Horizontal Angulation Research Articles

Distal surface caries in the mandibular second molar in the presence of a partially erupted/impacted third molar

Distal surface caries in the mandibular second molar is a common outcome of impaction of the adjacent third molar. To determine the prevalence of this type of caries in the Netherlands, 250 radiographs were evaluated. The prevalence among the research population was 26%. Risk factors for developing distal surface caries in the mandibular second molar were partially erupted/impacted third molars with a mesioangular or horizontal angulation, an LD loss of ≥ 2mm and an increased modified DMFT score. The relation between the point of contact of the third molar and the adjacent mandibular second molar, on the one hand, and, on the other, the cemento-enamel junction of the mandibular second molar and the prevalence of distal surface caries almost reached statistical significance (p = 0.052). The relatively low prevalence of distal surface caries in the Netherlands is probably related to the current clinical guidelines recommending early extraction of partially erupted/impacted third molars, particularly in cases of third molars with a mesioangular or horizontal angulation.

Assessment of the relationship between the three-dimensional precise location of the mandibular third molar and the volume ratio of the impacted mandibular third molar to the mandibular angle, and the patterns of mandibular angle fracture: A retrospective study

This study aimed to evaluate the relationship between the precise three-dimensional location of the third molar (M3) and mandibular angle fracture (MAF) patterns and to assess the effect of the volume ratio occupied by M3 in the mandibular angle on fracture patterns. The location of M3 was assessed in 218 patients with MAF using computed tomography reconstruction. The bone volume of the mandibular angle and the bone volume occupied by M3 were measured to calculate the volume ratio of M3 to the mandibular angle (M3/MA). MAF patterns were categorized into simple fracture (Type I), displaced fracture (Type II), and comminuted fracture (Type III) based on fracture severity. The results showed that the location of M3 significantly influenced MAF patterns (vertical position: P = .001; horizontal position: P = .002; angulation: P = .027, respectively) and the volume ratio of M3/MA was significantly higher for Type III fracture than Types I and II (P < .001). Regression analysis showed that the horizontal position and angulation of M3 and the volume ratio of M3/MA were the main predictors for comminuted MAF. A larger volume ratio (odds ratio [OR], 1.201; 95% confidence interval [CI], 1.037–1.391; P < .014), Class III position (OR, 7.978; 95% CI, 1.275–49.910; P < .026), and horizontal angulation (OR, 7.212; 95% CI, 1.028–50.581; P < .047) of the M3 were more prone to comminuted MAF than simple fracture. Our findings indicate that the location of M3 significantly affects MAF patterns, and that M3 may weaken the mandibular angle by occupying more bone space, thereby increasing the risk of a comminuted fracture.

Utilizing a Film Holder to Enhance Radiographic Imaging in Maxillary Molar Trifurcation

Background: The parallel technique stands as a prominent method for radiographic examinations aiming to identify furcation involvement. Nevertheless, an inherent limitation lies in the frequent superimposition of the trifurcation region with tooth roots, potentially leading to inaccurate diagnoses. The Same Lingual Opposite Buccal (SLOB) technique was devised to yield radiographic images that alleviate superimposition at the trifurcation of the maxillary first molar. Purpose: to observe and compare the radiographic images of the trifurcation region of the maxillary first molar generated through the SLOB technique with the film holder modification set at a mesial and distal angulation of 20˚ with the parallel technique. Methods: This observational analytic research encompassed a sample size of 24 instances. Each individual sample underwent three separate exposures: the SLOB technique with a horizontal angulation of 20˚ towards both mesial and distal directions, and the parallel technique (serving as the control). Results: a significant difference in radiographic images of the trifurcation region of the maxillary first molar obtained through the SLOB technique, employing the film holder modification with a mesial angulation of 20˚ and a distal angulation of 20˚, as opposed to the parallel technique (control). Conclusion: A radiographic image capturing the trifurcation of the maxillary first molar, devoid of superimposition, was successfully generated through the SLOB technique incorporating a horizontal angulation of 20˚ towards the distal direction.

Single-centre retrospective study of postoperative complications after removal of mandibular third molars using a straight lowspeed handpiece

ObjectiveWe aimed to analyze the incidence of postoperative complications after the removal of impacted mandibular third molars using a dental straight, low-speed handpiece. MethodsThis single-center retrospective descriptive study was conducted from January 2018 to December 2021. Inclusion criteria for the enrolled patients were complete medical records, no history of systemic disease, and received surgical removal of impacted mandibular third molars using a straight, low-speed handpiece. ResultsA total of 1050 patients underwent mandibular third molar removal with a straight, low-speed handpiece under local anesthesia. Most complications occurred in cases involving horizontal angulation (15.4%) and those categorized as level B (13.3%) and class II (13.9%) impactions. The difficulty index indicated moderate difficulty in most cases (55.3%), with the most and least common postoperative complications being pain (5.7%) and paresthesia (1.5%), respectively. ConclusionMost complications reported in this study were minor, transient, and within the ranges reported in the literature. No major complications, such as emphysema, were reported, while paresthesia was the least frequently reported complication. Thus, third molar removal using a straight, low-speed handpiece was associated with few complications and might be used as one of the safe procedures.

Impacted Lower Third Molar Profile at Dental Hospital of Padjadjaran University

&#x0D; Introduction: Impacted teeth are teeth that erupt incompletely in the normal eruption period. This situation can be caused by hard or soft tissue obstructions or a lack of arch jaw. Objectives: This study aimed to determine the impacted lower third molar teeth profile by age, sex, class, angulation, treatment, and anesthesia at RSGM UNPAD in 2017-2019. Methods: The study was conducted from February 8, 2020, to March 8, 2020. The study represents the impacted lower third molar teeth profile of patients referred to Outpatient Installation, Central Surgical Installation, and the Radiology Installation. Classification of tooth impaction was based on Pell &amp; Gregory and Winter classifications using ImageJ application, while Intraclass Correlation Coefficient (ICC) was used to confirm data validity. Results: There were 146 impacted dental cases, with a total case of 62 (42.5%) for males and 84 (57.5%) for females. Most impacted teeth occurred in the 12-25 years age group up to 72 (49.3%). A total of 177 impacted teeth mostly occurred in 48 teeth, as many as 91 (51.4%). Impaction class Pell &amp; Gregory class B with 110 (62.1%) cases were found the most. Based on the anterior border of ramus, class II with 164 (91.1%) cases was found the most. Horizontal (79 cases, 44.6%) became the most frequent angulation. The procedures taken were all odontectomy 177 (100%) with more use of local anesthesia 136 (93.2%) compared to general anesthesia 10 (6.8%). Conclusion: Cases of impacted lower third molar teeth at RSGM UNPAD in 2017-2019, were most common in females and mostly in the 12-25 years age group, with Pell &amp; Gregory class IIB classification and Winter horizontal angulation classification, all procedures performed were odontectomy, majority using local anesthesia.

Pattern of mandibular third molar impaction: a cross-sectional CBCT study

Objective: This study aimed to describe the mandibular third molar&amp;apos;s impaction classifications in three dimensions by using cone beam computed tomography (CBCT). These classifications might help oral and maxillofacial surgeons in making a clinical choice about when to extract a tooth or prepare another treatment strategy. Methods: A total of 259 CBCT scans were found eligible for inclusion in the study. Impacted mandibular third molars were radiographically assessed for Pell and Gregory&amp;apos;s classification (impaction), Winter&amp;apos;s classification (angulation of the impaction), and the relation of the impacted mandibular molar to the buccal and lingual bone (horizontal relation). Results: Mesioangular angulation constituted 55.6% of all angulations, with horizontal angulation constituting 21.62% and vertical angulation 16.22%. The most frequent horizontal relation was lingual impaction. The most prevalent level of impaction was level A, and the most prevalent ramus relationships were class II at 52.51%. Both men and women were classified similarly, and there was no discernible difference between the right and left sides of the mouth (p &amp;gt; 0.05). Conclusion: Additional research with a bigger sample size is required to assess the Saudi Arabian third mandibular molar impaction pattern.

CBCT Imaging of a Rare Case of Radix Entomolaris in Mandibular Second Molar

The presence of an additional supernumerary distolingual root in the mandibular molar is termed Radix Entomolaris (RE). It is common in the mandibular first molar, but its occurrence in the mandibular second molar is scarcely reported in the literature. Two-dimensional imaging can diagnose anatomical root canal variations when taken with different horizontal angulations. With the recent innovations in three-dimensional diagnostic imaging, cone beam computed tomography (CBCT) can aid in unfolding the complexities of the root canal system. Accurate diagnosis by CBCT leads to the success of endodontic treatment. A rare case of radix entomolaris in the mandibular second molar in an Indian female is reported here with three of its CBCT findings. Imaging in all three dimensions, oblique sections and volume rendering by CBCT proved to be of additional help to understand the complex anatomy and root canal morphology of the tooth.

Distinct microbiome profiles in convergent wisdom tooth impactions.

Long-term retention of impacted third molars (wisdom teeth) is associated with plaque stagnation and the development of caries on the adjacent surface of the neighboring second molar. While caries and tooth loss are common outcomes of impaction, there is currently insufficient evidence to support the pre-emptive removal of asymptomatic wisdom teeth. Emerging evidence suggests that convergently growing impactions are associated with caries. We have therefore investigated the composition of dental plaque on the distal surface of the mandibular second molar at various impaction angles. We have compared the microbiome of these surfaces at four impaction angulations using short-read sequencing of the bacterial 16S rRNA gene: two convergent (horizontal and mesial) and two divergent (distal and vertical) angulations, and in cases where the wisdom tooth is missing. Horizontal angulations exhibited lower microbial diversity than mesial impactions. Amplicon Sequence Variants (ASVs) associated with Veillonella were significantly more abundant at impactions with angulations toward the midline. Using machine learning, a random forest classifier trained to distinguish microbiome profiles was used to predict the native angulations for a subset of samples, with samples from the two convergent impactions estimated with the greatest accuracy. Differences in microbial diversity were apparent between caries-associated convergent (horizontal and mesial) impacted wisdom teeth, as well as greater abundances of Veillonella ASVs at horizontal impactions.

Pathological Abnormalities Due to Impaction of Third Molar Mandibular Horizontal and Mesioangular Angulation with Observation of Panoramic Radiography

Background: The lower third molar teeth are the most commonly impacted teeth due to a lack of place for an eruption. Impacted teeth affect the surrounding tissue and can lead to pathological abnormalities. The effect of impacted teeth results in various complaints such as pain, caries, pericoronitis, adjacent tooth root resorption, dentigerous cysts, and odontogenic tumors. The impacted mandibular third molars and associated pathological abnormalities were observed with panoramic radiography. Purpose: To determine the pathological abnormalities that accompany the molar impaction of horizontal and mesioangular angular mandibula with panoramic radiographic observation. Material&Methods: In this study, using the panoramic radiograph, consisting of 53 samples of radiographs were evaluated based on the mesioangular and horizontal angulation of mandibular impacted third molars and pathology abnormalities caused. The data were processed and analyzed by using the Friedman test and Chi-square test. Result: In impaction with mesioangular angulation, bone loss at the interalveolar between third molar and mandibular second molars by 33.3%, caries on the mandibular second molars and mandibular second molar’s root resorption had a similar percentage by 26.7% and caries in mandibular third molar impaction amounted to 13.3%. In impaction with horizontal angulation bone loss at interalveolar third molar and mandibular second molar by 59.1%, mandibular second molars of caries were 22.7%, caries in mandibular third molar impaction and mandibular second molar root resorption by 9.1%. Conclusions: The most common pathological abnormalities in mandibular third molar impaction of mesioangular and horizontal angulation are bone loss in the interalveolar third molar and the mandibular second molar.

Radiographic Position of Impacted Mandibular Third Molars and Their Association with Pathological Conditions.

Objectives This study aimed to assess the radiographic position of impacted mandibular third molars (IMTMs) and their association with pathological conditions. Materials and Methods The impaction depth, relationship with ramus, and angulation of 1600 IMTMs and their association with 2nd molar distal caries and root resorption, pathological conditions, and proximity to the mandibular canal were evaluated on panoramic radiographs. The IMTM position was determined based on the depth of impaction according to the Pell and Gregory classification, relationship with ramus according to the Pell and Gregory classification, and angulation according to the Winter's classification. The classical and Bayesian logistic regressions were applied to analyze the effect of IMTM position on the associated complications using the odds ratio (OR) and 95% confidence interval (credible interval for Bayesian models). Two-tailed P value < 0.05 was considered statistically significant. Results Of 1600 IMTMs evaluated in this study, 195 (12.2%), 252 (15.8%), and 119 (7.4%) had caused second molar distal caries, second molar root resorption, and pathological lesions, respectively, and 872 (54.5%) had contact with the mandibular canal. Impaction angulation was a risk factor for second molar distal caries (maximum OR = 5.01, 95% CI: 3.12–8.18). Changed angulation and greater impaction depth were the risk factors for second molar root resorption (minimum OR = 1.64, 95% CI: 0.58–4.02). Decreased distance between the ramus and distal side of the second molar was a risk factor for associated pathological lesions (minimum OR = 2.73, 95% CI: 1.79–4.25). Mesioangular and horizontal angulations and greater impaction depth were the risk factors for contact with the mandibular canal (maximum OR = 3.44, 95% CI: 2.6–4.57 and minimum OR = 1.3, 95% CI: 094–1.8). Conclusions The frequency of complications associated with IMTMs was low, but considerable. The occurrence of these conditions might be affected by the impaction position. Thus, regular follow-ups are recommended in order to be able to surgically intervene when the first signs of pathologies arise.

Occurrence of internal root resorption defects in anterior teeth with a history of concussion injury: A cross-sectional study among select adult North Indian dental patients

Objectives: The aim of this study was to assess the frequency of internal resorption (IR) defects in select adult North Indian population with a history of concussion injury to their anterior teeth. Material and Methods: The study population consisted of patients reporting with a history of concussion injury to their anterior teeth. At least two intraoral periapical radiographs, one at central and other at a 20° horizontal angulation, were taken for each of the affected teeth to check for any IR defect. The radiographs were inspected after placing them over a viewing box using magnifying glasses. Percentage of IR defects and their occurrence on the basis of tooth type, duration of trauma, gender, and side was assessed. Results: A total of 1507 patients reported with a history of a traumatic dental injury (TDI) to their anterior teeth. About 37.1% (560/1507) patients and 602 teeth with TDI had a history concussion injury. The percentage of patients with concussion injuries resulting in IR defect was 3.3% (19/560), and the percentage of teeth with IR defect was 3.16% (19/602). About 68.42% (13/19) were in males, and 31.58% (6/19) were in females; however, the difference was not statistically significant (χ2 = 1.05, P = 0.590). Most of the patients reported with a history of TDI within 0–5 years back, and the median age at the time of presentation was 20 years. Maxillary left central incisor was most affected, 4.84% (9/186) followed by maxillary right central incisor 3.5% (7/200) mandibular left lateral incisor 3.85% (1/26), mandibular left central incisor 3.57% (1/28), and maxillary lateral incisor 1.52% (1/66). Out of the 19 IR defects, 15 (78.9%) were located in the root, four were located coronally (21.05%), out of which 2 had a pink-colored crown. Conclusion: Silent injuries such as concussion and subsequent IR can potentially weaken the tooth; therefore, follow-up of patients with a history of TDIs is vital to rule out any developing but obscure resorptive defects.

Een klachtenvrije derde molaar, verwijderen of niet?

Three adult patients, ages 28 (female), 36 (male) and 53 (male), respectively, were referred by their dentists to an orofacial surgeon concerning problems with their third molars. With the woman, teeth 38 and 48 were removed. After the removal of tooth 38, a permanent periodontal attachment loss of the adjoining second molar occurred. With the second patient, retention of tooth 48 caused serious damage to the adjoining second molar, resulting in the loss of the tooth. At the time of removal, there was a question of increased risk of inflammatory complications and nerve damage. With the third patient, removal of his impacted tooth 38 led to osteomyelitis and a fracture of the angle of the mandible. According to the newly published 'Third molar' in the Dutch Clinical Guidelines, the advice is to consider the removal of asymptomatic third molars in 17-year-old patients. In the case of impacted third molars with mesial or horizontal angulation and partial eruption, the risk of pathology is such that preventive removal is advised. An intraoral radiograph (periapical or bitewing) as a first screening is recommended here.

Outcomes of different radioprotective precautions in children undergoing dental radiography: a systematic review.

To evaluate the effectiveness of all radioprotective measures in underage patients who undergo a dental radiodiagnostic examination. A systematic review was performed including randomised controlled trials (RCTs), or cluster trials, cohort studies, cross-sectional studies, case-control studies and comparative in vitro research. These studies examined the healthy underage human population (below 18years) undergoing a dental radiodiagnostic examination. All radioprotective measures were included except for justification as an intervention. The primary outcomes were in vivo mortality and morbidity. Some surrogate or indirect outcomes such as in vitro effective dose and organ absorbed doses were also accepted. Secondary outcomes with regards to image quality and therapeutic value were also analysed. Eighteen papers were eligible for implementation. Fifteen studies underwent narrative synthesis. Regression analysis was performed on three studies. The following radioprotective measures can reduce the exposure dose. For lateral cephalometry: collimation, filtration, the fastest receptor type and circumstantial thyroid shielding. For oblique lateral radiographs: the shortest exposure time, a smaller horizontal angulation, a longer focus to skin distance. For intraoral radiography: rectangular collimation, the fastest image receptor speed and thyroid shielding when the thyroid gland is in line of or very close to the primary beam. For panoramic radiographs: collimation, the fastest receptor type and the use of automatic exposure control (AEC) or manual adjustment of intensity. For cone-beam computed tomography: collimation, the largest voxels size in relation to the treatment need, change in image settings such as ultra-low dose settings, shorter exposure time, a lower amount of projections, lower beam intensity, reduction of the potential, use of a thyroid shield except in two situations and the use of AEC. All of the changes in exposure parameters should be performed while maintaining a sufficient therapeutic value on an individual and indication-based level.

An efficacious horizontal angulation separated radiographically superimposed canals in upper premolars with different root morphologies

ObjectivesTo determine the effect of various horizontal beam angulations on radiographically separating superimposed canals in upper premolars with different external root morphologies. Materials and methodsThe independent variables were 1) three different external root morphologies of upper premolars (n = 30); one-root (A), fused-root (B) and two-root (C), 2) thirteen angulations (0° and mesial (Ms) and distal (Ds) shifts of 15, 20, 25, 30, 35, and 40°), and 3) the superimposed canal at the apex (apx) and 5-mm from the apex (5apx). The dependent variables were the percentage of radiographs demonstrating canal separation. The separated canal distances were analysed using analysis of variance (ANOVA) and Tukey HSD. ResultsSeparation distances at apx and 5apx on one-root, fused-root and two-root premolar radiographs increased as the angulation increased. Ms angulations generated a higher separation distance (SepDist) in mm compared with the Ds angulations. Significantly different separation distances were observed from various horizontal shift angulations (p < 0.05). Percentage of canal separation from 0o was achieved differently in different morphology of upper premolars (14–80%) at apx and 10–40% at 5apx. The 20–40Ms/Ds and 25Ds/30‒40Ms/Ds resulted in 100% of radiographs with canal separation for two-root and fused-root premolars, respectively, at apx and 5apx. Only the 35/40Ms resulted in 100% of radiographs with separation at apx in one-root teeth. ConclusionThe ideal horizontal angulation which revealed the superimposed canal at the apx/5apx for one-root, fused-root, and two-root teeth are 35M/35M, 20D/20M, and 15M/20M, respectively. SignificanceThe 25Ms was the optimal angulation which strongly recommended with the highest probability of separation and acceptable image quality in endodontic and prosthodontic treatment for unknown morphologies evaluated.

New device for dental radiographic standardization

Context: The device for dental radiographic standardization (DDRS) was developed to minimize the distortions in conventional periapical radiographs or digital subtraction, improving the effectiveness of the technique. Objectives: The objective of this study is to present the DDRS and prove its effectiveness through comparative test, performed with the techniques of Bissetrix and Parallelism. Configurations and Design: The DDRS adapts to the universal radiographic positioner, is economical, and easy to operate. It is recommended for the use in research, where standardization is a requirement. Subjects and Methods: DDRS is produced using the additive manufacturing method for prototyping, after creating a three-dimensional (3D) model using a specific program (Autodesk Inventor 2016, Autodesk, Inc, California, USA). The final prototype was converted to the STL format, which was later read by a 3D printer (3D Machine ONE, Sao Paulo, Brazil). To perform the tests, three radiographic techniques were compared, Bisecting angle technique, parallelism and DDRS fitted to the universal positioner, and two examiners performed the evaluation independently. Statistical Analysis Used: Differences between the techniques were compared by the analysis of variance, followed by Dunnett’s multiple comparisons. The variability of the measured values among the techniques was compared by the Levene’s test. The intraclass correlation coefficients were calculated to evaluate the reproducibility and interexaminer agreement for each technique and parameter. Results: DDRS eliminates the effect of distortion factors that normally affect conventional methods, allowing greater reliability in the interpretation of the image before, during, and after treatment. Conclusions: The DDRS should be used for clinical and routine research purposes, facilitating comparisons of the same image at different time intervals, with minimized errors of vertical and horizontal angulation. This allows greater reliability in the interpretation of the image in relation to the structures of interest.

X-ray beam angulation can compromise 2-dimensional diagnosis of interradicular space for mini-implants

The aim of this research was to evaluate the influence of x-ray projection geometry on interradicular space of the posterior maxillary arch. Cone-beam computed tomography (CBCT) scans of 32 patients (16.85±4.93years) who met the selection criteria were enrolled. One hundred ninety-two interradicular sites of the posterior maxillary arch were evaluated. Before measurements, each side of the maxillary arch was orientated in all 3 planes of space to obtain CBCT synthesized periapical radiographs with 0° projection geometry (orthogonal x-ray beam-orthogonal X-ray angulation [OX]). Standardized CBCT axial rotations (10°, 20°, -10°, and -20°) were used to simulate periapical radiographs taken with mesial and distal angulation of the x-ray beam (mesial x-ray angulation [MX] and distal x-ray angulation [DX]). Interradicular space widths were measured on OX, MX, and DX CBCT synthesized periapical radiographs. Measurements were performed parallel to the occlusal plane at 3mm and 6mm apical to the midpoint of the alveolar crest. Interradicular distances were statistically compared (P<0.05). Interradicular distances measured on MX and DX CBCT synthesized periapical radiographs were significantly smaller than those measured on OX. Interradicular distance was significantly correlated with the horizontal angulation of the x-ray beam. X-ray projection angle was the most influential variable on interradicular distance. About 30% reduction in interradicular space was observed for every 10° of deviation from orthogonal x-ray. Two-dimensional radiographs obtained away from the 0° projection geometry can reduce the actual interradicular space for mini-implants, inducing misdiagnosis.

Pattern of Angulations and Common Indications for Extraction of Impacted Mandibular Third Molar at KMU-Institute of Dental Sciences, Kohat

Background: The extraction of an impacted mandibular third molar (MTM), with associated pathologies or clinical manifestations is an important and one of the most frequent decisions in dentistry. The angle formed by the longitudinal axis of second and third molar is used to determine angulation of impacted MTM. The aim of this study was to identify the pattern of angulations of impacted mandibular third molar and common indications for extraction associated with these angulations.Material and Methods: This descriptive cross-sectional study was carried out at Department of Oral &amp; Maxillofacial Surgery, Khyber Medical University Institute of Dental Sciences, Kohat, Khyber Pakhtunkhwa (KP) from November 2017 to July 2018. A total of 349 patients presenting with impacted mandibular third molars were included in this study. Name, age, gender, address, the angulation of the impacted tooth and the indication for extraction of the impacted tooth were recorded. Data comprising of qualitative and quantitative variables were analyzed using SPSS version 17.Results: Out of 349 patients, 206 were male and 143 females, with the male to female ratio of 1.4:1. The age range of the patients was from 18 years to 60 years with a mean age of 26 ± 6 years. The most common age group with impacted third molar was ≤ 25 years followed by 26 to 30 years’ age group. The most common angulation was mesioangular followed by vertical, horizontal and distoangular impacted mandibular third molar. Pericoronitis was the most common indication for extraction in all angulations except horizontal impaction where root resorption of the second molar was more common.Conclusion: Mesioangular is the most common angulation in impacted mandibular third molars. Pericoronitis is the main indication for all angulations of impacted mandibular third molars except horizontal angulation, occurring mostly in the third decade of life.

Diagnostic considerations while utilizing intraoral periapical radiographs for diagnosing radix entomolaris

Radiopacity seen in periapical area in periapical radiographs can be sometimes be tricky to interpret and diagnose. Occurrence of radix entomolaris is rare in mandibular first molar and mandibular second premolar. This rare entity may probably be misdiagnosed if the practitioner does not acquire periapical radiographs using appropriate techniques. A male patient aged 28 years presented with chief complaint of decayed teeth in right lower back region of mouth. On intraoral examination, 46 was observed to be decayed and non tender on vertical percussion. An intraoral periapical radiograph (IOPA) was advised for the same. Well defined radiopacities were observed in between roots of 46 and 45. A tentative diagnosis of idiopathic osteosclerosis was made. However, since the radiopaque structure resembled that of a tooth root, another IOPA at a different horizontal angulation was taken. To our surprise, 46 exhibited an additional supernumerary root. Also, the presence of an additional lingual root in relation to 45 was noted.The present case report demonstrates the impact on interpretation/diagnosis an angulation difference can make while taking a periapical radiograph through example of case which exhibited the rare occurrence of radix entomolaris and concurrent additional root in second mandibular premolar.

ANALYSIS OF ROOT CANAL MORPHOLOGY OF INCISOR TEETH USING PERIAPICAL RADIOGRAPHY BISECTING TECHNIQUE AND CHANGE HORIZONTAL ANGULATION 30º IN SUB RACE PROTO AND DEUTRO MALAY

The incisor has a variation of root canal morphology, which can be assessed using periapical radiography. Periapical radiography with standard angulation often makes complicates the assessment of the root canal morphology that is branched off in buccal and lingual directions because the radiograph result of the root canal will appear superimposed. Therefore, it is necessary to change horizontal angulation to mesial or distal to help assess the superimposed root canal. Root canal morphology may vary by population. The population in Indonesia consists mainly of the sub-races of Proto and Deutro-Malay. The purpose of this study was to determine the difference of root canal morphology between maxillary and mandibular incisors; between the sub-races of Proto and Deutro-Malay; and between the right and left regions, using twice the radiation projection. This study was an analytical study with cross-sectional method using 55 subjects who come from three previous generations of Proto and Deutro-Malay. On each tooth were performed twice radiations periapical radiography, using standard angulation and altering horizontal angulation toward distal 30º. The results showed that in Proto-Melayu, for maxillary central incisors maxillary teeth were obtained type I (99.1%) and III (0.9%) Vertucci, and maxillary lateral incisors were obtained type I Vertucci (100%). In mandibular central incisors were obtained type I (90%), II (3.6%), III (2.7%) Vertucci and IV Gulabivala (3.6%), and mandibular lateral incisors were obtained type I (87.3 %), II (1.8%), III (7.3%) Vertucci and type IV Gulabivala (3.6%). In Deutro-Malay, maxillary central incisors were obtained 100% Vertucci type I and maxillary lateral incisors were obtained type I (99.1%) and II (0.9%). In mandibular central incisors were obtained type I (85.5%), III (11.8%) Vertucci, IV Gulabivala (1.8%), and other types 1-2-1-2-1 (0.9%), and mandibular lateral incisors were obtained by type I (81.8%) and III (18.2%) Vertucci. The result of chi-square analysis showed there were no significant differences of root canal morphology of maxillary insicors tooth between Proto and Deutro-Malay and between right and left region (p&gt; 0,05), but there were significant differences of root canal morphology between maxillary and mandibular incisors and root canal morphology of the mandibular incisor between Proto and Deutro-Malay (p &lt;0.05). In conclusion, maxillary and mandibular incisors of Proto and Deutro-Malay sub-races have variations in root canal configuration and there were differences found in the mandibular incisors.

In vitro effect of changing the horizontal angulation of X-ray beam on the detection of proximal enamel caries in bitewing radiographs.

Bitewing radiography is an important modality useful for the evaluation of teeth in patients of various ages and in different stages of tooth eruption. Clinical examination of proximal surfaces for caries may result in false negative results, especially in tight contact areas. Thus, radiography, as an adjunct to clinical examination, is used as a routine diagnostic modality for caries detection. The objective of this study was to assess the in vitro effect of changing the horizontal angulation of X-ray beam on the detection of proximal enamel caries in bitewing radiographs. This in vitro study was conducted on 150 caries-free human premolars (code: p/16/35/9/210). The teeth were randomly divided into 3 groups (n = 50). Group 1 served as the control group and no carious lesions were induced in this group. Teeth in groups 2 and 3 were immersed in demineralizing solution for 2 and 4 months, respectively. After induction of caries and its radiographic confirmation, the teeth were mounted in wax in groups of 3 and bitewing radiographs were obtained at 0°, 5°, 10° and 15° horizontal angles. The sensitivity values of bitewing radiographs at 0°, 5°, 10° and 15° horizontal angles were 88%, 90%, 88%, 92% in group 2 and 88%, 94%, 94% and 94% in group 3, respectively. The specificity values of bitewing radiographs at 0°, 5°, 10° and 15° horizontal angles were 92%, 86%, 84% and 76%. The accuracy of bitewing radiographs at 0°, 5°, 10° and 15° horizontal angles was 89.3%, 90%, 88.7% and 87.3%, respectively. The highest diagnostic accuracy was obtained at 5° horizontal angle for caries detection; however, the difference in this regard among the tested horizontal angles was not statically significant (p = 0.846). Based on the results of this study, changing the horizontal angulation has no significant effect on the detection of proximal enamel caries in bitewing radiographs.