Accuracy of one-step automated orthodontic diagnosis model using a convolutional neural network and lateral cephalogram images with different qualities obtained from nationwide multi-hospitals / 대한치과교정학회지

Objective@#The purpose of this study was to investigate the accuracy of one-step automated orthodontic diagnosis of skeletodental discrepancies using a convolutional neural network (CNN) and lateral cephalogram images with different qualities from nationwide multi-hospitals. @*Methods@#Among 2,174 lateral cephalograms, 1,993 cephalograms from two hospitals were used for training and internal test sets and 181 cephalograms from eight other hospitals were used for an external test set. They were divided into three classification groups according to anteroposterior skeletal discrepancies (Class I, II, and III), vertical skeletal discrepancies (normodivergent, hypodivergent, and hyperdivergent patterns), and vertical dental discrepancies (normal overbite, deep bite, and open bite) as a gold standard. Pre-trained DenseNet-169 was used as a CNN classifier model. Diagnostic performance was evaluated by receiver operating characteristic (ROC) analysis, t-stochastic neighbor embedding (t-SNE), and gradientweighted class activation mapping (Grad-CAM). @*Results@#In the ROC analysis, the mean area under the curve and the mean accuracy of all classifications were high with both internal and external test sets (all, > 0.89 and > 0.80). In the t-SNE analysis, our model succeeded in creating good separation between three classification groups. Grad-CAM figures showed differences in the location and size of the focus areas between three classification groups in each diagnosis. @*Conclusions@#Since the accuracy of our model was validated with both internal and external test sets, it shows the possible usefulness of a one-step automated orthodontic diagnosis tool using a CNN model. However, it still needs technical improvement in terms of classifying vertical dental discrepancies.

Comparison of one-jaw and two-jaw orthognathic surgery in patients with skeletal Class III malocclusion using data from 10 multi-centers in Korea: Part I. Demographic and skeletodental characteristics / 대한치과교정학회지

Objective@#To investigate demographic and skeletodental characteristics of one-jaw (1J-OGS) and two-jaw orthognathic surgery (2J-OGS) in patients with skeletal Class III malocclusion. @*Methods@#750 skeletal Class III patients who underwent OGS at 10 university hospitals in Korea between 2015 and 2019 were investigated; after dividing them into the 1J-OGS (n = 186) and 2J-OGS groups (n = 564), demographic and skeletodental characteristics were statistically analyzed. @*Results@#2J-OGS was more frequently performed than 1J-OGS (75.2 vs. 24.8%), despite regional differences (capital area vs. provinces, 86.6 vs. 30.7%, p 0.05). The most prevalent skeletal patterns in both groups were hyper-divergent pattern (50.0 and 54.4%, respectively) and left-side chin point deviation (both 49.5%).Maxillary spacing (odds ratio [OR], 3.645; p < 0.001) increased the probability of 2J-OGS, while maxillary crowding (OR, 0.672; p < 0.05) and normo-divergent pattern (OR, 0.615; p < 0.05) decreased the probability of 2J-OGS. @*Conclusions@#In both groups, males outnumbered females, and their mean operation age was older. The most frequent ALD was crowding in the 1J-OGS group, and spacing in the 2J-OGS group, while skeletal characteristics were not significantly different between the two groups.

Accuracy of artificial intelligence-assisted landmark identification in serial lateral cephalograms of Class III patients who underwent orthodontic treatment and two-jaw orthognathic surgery / 대한치과교정학회지

Objective@#To investigate the pattern of accuracy change in artificial intelligence-assisted landmark identification (LI) using a convolutional neural network (CNN) algorithm in serial lateral cephalograms (Lat-cephs) of Class III (C-III) patients who underwent twojaw orthognathic surgery. @*Methods@#A total of 3,188 Lat-cephs of C-III patients were allocated into the training and validation sets (3,004 Lat-cephs of 751 patients) and test set (184 Lat-cephs of 46 patients; subdivided into the genioplasty and non-genioplasty groups, n = 23 per group) for LI. Each C-III patient in the test set had four Lat-cephs: initial (T0), pre-surgery (T1, presence of orthodontic brackets [OBs]), post-surgery (T2, presence of OBs and surgical plates and screws [S-PS]), and debonding (T3, presence of S-PS and fixed retainers [FR]). After mean errors of 20 landmarks between human gold standard and the CNN model were calculated, statistical analysis was performed. @*Results@#The total mean error was 1.17 mm without significant difference among the four timepoints (T0, 1.20 mm; T1, 1.14 mm; T2, 1.18 mm; T3, 1.15 mm). In comparison of two time-points ([T0, T1] vs. [T2, T3]), ANS, A point, and B point showed an increase in error (p < 0.01, 0.05, 0.01, respectively), while Mx6D and Md6D showeda decrease in error (all p < 0.01). No difference in errors existed at B point, Pogonion, Menton, Md1C, and Md1R between the genioplasty and non-genioplasty groups. @*Conclusions@#The CNN model can be used for LI in serial Lat-cephs despite the presence of OB, S-PS, FR, genioplasty, and bone remodeling.

Treatment of Class I crowding using simple tubes bonded with customized resin coverings: A case report / 대한치과교정학회지

As an alternative to the conventional fixed appliance that uses orthodontic brackets, a simple round tube without a bonding base can be bonded to the tooth surface by covering the tube with flowable resin. In this technique, bent wires cannot be inserted into the simple tubes; therefore, repositioning of the simple tubes is often required for adjustments. To reduce repositioning of simple tubes, a dome-shaped resin covering of the simple tube can be designed with a customized in-and-out compensation, using three-dimensional computer-aided design software based on digital simulation of orthodontic tooth movement. In the present case, the use of simple tubes bonded with customized resin coverings in a Class I nonextraction case is described in a 17-year-old male, in whom moderate crowding of the anterior teeth was treated over an 8-month period. This case shows that simple tubes can be used as an alternative to brackets in some Class I nonextraction cases, with the potential benefit of reducing decalcification.

Multiscale Clustering and Profile Visualization of Malocclusion in Korean Orthodontic Patients: Cluster Analysis of Malocclusion

Understanding the classification of malocclusion is a crucial issue in Orthodontics. It can also help us to diagnose, treat, and understand malocclusion to establish a standard for definite class of patients. Principal component analysis (PCA) and k-means algorithms have been emerging as data analytic methods for cephalometric measurements, due to their intuitive concepts and application potentials. This study analyzed the macro- and meso-scale classification structure and feature basis vectors of 1020 (415 male, 605 female; mean age, 25 years) orthodontic patients using statistical preprocessing, PCA, random matrix theory (RMT) and k-means algorithms. RMT results show that 7 principal components (PCs) are significant standard in the extraction of features. Using k-means algorithms, 3 and 6 clusters were identified and the axes of PC1~3 were determined to be significant for patient classification. Macro-scale classification denotes skeletal Class I, II, III and PC1 means anteroposterior discrepancy of the maxilla and mandible and mandibular position. PC2 and PC3 means vertical pattern and maxillary position respectively; they played significant roles in the meso-scale classification. In conclusion, the typical patient profile (TPP) of each class showed that the data-based classification corresponds with the clinical classification of orthodontic patients. This data-based study can provide insight into the development of new diagnostic classifications.

Reference points suitable for evaluation of the additional arch length required for leveling the curve of Spee / 대한치과교정학회지

OBJECTIVE: The additional arch length required for leveling (AALL) the curve of Spee (COS) can be estimated by subtracting the two-dimensional (2D) arch circumference, which is the projection of the three-dimensional (3D) arch circumference onto the occlusal plane, from the 3D arch circumference, which represents the arch length after leveling the COS. The purpose of this study was to determine whether the cusp tips or proximal maximum convexities are more appropriate reference points for estimating the AALL. METHODS: Sixteen model setups of the mandibular arch with COS depths ranging from 0 mm to 4.7 mm were constructed using digital simulation. Arch circumferences in 2D and 3D were measured from the cusp tips and proximal maximum convexities and used to calculate the AALL. The values obtained using the two reference points were compared with the paired t-test. RESULTS: Although the 3D arch circumference should be constant regardless of the COS depth, it decreased by 3.8 mm in cusp tip measurements and by 0.4 mm in proximal maximum convexity measurements as the COS deepened to 4.7 mm. AALL values calculated using the cusp tips as reference points were significantly smaller than those calculated using the proximal maximum convexities (p = 0.002). CONCLUSIONS: The AALL is underestimated when the cusp tips are used as measurement reference points; the AALL can be measured more accurately using the proximal maximum convexities.

Effect of silica coating on bond strength between a gold alloy and metal bracket bonded with chemically cured resin / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to evaluate the effects of three different surface conditioning methods on the shear bond strength (SBS) of metal brackets bonded directly to gold alloy with chemically cured resin. METHODS: Two hundred ten type III gold alloy specimens were randomly divided into six groups according to the combination of three different surface conditioning methods (aluminum oxide sandblasting only, application of a metal primer after aluminum oxide sandblasting, silica coating and silanation) and thermocycling (with thermocycling, without thermocycling). After performing surface conditioning of specimens in accordance with each experimental condition, metal brackets were bonded to all specimens using a chemically cured resin. The SBS was measured at the moment of bracket debonding, and the resin remnants on the specimen surface were evaluated using the adhesive remnant index. RESULTS: Application of metal primer after aluminum oxide sandblasting yielded a higher bond strength than that with aluminum oxide sandblasting alone (p < 0.001), and silica coating and silanation yielded a higher bond strength than that with metal primer after aluminum oxide sandblasting (p < 0.001). There was no significant change in SBS after thermocycling in all groups. CONCLUSIONS: With silica coating and silanation, clinically satisfactory bond strength can be attained when metal brackets are directly bonded to gold alloys using a chemically cured resin.

Crown and root lengths of incisors, canines, and premolars measured by cone-beam computed tomography in patients with malocclusions / 대한치과교정학회지

OBJECTIVE: The purposes of this study were to determine the accuracy of crown and root length measurements of premolars using cone-beam computed tomography (CBCT) and to generate reference CBCT-based data on incisor, canine, and premolar lengths in patients with malocclusions. METHODS: Imaging was performed using a CBCT scanner with a 0.292-mm voxel size and 12-bit grayscale. The CBCT-based length measurements were compared with direct measurements of 94 subsequently extracted premolars without metal restorations using the paired t-test. Furthermore, the crown and root lengths of incisors, canines, and premolars in 62 Korean patients with malocclusions were measured using CBCT, and Pearson's correlation coefficients were calculated to examine the relationship between the crown and root length measurements of each tooth type. RESULTS: The differences between the CBCT-based and direct measurements of the extracted premolars were not significant, with 95% limits of agreement of -0.90 to 0.90 mm for crown length and -1.23 to 1.18 mm for root length. Weak positive correlations between the crown and root length measurements were observed for the mandibular canine and premolars. CONCLUSIONS: The CBCT-based measurements showed a wider range of limits of agreements for root length than for crown length. The CBCT-based data can be used as a reference for evaluating root length and resorption of teeth without metal restorations in patients with malocclusions.

Early Presentation of Heterotopic Ossification Mimicking Pyomyositis: Two Case Reports

Early diagnosis and treatment of heterotopic ossification (HO) is essential to the prevention of complications. It is difficult to diagnose HO in its initial phase because non-specific clinical manifestations, laboratory findings and imaging findings of immature HO may mimic other diseases such as cellulitis, osteomyelitis, thrombophlebitis, deep vein thrombosis and local infection with abscess. We experienced two cases of HO, which were misdiagnosed as pyomyositis at first by clinical signs and MRI findings indicating the deep infection; the extensive intramuscular ossification appeared later on. We observed an increase of C-reactive protein and creatine kinase followed by the elevation of alkaline phosphatase with abnormal triphasic bone scan. The trajectory of these biomarkers was analyzed to get more insight into the early stages of HO along with the imaging findings. Although our cases cannot be generalized as typical of immature HO, they clearly demonstrate that the change of specific biomarkers with a careful history taking and physical examination should be noted to detect HO as early as possible while avoiding confusion with other mimicking conditions.

Relationship between mesiodistal width and enamel thickness in mandibular incisors / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to investigate the relationship between the enamel thickness of proximal surfaces and the morphologic features of mandibular incisors. METHODS: Mesiodistal/faciolingual (MD/FL) index, MD width, and height of contour width/cervical width ratio were measured in 40 incisors extracted from Koreans. For determining the height of contour width/cervical width ratio, the cervical width was measured as the distance between proximal cementoenamel junctions. Then, the labial surface was ground to the height of the contour level to measure enamel thickness. Pearson correlation analysis was used to investigate the correlation between enamel thickness and morphologic features. RESULTS: Enamel thickness was 0.75 +/- 0.07 mm per side, and MD width was 5.56 +/- 0.40 mm. Enamel thickness and MD width were significantly correlated. However, a significant relationship was not observed between enamel thickness and MD/FL index or the height of contour width/cervical width ratio. CONCLUSIONS: The results suggest that enamel thickness is affected only by MD width. Therefore, if the MD width is the same for mandibular incisors with a large MD/FL index or triangular shape and mandibular incisors with normal shape, then the limit of enamel reduction for reproximation will be the same.

Buccal cortical bone thickness on CBCT for mini-implant / 대한구강악안면방사선학회지

PURPOSE: Cortical bone thickness is one of the important factor in mini-implant stability. This study was performed to investigate the buccal cortical bone thickness at every interdental area as an aid in planning mini-implant placement. MATERIALS AND METHODS: Two-dimensional slices at every interdental area were selected from the cone-beam computed tomography scans of 20 patients in third decade. Buccal cortical bone thickness was measured at 2, 4, and 6 mm levels from the alveolar crest in the interdental bones of posterior regions of both jaws using the plot profile function of Ez3D2009trade mark (Vatech, Yongin, Korea). The results were analyzed using by Mann-Whitney test. RESULTS: Buccal cortical bone was thicker in the mandible than in the maxilla. The thickness increased with further distance from the alveolar crest in the maxilla and with coming from the posterior to anterior region in the mandible (p<0.01). The maximum CT value showed an increasing tendency with further distance from the alveolar crest and with coming from posterior to anterior region in both jaws. CONCLUSION: Interdental buccal cortical bone thickness varied in both jaws, however our study showed a distinct tendency. We expect that these results could be helpful for the selection and preparation of mini-implant sites.

Effect of cutting flute length and shape on insertion and removal torque of orthodontic mini-implants / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to evaluate the effect of length and shape of cutting flute on mechanical properties of orthodontic mini-implants. METHODS: Three types of mini-implants with different flute patterns (Type A with 2.6 mm long flute, Type B with 3.9 mm long and straight flute, Type C with 3.9 mm long and helical flute) were inserted into the biomechanical test blocks (Sawbones Inc., USA) with 2 mm and 4 mm cortical bone thicknesses to test insertion and removal torque. RESULTS: In 4 mm cortical bone thickness, Type C mini-implants showed highest maximum insertion torque, then Type A and Type B in order. Type C also showed shortest total insertion time and highest maximum removal torque, but Type A and B didn't showed statistically significant difference in insertion time and removal torque. In 2 mm cortical bone thickness, there were no significant difference in total insertion time and maximum removal torque in three types of mini-implants, but maximum insertion torque of Type A was higher than two other Types of mini-implants. CONCLUSIONS: Consideration about length and shape of cutting flute of mini-implant is also required when the placement site has thick cortical bone.

Comparison of model analysis measurements among plaster model, laser scan digital model, and cone beam CT image / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to evaluate the possibility of using a digital model and cone beam computed tomograph (CBCT) image for model analysis. METHODS: Model analyses of CBCT images, plaster models, and digital models of 20 orthodontic patients with a permanent dentition with no proximal metal restorations, were compared. RESULTS: The average differences of tooth size measurements were 0.01 to 0.20 mm, and the average difference of arch length discrepancy measurements were 0.41 mm in the maxilla and 0.82 mm in the mandible. The difference in Bolton discrepancy measurements was 0.17 mm for the anterior region and 0.44 mm overall but with no statistically significant difference. When comparing CBCT images with plaster models, the average differences in tooth size measurements were -0.22 to 0.01 mm, and the average differences in arch length discrepancy measurements were 0.43 mm in the maxilla and 0.32 mm in the mandible. Difference in Bolton discrepancy measurements were 0.35 mm in the anterior region and 1.25 mm overall. CBCT images showed significantly smaller overall Bolton discrepancy measurements. CONCLUSIONS: Although there were statistically significant differences in some model analysis measurements, the ranges of measurement errors of the digital model and CBCT images were clinically acceptable. Therefore, a digital model and CBCT image can be used for model analysis.

Load-deflection characteristics and plastic deformation of NiTi closed coil springs / 대한치과교정학회지

OBJECTIVE: NiTi closed coil springs were reported to have relatively constant unloading forces. However, the characteristics of NiTi closed coil springs from various manufacturers have not been elucidated. The purpose of this study was to compare load-deflection characteristics of various NiTi closed coil springs and to find out the optimal range of extension. METHODS: Seven kinds of NiTi closed coil springs from five manufacturers were tested. Load deflection curves were obtained at extension ranges from 2 mm to 30 mm. Also, springs were kept extended during a 4 week period, and then load deflection curves were obtained again. RESULTS: Sentalloy (Tomy) and Jinsung blue (Jinsung) showed superelasticity in every extension ranges tested and showed plastic deformation of less than 1 mm. Ni-Ti (Ormco) showed superelasticity only after the springs were extended at or more than 10 mm, thereby meaning that clinicians should extend these springs at or more than 10 mm to utilize the superelasticity. Orthonol (RMO) and Nitanium (Ortho Organizers) did not show superelasticity. After 4 weeks of extension, all springs showed plastic deformation less than 1 mm when the extension was at or under 25 mm. CONCLUSIONS: The superelastic behavior of NiTi closed springs were different among various NiTi spring products, and some NiTi closed springs failed to show superelasticity.

Anatomic study of the incisive canal in relation to midpalatal placement of mini-implant / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to reveal the position of the incisive foramen in relation to the incisive papilla and cusp tips. METHODS: Plaster models and CT images of 25 adult orthodontic patients were used to measure the width of the incisive canal and positions of the anterior and posterior borders of the incisive foramen in relation to the incisive papilla. RESULTS: The palatal surface distance from the interdental papilla between the maxillary central incisors to the posterior border of the incisive foramen along the palatal surface was 1.7 fold of the distance from the interdental papilla between the central incisors to the posterior border of the incisive papilla. The distance between the posterior border of the incisive papilla and posterior border of the incisive foramen along the palatal surface was 6.15 +/- 1.75 mm. The anteroposterior position of the posterior border of the incisive foramen was slightly anterior to the lingual cusp tips of the maxillary 1st premolars. The width of the incisive foramen was 4.03 +/- 0.64 mm, therefore it is recommended to position the mini-implant more than 3 mm laterally when placing a mini-implant lateral to the incisive foramen, from the center. CONCLUSIONS: These results can be used as a reference in presuming the position of the incisive foramen when placing mini-implant in the anterior palate area.

Distortion of tooth axes on panoramic radiographs taken at various head positions / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to evaluate the effect of head position changes on the root parallelism between adjacent teeth on panoramic radiographs. METHODS: A model with normal occlusion was constructed in the SolidWorks program, then RP (rapid protyping) model was fabricated. The model was repeatedly imaged and repositioned five times at each of the following nine positions: ideal head position, 5degrees C up, 10degrees C up, 5degrees C down, 10degrees C down, 5degrees C right, 10degrees C right up, and 5degrees C right rotation, 10degrees C right rotation. Panoramic radiographs were taken by Planmeca ProMax and the angle between the long axes of adjacent teeth was directly measured in the monitor. RESULTS: Axes of adjacent teeth tended to converge toward the occlusal plane when the head tilted up and converged in the opposite direction to the occlusal plane when the head tilted down. Anterior teeth showed the most notable differences. When one side of the head tilted up 5degrees C and 10degrees C along the anteroposterior axis (Y axis), tooth axes of the same side tended to converge toward the occlusal plane and tooth axes of the opposite side tended to converge in the opposite direction to the occlusal plane. When the head rotated to one side along the vertical axis (Z axis), the canine and lateral incisor of the same side converged in the opposite direction to the occlusal plane and the canine and lateral incisor of the other side converged toward the occlusal plane. CONCLUSIONS: When assessing the root parallelism on panoramic radiographs, the occlusal plane cant (anteroposterior or lateral) or asymmetry of the dental arch should be considered because these can cause distortion of tooth axes on panoramic radiographs.

CBCT analysis of three implant cases for treatment planning / 대한구강악안면방사선학회지

The role of radiographic imaging in determining the size, numbers and the position of implants is very important. To perform the implant procedure, the dentist needs to evaluate the bone pathology and bone density, and to know the precise height, width, and contour of the alveolar process, as well as its relationship to the maxillary sinus and mandibular canal. The author analyzed 3 implant cases for treatment planning with the cone beam CT. All axial, panoramic, serial and buccolingual-sectioned images of 3 cases with stent including vertical marker were taken by using Mercuray (Hitachi, Japan). When the curved line drawn intentionally did not include dot image of a vertical marker on the axial image of CBCT, the image of the vertical marker was deformed on its buccolingually sectioned image. There was wide discrepancy in inclination between the alveolar bone and tooth on buccolingually sectioned image.

The effect of temperature changes on force level of superelastic nickel-titanium archwires / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to evaluate the influence of intraoral temperature changes on the orthodontic force level of a superelastic nickel-titanium alloy wire. METHODS: Nickel-titanium archwires of 0.016" x 0.022" thickness were tested with a three point bending test setup, and temperature changes were applied. The force level changes according to temperature changes were measured at a 1.5 mm deflection during the loading phase and a 1.5 mm deflection during the unloading phase from a deflection to 3.1 mm. Ten cycles of thermal cycling from baseline (37 degrees C) to cold (20 degrees C) or hot (50 degrees C) temperature were applied. RESULTS: After thermal cycling, the force level during the loading phase decreased and the force level during the unloading phase increased even after the temperature was changed to the initial 37 degrees C. CONCLUSIONS: The results suggest that the orthodontic force level can not return to the initial force level after temperature changes. When applying superelastic nickel-titanium archwires, we must consider that a lighter force than the loading force and a heavier force than the unloading force will be applied after intraoral temperature changes caused by eating and drinking.

The reliability of the cephalogram generated from cone-beam CT / 대한치과교정학회지

OBJECTIVE: Three-dimensional approaches for the diagnosis and analysis of the dentofacial area are becoming more popular in accordance with the development of cone-beam CT (CBCT). The purposes of this study were to evaluate the reliability of cephalometric measurements of lateral cephalograms generated from a CBCT image by making comparisons with the traditional digital lateral cephalogram, and to evaluate the possibility of the clinical application of CBCT generated cephalogram images. METHODS: Twenty patients whose external auditory meatus could be identified in the CBCT image were selected, and both CBCT and digital cephalograms were taken. Differences between the measurements of both cephalograms were tested by paired t-test. RESULTS: Among the 22 measurements used, only U1-FH, Mx6 to PTV, and maxillomandibular difference showed statistically significant differences between the CBCT generated cephalogram and the digital cephalogram. CONCLUSIONS: The results suggest that the CBCT generated cephalogram can be used for some cephalometric measurements not requiring porion, PTV, condylion as a landmark (SNA, SNB, U1 to SN, IMPA, interincisal angle, etc.).

Change in tooth length and angulation on panoramic radiographs taken at different labiolingual and buccolingual inclinations / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to examine how the mesio-distal angulation and the length of each tooth changes on panoramic radiograph at different bucco-lingual inclinations. METHODS: After constructing an acrylic model based on the mean arch of 30 adults with normal occlusion, the wire was placed in the center of the teeth on the acrylic model. First, the wire was implanted in normal angulation and inclination and a panoramic radiograph taken. After changing the inclination from I-15 degrees to I+15 degrees by 5 degrees a panoramic radiograph was taken again and the mesio-distal angle and wire length on the panoramic radiograph were assessed. RESULTS: When the wire was implanted at the normal angulation and inclination, the length measured in the panoramic radiograph was magnified 111 ~ 117% from the original length in the anterior region and 121 ~ 125% in the posterior region. Only the central and lateral incisors showed significant length differences when the inclination was changed from I-15 degrees to I+15 degrees at fixed angulation. When the inclination was changed from I-15 degrees to I+15 degrees, the angulation of most teeth on panoramic radiograph appeared to be more disto-angulated than in reality, and the lateral incisor and canine showed the largest difference. Only I-15 degrees, I+15 degrees groups of premolars and I+15 degrees group of molars showed more mesio-angulation than in reality. As the labio(bucco)lingual inclination of all teeth were decreased, tooth angulation in the panoramic radiograph appeared to be more disto-angulated. CONCLUSION: The labio-liugual inclination of teeth should be considered because it affects panoramic image of teeth, such as length of incisors and angulation of other teeth.