Use of unleavened bread to reduce the appearance of radiolucent areas associated with the palatoglossal air space in panoramic radiographs: A comparative study

Introduction: Proper tongue positioning is crucial for obtaining high-quality diagnostic images in orthopantomography (OPG). Incorrect positioning often results in a radiolucent artifact in the palatoglossal air space, compromising image quality. This issue may necessitate repeating the study or advancing to Cone-Beam Computed Tomography (CBCT), both of which increase radiation exposure. This study aimed to evaluate the effectiveness of using unleavened bread as a physical aid to decrease the occurrence of this artifact. Materials and methods: An experimental study was conducted involving 100 individuals, who were divided into two groups. The control group consisted of 50 participants who received standard verbal instructions, while the study group included 50 participants who used unleavened bread placed against the palate. Two trained technicians acquired panoramic radiographs, and a blinded evaluator analyzed the images for the presence or absence of radiolucency in both the anterior and posterior regions. The Chi-square test was utilized to compare prevalence rates, and a binary logistic regression was performed to identify predictors, adjusting for age and sex. Results: No significant differences were observed in the baseline characteristics of the sample (p = 0.763). The prevalence of the posterior artifact in the control group was 50%, compared to 22% in the Unleavened Bread group. This difference was statistically significant (p = 0.006). A binary logistic regression analysis confirmed that membership in the Unleavened Bread group was the only significant independent predictor (OR = 0.25; p = 0.003), indicating a 75% protective effect against the posterior artifact. However, the intervention did not show statistical significance in correcting anterior radiolucency. Conclusions: The use of unleavened bread is an effective method for controlling artifacts associated with the palatoglossal air space in the posterior region. This confirms that the issue is a correctable technical error. The maneuver serves as a reliable biomechanical standard, enhancing diagnostic quality and reducing the patient's overall radiation exposure by minimizing the need for repeat examinations. However, its effectiveness is selective; it shows no statistical impact on the anterior region due to certain mechanical limitations.