buccal or palata/ dental courses

PALATAL OR BUCCAL?PALATAL OR BUCCAL?
““THE RELIABILITY AND UTILITY OF A SINGLETHE RELIABILITY AND UTILITY OF A SINGLE
ORTHOPANTOMOGRAPH IN DETERMINING THE BUCCO-PALATALORTHOPANTOMOGRAPH IN DETERMINING THE BUCCO-PALATAL
POSITION OF IMPACTED MAXILLARY CANINES’’POSITION OF IMPACTED MAXILLARY CANINES’’
INDIAN DENTAL ACADEMY
Leader in continuing Dental
Education
www.indiandentalacademy.com

• FREQUENCY OF IMPACTION OR RETENTION – 20%
• MAXILLARY CANINE HAS GREATEST IMPLICATION IN DENTISTRY.
MAJORITY OF IMPACTED TEETH INVOLVES
3RD
MOLARS - MAX. CANINES - MAND. 2ND
PREMOLARS
MAXILLARY CANINES
PREVALENCE DEPENDING ON THE POPULATION EXAMINED.
0.92% DACHI & HOWELL 1961
2.56% MCKAY 1978
FEMALES (1.17%) COMPARED TO MALES (0.51 %).
INTRODUCTION

THE CANINE WAS OFTEN IRREGULAR BECAUSE IT ERUPTED LATE IN THE
SERIES, AND THE ADJACENT TEETH TOOK ITS PLACE. IT IS GENERALLY
ACCEPTED THAT EARLY LOSS OF DECIDUOUS TEETH AND CROWDING OF
THEPERMANENTSUCCESSORS MAY DISPLACEA CANINELABIALLY.
HUNTER
1803
RETARDED RESORPTION OF DECIDUOUS TOOTH, CAUSING ABNORMAL
GUIDANCEOF THEBULBOUS CROWN OF THEPERMANENTCANINE, WILL
RESULTIN PALATALDISPLACEMENT.
DEWEL

• THE PANORAMIC RADIOGRAPH - FIRST CHOICE RADIOGRAPH FOR
ORTHODONTIC PATIENTS SOUTHALL &
GRAVELY 1987.
IMPACTION OF MAXILLARY CANINE IS AN OCCASIONAL BUT
SIGNIFICANT FINDING. IT WOULD BE ADVANTAGEOUS IF THIS SINGLE
FILM COULD BE RELIABLY USED FOR LOCALIZATION OF THE
UNERUPTED TOOTH
• HENCE, THE PRESENT STUDY WAS CONDUCTED TO ESTABLISH A
METHOD TO LOCALIZE IMPACTED MAXILLARY CANINES USING A

• LOCALIZATION
THE DETERMINATION OF THE SITE OR PLACE OF
ANY PROCESS OR LESION.
DORLAND
• METHODS OF LOCALIZATION
INSPECTION
PALPATION
RADIOGRAPHY

RADIOGRAPHIC TECHNIQUES
1-TUBE SHIFT METHOD / PARALLAX TECHNIQUE
CLARK 1909
2-VERTEX OCCLUSAL RADIOGRAPH FOR UNERUPTED MAXILLARY
CANINES. ( Right Angle Technique)
HITCHIN 1951
• UNRELIABLE UNDER CERTAIN CONDITIONS
• SUPERIMPOSITION OF THE FRONTAL BONE ON THE
ANTERIOR TEETH .
HILL & TOVEY
1985 www.indiandentalacademy.com

3-STEREOSCOPY
4-STATUS X-RADIOGRAPHY
5-PANAGRAPHY
6-ORTHOPANTOMOGRAPH

PANORAMIC RADIOGRAPHY
• PRINCIPLE OF IMAGE DISTORTION -THAT IS FOR A GIVEN ‘FOCAL
SPOT FILM DISTANCE’OBJECTS FURTHER AWAY FROM THE IMAGE
RECEPTOR WILL APPEAR MAGNIFIED.
WOLF & MATTILA 1979
• IF A CANINE IS RELATIVELY MAGNIFIED COMPARED TO THE
ADJACENT TEETH - PALATALLY,
• DIMINISHED - LABIALLY.
• ACCURATE DETERMINATION OF THE LABIOPALATAL POSITION OF
IMPACTED MAXILLARY CANINES - 80% OF CASES

AIMS AND OBJECTIVES
◊ TO LOCALIZE IMPACTED MAXILLARY CANINES UTILIZING
AN ORTHOPANTOMOGRAPH
◊ TO ESTABLISH A RELIABLE METHOD TO LOCALIZE AN
IMPACTED MAXILLARY CANINE BASED SOLELY ON
ASSESSMENT OF A SINGLE RADIOGRAPH

◊ TO CALCULATE THE RELATIVE MAGNIFICATION OF BOTH
THE BUCCALLY AND PALATALLY IMPACTED CANINES AT
DIFFERENT VERTICAL POSITIONS ON THE OPG RADIOGRAPH.
◊ TO DETERMINE A CLEAR ‘CUT-OFF MAGNIFICATION INDEX’
IN ORDER TO DIFFERENTIATE BUCCAL IMPACTIONS FROM
PALATAL IMPACTIONS.

MATERIALS AND METHOD
• THE PATIENTS –WERE IN THE AGE GROUP 13-25 YEARS OF BOTH THE
SEXES
• PATIENTS WITH IMPACTED/UNERUPTED PERMANENT MAXILLARY
CANINE
• UNILATERAL OR BILATERAL
• PANORAMIC RADIOGRAPH AND TWO PERIAPICAL RADIOGRAPHS.
• SURGICAL EXPOSURE.

INCLUSION CRITERIA:
• SUBJECTS MORE THAN 13 YEARS OF AGE OF EITHER SEXES .
• WITH IMPACTED MAXILLARY CANINE/S IN THE ANTERIOR
REGION.
• PATIENTS WITH CLASS I MALOCCLUSION .
• NON SYNDROMIC PATIENTS

EXCLUSION CRITERIA:
• HORIZONTALLY, ROTATED AND INVERTED CANINE
• SUBJECTS IN WHOM A PART OF THE IMPACTED CANINE WAS VISIBLE IN
THE ORAL CAVITY
• MALALIGNED UPPER CENTRAL INCISORS.
• DEVELOPMENT DISORDERS OF DENTITION / GROSS DISTORTIONS OF
DENTAL ARCHES WITH OR WITHOUT CRANIOFACIAL SYNDROMES.
• INSUFFICIENT NUMBER OF ERUPTED TEETH / SUPERNUMERY IN THE
MAXILLARY ANTERIOR REGION

RADIOGRAPHS
OPG IOPA

OPG

VERTICAL RESTRICTION CRITERIA

DETERMINATION OF CANINE INCISOR INDEX
MESIO DISTAL DIMENSION OF CANINE[C] =CANINE –INCISOR INDEX
MESIO DISTAL DIMENSION OF INCISOR[I] [CII]
C
I

DETERMINATION OF CANINE CANINE INDEX[CCI]
MESIO DISTAL DIMENSION OFCANINE[C] =CANINE CANINE
MESIO DISTAL DIMENSION OF CANINE[C] INDEX
C
C

DETERMINATION OF CONTROL CANINE INCISOR
INDEX[c CII]
MESIO DISTAL DIMENSION OF THE ERUPTED CANINE = CONTROL
MESIO DISTAL DIMENSION OF THE CENTRAL INCISOR CANINE INCISOR[cCII]
CI

• THE SLOB TECHNIQUE OF LOCALIZATION

..The interpretation of radiographic results from the SLOB technique and
accuracy in localization of the impacted canine using the surgical
exposures were recorded and were purposely hidden from the person
conducting the study using OPG magnification criteria for the purpose
of avoiding bias.
The patients with their radiographs and the OPG were coded with the
same numbers and at the end of the study ,they were compared and
tabulated for the accuracy in revealing the position of their exact
location in the Maxilla.

RESULTS
0
10
20
30
MALE FEMALE
GENDER
NUMBER
MALE
FEMALE
16/31%
35/69%
UNILATERAL
BILATERAL
IMPACTION
0
10
20
30
40
BUCALLY PALATALLY
BUCALLY
PALATALLY

S.N CII cCII CCI OPG MAG C SLOB SURG
1 1.714 1.714 1.714 apical-palatal palatal Buccal
2 1.750 1.750 0.875 middle-palatal palatal Buccal
3 1.000 1.000 0.900 middle-buccal buccal Palatal
5 1.000 1.000 1.110 apical-buccal buccal Palatal
6 0.170 1.714 1.710 middle-buccal buccal Palatal
7 0.700 0.700 0.800 coronal-buccal buccal Palatal
9 1.090 1.090 1.200 apical-buccal buccal Palatal
10 1.625 1.625 1.625 apical-palatal palatal Buccal
11 1.200 1.200 1.333 apical-palatal palatal Palatal
12 1.272 1.272 1.400 coronal-palatal palatal Palatal
14 1.272 1.272 1.750 middle-palatal palatal Palatal
15 0.900 0.900 0.900 coronal-buccal buccal Buccal
16 1.000 1.000 1.250 middle-buccal buccal Buccal
18 1.500 1.500 1.500 middle-Palatal palatal Buccal
29 2.000 2.000 1.714 apical-Palatal buccal Buccal
31 1.110 1.100 1.250 apical-buccal buccal Buccal
34 1.200 1.200 1.333 middle-Palatal buccal Buccal
35 1.110 1.200 1.250 apical-buccal buccal Buccal
S.N CII cCII CCI OPG MAG C SLOB SURG
36 1.166 middle-palatal palatal Palatal
37 1.000 coronal-buccal buccal Buccal
38 1.200 coronal-palatal palatal Palatal
40 1.000 middle-buccal buccal Buccal
52 1.000 apical-buccal palatal Buccal
56 1.200 middle-palatal buccal Palatal
57 0.900 middle-buccal palatal Buccal
58 1.200 coronal-palatal buccal Palatal
61 1.000 coronal-buccal palatal Buccal
62 1.142 middle-buccal palatal Buccal
63 1.250 apical-palatal buccal Palatal

IMPACTED MAXILLARY CANINES PREDICTION
CHART
POSITION
NO. OF
IMPACTIONS
PREDICTION
BY OPG
PREDICTION
BY SLOB
SURGICAL
EXPOSURE
BUCCAL 31 24 17 31
PALATAL 36 31 23 36
TOTAL 67 55 40 67
% 100% 82.08% 59.70% 100%

The range of CII values for different groupsThe range of CII values for different groups
LABIALLY IMPACTED CANINE 0.70-1.140
PALATALLY IMPACTED CANINE 0.91-1.714
MEAN-1.17
0
0.5
1
1.5
CORONAL MIDDLE APICAL
BUCCAL
PALATAL

0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
CORONAL MIDDLE APICAL
BUCCAL
PALATAL
RANGE OF CCI FOR DIFFERENT GROUP
LABIALLY IMPACTED CANINE 0.97-1.710
PALATALLY IMPACTED CANINE 0.86-1.857
MEAN 1.174
CONTROL CANINE INCISOR INDEX (C- CII)
0.74-1.75

CLEAR DIFFERENCE COULD BE SEEN BETWEEN LABIALLY AND
PALATALLY LOCATED CANINES, ENABLING BUCCOLINGUAL
DIAGNOSIS .
82% ACCURACY CAN BE MADE FROM HORIZONTAL AND VERTICAL
MAGNIFICATION CRITERIA
60% ACCURACY CAN BE MADE BY LOCALIZATION BY THE SLOB
TECHNIQUE.
CHI-SQUARE TEST FOR BUCCAL AND PALATAL CANINE
MEAN IS 0.0001

FOR THE MAGNIFICATION TO BE RELIABLE
• IDEAL ARCH FORM IS NECESSARY SO THAT CII OF LABIALLY
IMPACTED CANINES SHOULD BE LESSER THAN ONE AND OF
PALATALLY IMPACTED CANINES GREATER THAN ONE, WHICH IS
VERY DIFFICULT.
• IF THE SIZE OF IMPACTED MAXILLARY CANINE IS COMPARED
WITH THE SIZE OF A TOOTH THAT IS MALALIGNED, THIS
MALALIGNMENT COULD LEAD TO AN INCORRECT
INTERPRETATION OF THE POSITION OF IMPACTED MAXILLARY
CANINE . www.indiandentalacademy.com

A PRECISE CUT OFF POINT VALUE OF 1.16 WAS DETERMINED WHICH
GIVES A HINT REGARDING THE LOCATION OF IMPACTED
MAXILLARY CANINE.
• A PALATALLY IMPACTED CANINE COULD BE RELIABLY
LOCALIZED IF ITS CII IS HIGHER THAN OR EQUAL TO 1.16
STELLA CHAUSHU & GAVRIEL
CHAUSHU

• THE LABIO-PALATAL POSITION OF APPROXIMATELY 90% OF ALL
CASES CAN BE DETERMINED ACCURATELY. THE GREATEST
ACCURACY WAS ACHIEVED WITH PALATALLY LOCATED TEETH,
WHERE MAGNIFICATION IS LARGEST.
WOLF &
MATTILA 1979
• THE ACCURACY OF THIS METHOD DECREASED SIGNIFICANTLY
WHEN THESE WERE POSITIONED AT THE LEVEL OF DENTAL ARCH
OR BUCCAL TO IT.

CORRECT PREDICTION OF PALATAL UNERUPTED
MAXILLARY CANINE USING DIFFERENTIAL
MAGNIFICATION ON DENTAL PANORAMIC
RADIOGRAPHS IS POSSIBLE IN ABOUT 4 OUT OF 5
CASES.
N.A FOX & G.A
FLETCHER

CONCLUSION
PRIMARY INTENTION - ARRIVE AT A RELIABLE METHOD TO
LOCALIZE AN IMPACTED MAXILLARY CANINE AND TO AVOID
UNNECESSARY PRESCRIBING MORE RADIOGRAPHS.
WHEN CII AND CCI VALUES OF LABIALLY AND PALATALLY
IMPACTED CANINES WERE COMPARED A STATISTICALLY
SIGNIFICANT DIFFERENCE WAS FOUND BETWEEN THE TWO.
THE PALATALLY IMPACTED CANINES COULD BE RELIABLY
LOCALIZED IF CANINES WITH CII OF 1.16 OR ABOVE WERE
CONSIDERED AS PALATAL AND BELOW IS CONSIDERED LABIAL.

ALTHOUGH NARROW IMAGE LAYER IN THE ANTERIOR
REGION IS A DISADVANTAGE OF PANORAMIC
RADIOGRAPH, BUT THE RESULTING DISTORTION CAN
PROVE TO BE A BLESSING IN DISGUISE IF A METHOD IS
ESTABLISHED TO RELIABLY LOCALIZE IMPACTED
MAXILLARY CANINE USING A SINGLE PANORAMIC
RADIOGRAPH.

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