Introduction: Our objective was to determine the diagnostic capability of panoramic imaging in any of its forms to detect mandibular asymmetry.
Methods: Several electronic databases were searched. Abstracts that appeared to fulfill the initial selection criteria (mandibular or craniofacial asymmetry, panoramic imaging, and evaluation of validity or accuracy of diagnosis with an appropriate gold standard) were selected, and full articles from these abstracts were gathered. The references from these articles were also examined for possible articles that could have been missed.
Results: Only 11 articles met all criteria. Vertical measurements, although more accurate than horizontal or angular measurements, are still not true representations of the real objects they correspond to. Magnification values reported by the manufacturer might not correspond to the calculated magnification value and be uniform across the panoramic imaging entire area.
Conclusions: Caution is advised when using conventional or digital panoramic images to assess mandibular asymmetry. Understanding the limitations of every form of panoramic imaging is required. Future studies with panoramic images generated from 3-dimensional data are required to determine whether they overcome the limitations of conventional and digital panoramic images.