Original Research

Predicting the actual length of premolar teeth on the basis of

panoramic radiology

S Yassaei, F Ezoddini-Ardakani1, N Ostovar2

Department of Orthodontics
and 1Oral and Maxillofacial
ABSTRACT
Radiology, School of Dentistry,
Shahid Sadoughi University of
Medical Sciences,
2
Shahid Sadoughi University of
Medical Sciences, Yazd, Iran
Received : 03-03-09
Review completed : 19-11-09
Accepted : 16-06-10
Background: Panoramic radiography is one of the most common techniques for evaluating the
jaw bones and associated structures.
Aim: The aim of the study was to predict the actual length of the premolar teeth, based on
measurements taken on a panoramic radiograph.
Materials and Methods: This study was done in two stages. In the first stage, the actual and
panoramic lengths of 102 teeth of orthodontic patients were measured and compared. In the next
stage, the actual and radiographic vertical lengths of four metal balls placed in the molar and
first premolar areas of 27 patients, referred to radiography clinic were also analyzed. Comparison
of the mean magnification between the two methods was performed by one-sample T-test and
P<0.05 was considered as statistically significant.
Results: The total magnification of the premolar region in the vertical plane in the tooth length
measurement method was 17.39%, while the same in the metal markers method was 27.39%.
The upper teeth showed larger magnification than the lower teeth in the vertical plane. Similarly,
the magnification and distortion of the metal markers in the horizontal plane were significantly
more than this in the vertical plane and also their magnification and distortion in the molar
region were more than this in the premolar region. The actual length of the premolar teeth can
be estimated by using a suitable regression formula.
Conclusion: Panoramic radiography can be used for calculating the actual length of premolar
teeth.
Key words: Distortion, magnification, panoramic

Panoramic or rotational radiography is an easy and fast need to be estimated before orthodontic treatments
technique in which the images of the upper and lower arches such as force eruption and orthodontic movement of
along with their surrounding structures are studied in one teeth.[3,4] Accurate vertical measurements are required during
view with less radiation exposure than the complete series of stages of post and core treatment, for the measurement
intra-oral radiographs.[1] But one of the main problems of this of bony surface next to an implant, root measurements
method is magnification of anatomical structures, especially during orthodontic treatment and evaluation of the rate of
teeth, which limits its dimensional evaluation.[2] Estimation bony destruction in patients with periodontal problems.[5]
of the actual length of teeth from panoramic radiographs Lien and Soh studied the actual and panoramic lengths of
can help the orthodontists to review root resorption during permanent premolars that were candidates for extraction
treatment. The lengths of the roots and their angulations in orthodontic treatment and the results showed that the
magnification rate in the upper teeth was approximately 22%,
Address for correspondence: while in the lower teeth it was 11%.[6] Schulze et al. placed
Dr. Soghra Yassaei markers in the premolar region and left mandibular angle
E-mail: syassaei@yahoo.com of a skull and took 70 panoramic images in seven positions.
Repetition of vertical measurements was less than horizontal
Access this article online measurements and horizontal measurements were most
Quick Response Code: Website: reliable linear measurements in this study.[7] Yitschaky et al.
www.ijdr.in studied the actual length of 112 premolar teeth extracted for
PubMed ID:
orthodontic reasons and compared it with their radiographic
*** lengths. Results showed that the vertical magnification of
the first upper premolars was significantly more than the
DOI:
10.4103/0970-9290.74207
magnification of the lower first premolars.[8] Volchansky
et al. compared the vertical and horizontal lengths of
Indian J Dent Res, 21(4), 2010 468
Prediction of premolar teeth length Yassaei, et al.
posterior teeth in 16 skulls using standard intra-oral and
panoramic radiographies. They concluded that if the patient
is positioned properly in the focal trough, it is possible to
use panoramic radiography for making measurements in
posterior region.[9]
Therefore, due to the clinical importance of panoramic
radiography and its numerous practical uses, many studies
regarding magnification of panoramic radiography have
been performed, [6-9] but there is still no specific and
comprehensive formula to estimate the actual length of
teeth from their radiographic lengths. In the present study,
the authors have tried to derive a formula for estimating
the actual length of premolar teeth from their panoramic
radiographic length by evaluating the relationship between
the actual and radiographic length of teeth and the rate
of magnification of vertical panoramic views taken with
Planmeca machine.
MATERIALS AND METHODS
This is a descriptive, analytical and diagnostic study in
which the mean premolar teeth length from the panoramic
radiographs was compared with the mean of the actual
length of the teeth after extraction and a regression model
was used to derive a formula to estimate the actual length
from the radiographic length. Panoramic radiographs
were taken by Planmeca 2002 machine. The inclusion
criteria were existence and having complete root and apex
in premolar and molar teeth; and no pathologic lesion in
the crown and root area, permanent dentition without any
primary tooth. Exclusion criteria were metal restoration in
molar and premolar teeth.
To increase the precision of calculating the magnification of
panoramic radiography, two methods were used. In the first
method, in order to compare the actual and radiographic
lengths of the teeth, 29 orthodontic patients in the 15–20
years age group were selected. These cases were healthy
and their first premolars were extracted for orthodontic
treatment. A total of 22 pairs of lower first premolars
and 29 pairs of upper first premolars were included in
the study. The roots and their apices were completely
formed without any pathology in radiographic studies
(for example, decomposition of the roots, decay or repair).
Non-traumatic extractions were done. Before undergoing
orthodontic treatment, every patient routinely took a
panoramic radiography using Planmeca 2002 EC proline
(Planmeca Co., Helsinki, Finland) according to standard
conditions of 12 mA/80 KVP/18 seconds. The teeth were
divided into four groups according to their position in
the oral cavity: T44 (right upper first premolar), T34 (left
upper first premolar), T24 (right lower first premolar) and
T14 (left lower first premolar). The extracted teeth were
placed in 1/1 sodium hypochlorite (NaOCL 5%) and normal
saline solution.
469
Vertical height was considered as the maximum distance
between the apex and tip of the palatal cusp, both in
extracted teeth and radiographs. Measurement of the teeth
and the radiographs was performed twice at an interval of
1 week by a trained observer and a maxillofacial radiologist
using a Digimatic 500197, CD-8″CS Digital Vernier Caliper
(Mitutoyo Co., Kawasaki, Japan) with an accuracy of 0.01
mm by a standard table view box. The mean of measurements
was recorded for each case.
In the second method of the study, 27 patients referring
to the orthodontic clinic and requiring a panoramic
radiograph were included. Oral explanation of the whole
study was given to the patients and then informed consent
was taken from each participant. These patients had an
almost complete dental system to close their teeth over a
bite plan. In addition, the presence of 4th and 6th upper
and lower teeth on both sides was a compulsion. Two metal
balls of 6 mm in diameter were placed in red dentistry wax
with the dimensions of 20×40 mm at a distance of 13 mm
from each other as a set. The balls were made in China and
coated by stainless steel [Figure 1]. The wax was used to
prevent the balls from swallowing and it served as a bite
plan. Two sets were placed in each side of the patient’s
mouth in such a way that the first ball was parallel to the
crown of the first premolar and the second ball was at
the center of the crown of the first molar. The sets were
held in position by contact of the upper and lower teeth
[Figures 2 and 3]. The regions were named as S L4, S L6,
S R4 and S R6. After testing each patient, the balls were
removed from the wax, sterilized in Deconex Solarcept
solution for 5 minutes and new wax was used for the next
patient. The maximum vertical and horizontal lengths of
the balls were measured on the radiographs [Figure 4]. In
cases where the 4th or 6th tooth had been repaired and the
tooth filling interfered with the metal ball on radiography
for measuring the marker, the case was excluded from
the study. We did not consider the magnification factor
of the unit manufacturing factory because of the possible
variations in anthropometric measures of subjects.
Differential magnifications on both sides of each panoramic
radiograph were calculated and compared. Radiographs
with large difference in magnification between right and
left sides were ignored. The Ethics Committee of Shahid
Sadoughi University of Medical Sciences approved the
protocol.
Statistical analysis
Data obtained from two times measurements were entered
to a computer and their mean was calculated. The values
were then coded, entered in SPSS software program and
appropriate statistical tests like single specimen T-test and
Pearson’s correlation test were used for analysis. A linear
regression model was used to estimate the difference
between the actual and radiographic length and to produce
a mathematical formula. Confidence level of 95% and
Indian J Dent Res, 21(4), 2010
Prediction of premolar teeth length Yassaei, et al.

analytical value of 80% were considered for reporting the
results of the study.
RESULTS
The comparison of the actual and radiographic lengths of
the teeth according to the different jaw regions is shown in
Table 1. The difference between the magnification of the
upper and lower premolars was significant (P=0.000). In
addition, the overall horizontal magnification of panoramic
radiography in the area of first premolars was calculated to
be 17.39%.
The comparison of the actual and radiographic length
and width of the markers according to the different jaw
regions is shown in Tables 2 and 3. According to the data,
there was no significant difference between the vertical
and horizontal magnifications in the S R6 and S L6 groups.
Similarly, there was no significant difference between the
vertical and horizontal magnifications in the S R4 and S L4
groups. The difference in magnification of the markers in the
molar and premolar regions in the vertical dimension was
significant (P=0.000), while the difference in magnification
of the markers in the molar and premolar regions in the
horizontal dimension was not significant. The magnification
of panoramic radiographic images in the premolar region
by using markers was significantly different from the actual
dental length measurement method (P=0.000).
At the end, the X and Y coefficients and the regression
formula:

Figure 2: Method of placement of metal markers in the mouth

Figure 1: Metal balls

Figure 4: Method of measurement of metal markers by Digital Vernier

Figure 3: A panoramic radiography showing the metal balls in the mouth Caliper

Table 1: Mean and standard deviation of actual and radiographic lengths of premolars and their vertical magnification in
various groups
T14 T24 T34 T44
Radiographic length (mm) 26.47±1.77 26.44±1.70 25.87±2.51 26.04±2.53
Actual length (mm) 21.59±2.09 21.59±2.14 23.16±2.42 23.09±2.28
Magnification (%) 22.60 22.46 11.72 12.78
P value 0.000 0.000 0.000 0.000
One sample T-test

Indian J Dent Res, 21(4), 2010 470

Prediction of premolar teeth length Yassaei, et al.

Table 2: Mean and standard deviation of the vertical plane of markers and their vertical magnification in various groups
S L6 S L4 S R4 S R6
Radiographic length (mm) 7.72±0.15 7.62±0.12 7.66±0.11 7.77±0.14
Actual length (mm) 6±0.02 6±0.02 6±0.02 6±0.02
Magnification (%) 29.53 27.09 27.69 28.72
P value 0.000 0.000 0.000 0.000
One sample T-test

Table 3: Mean and standard deviation of the horizontal plane of the markers and their horizontal magnification in various groups
S L6 S L4 S R4 S R6
Radiographic width (mm) 7.90±0.75 7.57±0.73 7.98±0.76 8.17±0.72
Actual width (mm) 6±0.02 6±0.02 6±0.02 6±0.02
Magnification (%) 31.75 26.32 33.02 36.26
P value 0.000 0.000 0.000 0.000
One sample T-test

TA*=(TR**×X)+Y were used to calculate the actual premolar
dental length from the panoramic radiographic lengths on
the basis of statistical analysis of the data. This formula in
the different jaw regions is shown separately in Table 4.
The regression formulas for different groups are as following:
T14 group: TA=(TR×0.13)+18.14
T24 group: TA=(TR×0.082)+19.41
T34 group: TA=(TR×0.205)+17.86
T44 group: TA=(TR×0.084)+20.9
DISCUSSION
The present study was conducted in two ways so that the
conditions and factors effective in clinical measurement
of teeth could be considered and in addition to being just a
clinical study, it could be more of a practical use. As healthy
teeth free from any pathology were required for the study,
teeth extracted for the purpose of orthodontic treatment were
the best choices. In the first stage of the study, since factors
like root curvature, deviation of dental axis, growth position
and tooth size have effects on the measurements,[2] in the
second part of the study, metal ball markers with similar
size, dimension and suitable contrast were used.[7] Therefore,
use of these metal balls as markers reduced the effects of
factors like dental anatomical differences, overlapping or
haziness of the root ends, problem in developing and fixing
the films, and distortion of angles, on the results of the
study. [10] The accuracy of measurement in panoramic
radiography is affected by magnification and distortion.
Distortion is due to the asymmetrical magnification in
different subject dimensions.[11] Factors affecting both vertical
and horizontal magnifications include the distance of the
film from the source of radiation which is constant in each
panoramic radiography machine, and the distance of the film
from subject which is variable depending on the position
of the patient.[12] If the patient is positioned properly in the
machine, it is assumed that the lower jaw is in the image
layer. As a general role, placement of subject in the central
plane has an ideal vertical and horizontal magnification (no
distortion).[13] With the increase in the distance between
471
Table 4: Presentation of fixed coefficients and regression
formulas in various groups
X Y Estimated length R2
T14 0.13 18.14 TA=(TR×0.13)+18.14 0.006
T24 0.082 19.41 TA=(TR×0.082)+19.41 0.001
T34 0.205 17.86 TA=(TR×0.205)+17.86 0.045
T44 0.084 20.91 TA=(TR×0.084)+20.91 0.001
Linear regression model
subject and central plane image layer, the distortion and
haziness also increase which is more prominent in the
horizontal than the vertical plane because distortion is due
to the horizontal movement of film and radiation source and
haziness also occurs in the direction of the movement of the
radiation group (transversely).[12] If an object is not in an ideal
position, but within the image layer limit and it is moving
away from the film, magnification in the horizontal plane is
more than in the vertical plane, but if it is moving toward
the film, reduction in its dimensions in the horizontal plane
is much more than in the vertical plane. Anyway, the result
of both conditions is distortion of the image.[13]
There was no statistically significant difference between
the magnification of the left and right jaws in both
methods. Coordination of the magnifications of the
right and left sides depends on correct positioning of the
patient in the sagittal plane in the panoramic radiology
machine.[14] During measurement of the teeth, vertical
magnification of the upper premolars was 1.84 times
more than the lower premolars and this difference was
statistical significant. This finding is similar to the results
of the studies by Yitschaky et al.[8] and Lien and Soh.[6] The
difference between the vertical magnification of the upper
and lower premolars could be due to the bucco-lingual
angle of the teeth with the vertical plane of the film.[8]
According to a study by McDavid et al., there are different
angles between the central radiation rays and central
plane of image layer. Therefore, in order to estimate the
length more accurately for nonvertical subjects, other
factors like angle of the object should be considered.[15]
Indian J Dent Res, 21(4), 2010
Prediction of premolar teeth length Yassaei, et al.
Similarly, Stramotas et al. believe that even if an angular
object is placed firmly in the image layer of the machine,
different magnifications will be obtained due to the angle
of placement of that object.[14]
The angle of radiation also affects the rate of magnification.
Due to the negative angle of the ray tube in panoramic
radiography, the mandible is placed vertically over the
central rays. Therefore, the angle of radiation to the upper
jaw is more than this to the lower jaw. Thus, the effect of
magnification factors on the teeth of the lower jaw is reduced
and the magnification and distortion in them are less than
the upper teeth.[12]
Overall, collection of factors including relative position
of the radiation rays and its 4°–7° negative angle, relative
position of the occlusal plane and the distance between
the radiation rays and teeth have an effect on the vertical
distortion.[8] The vertical magnification of the premolar
region for the Planmeca machine was 17.39% and with a
discrepancy of ±3.5, was similar to the studies by Lien and
Soh[6] and Yitschaky et al.[8]
Overall, magnification of the markers in the premolar region
was significantly more than that of the teeth (P=0.000).
This could be due to the difference in method of study, or
shape, size and position of subjects. The markers were placed
between the teeth and due to their spherical shape, even
during movement or shift in position, there was no change
in the angle of their placement with respect to the vertical
plane of the film. Therefore, they were perpendicular both
to the film and central rays in all positions. But the teeth had
different bucco-lingual angles and this angle is an important
factor in vertical magnification.[14,15]
In addition to this, the physical shape of objects also has
an effect on the rate of magnification and on the basis of
this law of physics, the rate of distortion of the external
edges of an object in panoramic radiography depends on
the shape of that object. When an object is more spherical,
the measurement is also more accurate and distortion is
also less.[3] The mean vertical magnification of the metal
markers in the first molar region was significantly more
than premolar region (P=0.000). In the horizontal plane too,
the magnification of the metal markers in the first molar
region was more than premolar region, but this difference
was not significant.
On comparing the vertical and horizontal magnifications
of the metal markers, the horizontal magnification
was significantly more than the vertical magnification
(P= 0.005). This implies that the depth of an object (distance
from the clear layer) has less effect on vertical magnification.
Distortion in measurement occurs because of the horizontal
movement of the film and ray source, while the formation
of the image in the vertical plane is due to normal radiation
Indian J Dent Res, 21(4), 2010
of rays and is not affected by horizontal rotation of
rays.[1] These findings are in accordance with the findings
of Wyatt et al.[16] and Catic et al.,[17] but not in line with
the findings of Schulze et al.[7] In a study by Park and Kim,
displacement of the mandible in acentric positions resulted
in increased magnification errors in the horizontal plane,
but the vertical magnification errors in all positions were
relatively the same.[18]
Based on the results of the present study, the following
regression model formula with X and Y variables is proposed
for each quadrant of the jaw:
TA=(TR×X)+Y.
This formula is capable of estimating the length of the first
premolar tooth on the basis of its radiographic length on
Planmeca 2002 machine. This is practically possible under
special conditions including proper placement of the patient
and adjustment of the machine. But further studies are
required for use of this formula in different X-Ray machines.
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How to cite this article: Yassaei S, Ezoddini-Ardakani F, Ostovar N. Predicting
dimensional and angular measurements from panoramic and lateral
the actual length of premolar teeth on the basis of panoramic radiology. Indian
oblique radiographs. Dentomaxillofac Radiol 1995;24:225-31.
J Dent Res 2010;21:468-73.
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Source of Support: Nil, Conflict of Interest: None declared.
measurements on the human dental panoramic radiographs. Coll

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