Discerning observations opening pandoras box in orthopantomograms : Journal of Dentistry Defense Section

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Letter to the Editor

Discerning observations opening pandoras box in orthopantomograms

Ray, Saugat; Datana, Sanjeev

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Journal of Dentistry Defence Section 16(2):p 183-184, Jul–Dec 2022. | DOI: 10.4103/jodd.jodd_15_22
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Dear Editor,

This letter intends to emphasize the importance of the orthopantomogram (OPG) radiograph, routinely used in secondary and tertiary care dental setups. This preliminary diagnostic radiograph aids in screening of every minute anomalies or pathologies concerning the maxillomandibular complex. The primary endeavor of a dental surgeon or a specialist in a busy outpatient departments is to focus on the areas of interest for which specific treatment will probably be designed. With this being the most common practice, an inadvertent miss of a significant radiological finding may happen which may be attributable pathogenesis of the disease or anomaly or may have a significant prognostic implication. The above concern is deliberated with the aforementioned three scenarios encountered in the premier academic billet of the Indian Armed Forces.

A case of a 14-year-old male patient, already been published in your journal in 2021[1] who reported for the correction of forwardly placed upper front teeth and an incidental finding of taurodontism was done in OPG affecting first and second molars of all the four quadrants. The OPG revealed enlarged pulp chambers, unusual cervical constriction, and shortened roots suggestive of taurodontism [Figure 1]. The same was confirmed with the taurodont index[1] on intra-oral periapical radiographs. The information about this anomaly later had substantial implications on the orthodontic management of the patient as the anchorage value of the affected tooth is reduced due to a reduction in the surface area of the root. The existing literature information was given due consideration while planning the treatment for this case.[2,3]

Figure 1:
Taurodontism diagnosed on the pretreatment OPG. OPG: Orthopantomogram

In another case, an incidental finding of multiple pulp stones was detected in preorthodontic treatment diagnostic OPG [Figure 2]. This pathological finding was diagnosed while undergoing gross screening of the OPG during the routine case discussion. Recently, many authors had also found an increased incidence of pulp stones postorthodontic treatment, especially in maxillary and mandibular molars and premolars, respectively.[4,5] Further, a positive correlation was also found between systemic disorder and pulp stones. Cardiovascular patients had the maximum number of pulp stones.[6] Hence, the history of orthodontic treatment may be considered a significant factor while planning a case for planning an endodontic treatment. The presence of these pathological entities also aids as preliminary diagnostic indications for multiple systemic conditions, which may significantly affect dental treatment outcomes.

Figure 2:
Pulp stones identified on pretreatment OPG. OPG: Orthopantomogram

The clinical significance of OPG has also been emphasized in locating broken instruments, especially in endodontics and surgical interventions. In one such case,[7] a broken molar hook was located in postorthodontic treatment OPG concerning the right mandibular first molar [Figure 3]. This accidentally broken molar hook got dislodged in soft tissue intraoperatively while performing an orthognathic surgery. This inadvertent breakage and subsequent miss were rediscovered postdebonding as an incidental finding. Although the patient remained asymptomatic even 1 year postoperatively, this has duly been intimated to the patient.

Figure 3:
Broken molar hook identified on the right-side angle of the mandible

Keeping in view, we would like to highlight that routine sensitization of the dental surgeons should be made irrespective of specialties for careful examination of OPGs so that asymptomatic pathologies can be detected at an early stage before any intervention in maxillofacial regions rather than causing any iatrogenic damage by the virtue of undiagnosed problem due to ignorance or casual approach.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.


1. Datana S, Agarwal SS, Bhandari SK, Jain D. Implication of taurodontism in orthodontic diagnosis and treatment planning: A review and case report J Dent Def Sec. 2021;15:43–6
2. Shifman A, Chanannel I. Prevalence of taurodontism found in radiographic dental examination of 1,200 young adult Israeli patients Community Dent Oral Epidemiol. 1978;6:200–3
3. Yordanova M, Yordanova S, Tomov G. Orthodontic problems in patients with hypodontia and taurodontism of permanent molars JIMAB. 2011;17:109–13
4. Kjaer I. Morphological characteristics of dentitions developing excessive root resorption during orthodontic treatment Eur J Orthod. 1995;17:25–34
5. Jena D, Balakrishna K, Singh S, Naqvi ZA, Lanje A, Arora N. A retrospective analysis of pulp stones in patients following orthodontic treatment J Contemp Dent Pract. 2018;19:1095–9
6. Nayak M, Kumar J, Prasad LK. A radiographic correlation between systemic disorders and pulp stones Indian J Dent Res. 2010;21:369–73
7. Datana S, Agarwal SS, Roy ID. Broken orthodontic appliance during orthognathic surgery: Preventable adverse outcome Med J Armed Forces India. 2021
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