The diagnostic value of routine intra-oral premaxillary radiographs in orthodontic assessment

The purpose of this study was to determine whether significant dental abnormalities are likely to be overlooked in the anterior region of the maxilla if, in the absence of any clinical indication for further views, the only radiograph used during an initial orthodontic assessment is a good-quality orthopantomogram (OPT).

Two orthodontists examined, retrospectively, the written and radiographic dental hospital records of 1169 consecutive, new, young patients who on their first visit to a dental teaching hospital underwent radiographic examination comprising an OPT and one or more supplementary radiographs of the anterior maxilla.

In five cases (0.43%) significant findings would have been overlooked if the intra-oral views had not been taken. These included periapical lesions and supernumerary teeth, but in three of the cases the image quality of the OPT was poor.

If the OPT is not routinely supplemented by intra-oral views, the chances of completely missing significant findings in the anterior maxilla are small, provided a thorough history and clinical examination have been completed and the image quality of the OPT is good.