Image Distortion of the Roots of Maxillary Deciduous Molars on IOPA’s Recorded with Bisecting Angle or a Modified Paralleling Technique

Abstract

The maxillary deciduous molar periapical radiograph often presents a diagnostic challenge for the clinician due to the overlapping of their roots with the developing premolar tooth bud. Clear and distortion free images are necessary for decision making while planning the treatment. However, the practical anatomical difficulties discourage the clinician from using the paralleling technique in children. While looking for an alternative technique, it was hypothesized in the literature that the 20 degree paralleling compromise technique suggested by Van Aken (1969), could override the anatomic challenges in children and provide images that are superior compared to those recorded with the bisecting angle technique. To compare the image quality of maxillary deciduous molar IOPAR taken using the “20 degree paralleling compromise technique” with that taken using the “bisecting angle technique”. Parallel double blinded randomized clinical trial. Sixty children who fulfilled the inclusion criteria were randomly split into two groups. In group A, the bisecting angle technique was used and in Group B the 20 degree paralleling compromise technique was used. The radiographs were categorized into three groups according to the quality of the image (1: Foreshortened image of the roots, 2: Elongated Image of the roots, 3: Undistorted well-defined image) by two independent observers who were blinded to the study and then compared. The obtained data was analysed for inter and intra observer agreements using Kappa statistics and analyzed for significance using the Chi square test. The p values obtained for category 1 and 2 were 0.21 and 0.99 for observer 1 and 0.16 and 0.33 for observer 2 respectively. Under the conditions of the study, there was no difference in the image quality of maxillary deciduous molar roots on IOPAR recorded using either the “bisecting angle” or the “20 degree paralleling compromise” techniques.