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

Morphological Comparison of the Maxillary Arch in Buccal and Palatal Canine Impaction among Asian Population of Gujarati Origin: A Hospital-Based Study

Aim: To estimate the differences in the maxillary arch morphology in buccal and palatal canine impaction in an Asian population of Gujarati origin. Methodology: An institutional ethics committee’s approval was acquired before the commencement of this study. Sixty subjects were enrolled in the study. Thirty subjects (20 females and 10 males) had a maxillary impacted canine either buccal or palatal and thirty control group participants were selected aged 13 to 18 years who sought orthodontic treatment at the tertiary health care center in Ahmedabad, Gujarat, in western India. Routine pre-treatment radiographs and dental plaster models with good anatomic details were recorded. Measurements of the inter-molar width, palatal depth, arch length, sum of the mesio-distal width of the upper incisors, and available arch space were recorded from prepared orthodontic study models using digital vernier calipers with an accuracy of 0.01 mm and brass wire. The ratio of palatal depth to inter-molar width (Ratio 1), arch length to inter-molar width (Ratio 2), and width of the maxillary incisors to available arch space (Ratio 3) were also secondarily calculated. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 21, IBM Inc. The normality of the data was assessed by the Shapiro–Wilk test. As the data was found to be normally distributed, bivariate analyses were also performed (one-way ANOVA test, Bonferroni post hoc correction). The level of statistical significance was set at a p-value less than 0.05. Results: The comparison of the inter-molar width, palatal depth, arch length, sum of the mesio-distal width of the upper incisors, available arch space, Ratio 1, Ratio 2, and Ratio 3 among controls and subjects with buccal and palatal canine impaction showed overall significant differences in the inter-molar width, palatal depth, arch length, sum of the mesio-distal width of the upper incisors, and available arch space when compared using one-way ANOVA as p p p p p < 0.0001) with a clinically reduced mesiodistal width of the sum of maxillary incisors may be considered as risk factors for palatal maxillary canine impaction in an Asian population of Gujarati origin