Incidental findings from panoramic radiographs: A systematic review with meta-analysis.

Abstract

Purpose: The use of radiographs is widely spread, both among general dentists and specialists, since it provides a view of the oral and perioral tissues using a relatively easy-to-acquire and low-dose image. The aim of this systematic review was to critically appraise and summarize evidence from clinical studies on the prevalence of incidental findings from panoramic radiographs.

Method: Systematic literature searches without restrictions were undertaken in eight databases from inception up to January 2026 for studies reporting on incidental findings from panoramic radiographs of any dental patients. After duplicate study selection, data extraction, and risk-of-bias assessment using a custom tool based on the Joanna Briggs Institute's tool for prevalence studies, random-effects meta-analyses were performed, followed by subgroup, meta-regression, and sensitivity analyses.

Results: Twenty-five studies covering a total of 66 882 patients (44.1% male; average age 28.9 years) were included. The prevalence of incidental findings ranged from 5.2% to 88.1%, with average distribution prevalences between 22.9% and 53.1%, but heterogeneity was high across studies. Incidental findings were most often related to airways (30.9%), followed by teeth (12.2%), soft-tissue calcifications (9.4%), spine (7.4%), radiopacities (7.1%), and temporomandibular joint (1.8%). However, several methodological issues were present in the included studies (incomplete reporting of patient- or radiography-related details, incomplete categorization and reporting of the severity of findings, small sample sizes, and issues with research transparency).

Conclusion: Evidence indicates that incidental findings are common in panoramic radiographs of dental patients. Although many incidental findings are clinically insignificant, some may have important implications. When a dental panoramic image is justified, it should be adequately assessed for incidental findings by either a specialist oral and maxillofacial radiologist or a dentist with appropriate training and experience.