Impacted maxillary canine teeth occur in about 2% of the population. Late detection of palatal canines may have treatment implications for the patient and medicolegal implications for the dental practitioner. Dental panoramic tomograms (DPT) are widely taken in practice. Image formation in dental panoramic tomography results in relative magnification of objects placed palatal to the image layer and relative diminution of objects buccal to it. This provides a possible means of bucco-palatal localisation of teeth. The aim of this study was assess the validity of DPTs in locating ectopic canines using the vertex occlusal view (VO) as the gold standard. One hundred pairs of radiographs showing 139 ectopic canines were examined. Using the DPT, it was possible to accurately predict the position of a palatally displaced crown in about 80% of cases. The DPT alone is not sufficient for canine localisation, but clinical evidence and suggestion of ectopic positioning on a DPT should warrant further radiographic investigation. Careful interpretation of a radiograph widely used in practice may lead to earlier detection of palatal canines.
Observer reliability in performing linear measurements between the cementoenamel junction and alveolar crest was determined for mandibular posterior teeth from digitized clinical bitewing radiographs acquired during recall examinations. 6 measurements (corresponding to traditional probing measurements) were made per tooth by 3 observers. Mesial and distal measurements made to the most coronal aspects of the alveolar crest were the most reliable and least biased. As was anticipated, intra-observer reliability was better than inter-observer reliability although the 3 observers of our study were able to detect a significant mean change (0.1 mm, p<0.0001) in alveolar bone height over a 1-year period for 10 patients. For our most reliable and unbiased measurements (mesial measurements to the alveolar crest), a change of 0.54 mm (90th percentile) would be required to indicate change at a site from one time to the next. Based on the reliability of our digital radiographic measurements, with the alpha error rate set at 0.05 and beta at 0.20, a difference in alveolar bone height of 0.3 mm could be detected with a patient sample size of between 13 (best case) and 54 (worst case).
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