skull placed with the Frankfurt horizontal parallel to the ground (0 degrees) but also with the head in flexion at (-10 degrees) and (-15 degrees), respectively with the head in extension at (+10 degrees) and (+15 degrees). Three typologies were discussed according to Tweed's angle: normodivergent (FMA = 25 degrees), hypodivergent (FMA = 18 degrees) and hyperdivergent (FMA = 32 degrees) (where FMA=Frankfurt-Mandibular Plane Angle or Tweed Angle). For each typology, 5 radiographs were performed in each of the mentioned positions. 8 segments were defined (vertical and horizontal), which were measured on the 15 radiographs resulting in 120 numerical values. In addition, have been noted the inclinations of some vertical and horizontal segments according to the skull position. In the vertical axis: In the maxillary (all types), in extended position, the frontal segments can decrease by up to 17.5% , and in flexed position, the lateral segments may decrease by up to 20%. In the mandible, in extension, the frontal segments, in the hypodivergent can decrease by 9%. In flexion, the frontal segments (in all typologies), may decrease by approx. 9%. Horizontally, on the maxillary frontal area there are increases of up to 20% in extension and decreases of up to 40% in flexion. In the frontal mandibular area, there are decreases of up to 19% in hyperdivergents' flexion, and in the lateral mandibular area there are maximum decreases of 10% in hyperdivergents' flexion of the head.