Radiographic localization of unerupted maxillary anterior teeth using the vertical tube shift technique: the history...

The preferred means of radiographic localization is the parallax method introduced by Clark in 1910. He used 2 periapical radiographs and shifted the tube in the horizontal plane. In 1952, Richards appreciated that a vertical tube shift could also be carried out. No major changes then occurred in the technique until Keur, in Australia, in 1986 replaced the periapical radiographs with occlusal radiographs. This modification enables a greater tube movement and therefore a greater shift of the image of the impacted tooth; it also ensures that the whole of the tooth is captured on the radiograph. For the vertical tube shift, Keur introduced the use of a rotational panoramic radiograph with an occlusal radiograph. In 1987, Southall and Gravely discussed this vertical tube shift combination in the English dental literature, and it is now the preferred combination of radiographs for localizing impacted maxillary anterior teeth. Jacobs introduced this method to the American literature in 1999, but it has yet to gain acceptance in the continental European literature. Jacobs recommended, when using this combination, to routinely increase the vertical angulation for the occlusal radiograph by 10 degrees to achieve a greater image shift. Four case reports are presented in this article. Three have photographs taken at surgical exposure to illustrate how the position of the impacted tooth can be accurately predicted by appropriate interpretation of the radiographs.