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Ideal Horizontal X-Ray Beam Angulation for Maxillary Molars. A Retrospective Clinical Study Using Cone-Beam Computed

Jörg Philipp Tchorz¹, Nathalie Konstantiniuk¹, Johann Julian Alfons Sistig¹

¹Division for Endodontics, Center for Operative Dentistry and Periodontology, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, Krems, Austria.

Australian Endodontic Journal : the Journal of the Australian Society of Endodontology Inc

|July 1, 2025

Summary

This study analyzed cone-beam computed tomography (CBCT) scans to find ideal X-ray beam angles for maxillary molars. A distal tube shift greater than 18° is recommended for optimal visual separation of root canals.

Keywords:

X‐ray beam angulation intraoral radiographs maxillary molar tube shift

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Published on: April 8, 2020

Area of Science:

Dentistry
Radiology
Endodontics

Background:

Accurate imaging is crucial for endodontic treatment planning.
Maxillary molars present complex root canal anatomy, often requiring specific imaging techniques for clear visualization.

Purpose of the Study:

To determine optimal horizontal X-ray beam angulations for visualizing root canal anatomy in maxillary first and second molars using cone-beam computed tomography (CBCT).

Main Methods:

Retrospective analysis of 85 patients' CBCT scans.
Measurement of superposition angles between buccal (MB, DB) and palatal (P) root canals at coronal and apical levels for maxillary first and second molars.

Main Results:

Mean angles for MB1, MB2, and DB canal overlap with the palatal canal were 114.01° (±9.30), 119.47° (±11.05), and 87.48° (±12.02), respectively.
Coronal levels showed higher superposition angles compared to apical levels for all canals and tooth types.
A distal tube shift exceeding 18° from the orthoradial direction (90°) is suggested for ideal canal separation in typical maxillary molars.

Conclusions:

Specific horizontal angulations derived from CBCT analysis can significantly improve the visualization of maxillary molar root canal systems.
The findings provide valuable angulation guidelines for radiographic interpretation and treatment planning in endodontics.
A distal tube shift of over 18° is recommended for routine cases to enhance the clarity of root canal anatomy in maxillary molars.