Accuracy of Cone-Beam Computed Tomography Software in Predicting the Size of Impacted Canine: A Preliminary Study

Objective:To compare and analyze the precision, accuracy, and reliability of commonly used cone-beam computed tomography (CBCT) software in predicting the mesiodistal diameter of impacted canines.Methods:This study was conducted on 11 patients (six males and five females, mean age: 17.5±5.5 years) with either unilateral or bilateral impacted canines in the maxilla or mandible. DICOM data sets of the patients obtained from CBCT scans were then loaded and visualized with four selected CBCT software to measure the widest mesiodistal diameter of the impacted teeth. Physical measurements using a digital vernier caliper, kept as a control, were also made on the extracted teeth and orthodontically erupted teeth. The collected data underwent statistical analysis, and the statistical significance level was set at p<0.05.Results:The Bland-Altman analysis was performed to quantify the agreement between different software to the digital caliper, showing a narrow difference for all plots. Kruskal-Wallis ANOVA test followed by a post hoc test was performed to determine whether there was any difference in measuring the mesiodistal diameter of the impacted canine among the five methods, and tend no statistically significant difference was found among the five methods. Intraclass correlation (ICC) was performed, and measurements made with all CBCT software yielded an ICC greater than 0.95, indicating high reliability of the selected software.Conclusion:All the evaluated CBCT imaging software exhibited a high degree of reliability, and accuracy in precise measurement of the mesiodistal diameter of an impacted tooth

Rotational panoramic radiographs-unusual triple images

Currently clinicians advice rotational panoramic radiography (RPR) for preliminary investigation. Despite few inherent limitations, rotational panoramic radiography still remains the diagnostic tool of choice. Abnormal structures such as a supernumerary tooth or a device falling within the certain central regions in conventional RPR images may mislead the clinicians towards an inaccurate diagnosis by producing multiple ghost images. Such cases must be treated with circumspect, and apart from RPR, additional imaging modalities need be employed to provide a judicious interpretation of the clinical situation. Thus this manuscript, we present a case where a paramedian supernumerary tooth which exhibited double ghost images on a conventional RPR. This prompted us to elicit the use of a CBCT and 3 dimensional images to determine the true nature of the problem. We outline the working of the diamond principle behind a conventional RPR which cause the appearance of multiple ghost images. The discerning clinician must be cognizant of the possible positional and analytical errors which may be prevalent in a conventional RPR when viewing structures lying in the palatal region, specifically in the midline while making diagnosis