The development of new image receptor-holding instruments with appropriate horizontal X-ray beam angulation for periapical radiographs

This study aimed to develop new image receptor-holding instruments with appropriate horizontal X-ray beam angulation, based on the anatomical data of posterior region interproximal surfaces derived from archived CT images. CT images of 92 patients with sound upper and lower dental arches were collected from our CT database and analyzed to determine the angles between the tangential interproximal contact line and the central groove line of posterior teeth. The average angle for each site was calculated and used to modify instruments using a three-dimensional printer. The utilities of the conventional and the modified instruments for viewing proximal surfaces were compared using two dry skulls. The right and left sides of each site, except for the lower second premolar and first molar sites, did not differ significantly. The difference between the sites was 2.0°; hence, we calculated mean values for the two sides at each site. In the maxilla, the angles of the first and second premolar, second premolar and first molar, and first and second molar to the groove line were 83.9° (±5.4°), 84.4° (±3.9°), 81.6° (±5.1°), while those in the mandible were 85.0° (±9.2°), 85.0° (±4.0°), and 90.6° (±4.9°), respectively. The holding instruments modified to 80° demonstrated better proximal viewing ability in the upper molar region than conventional instruments. The mean angles of the interproximal surfaces were determined from CT data. The image receptor holding-instruments were modified according to these angles to allow appropriate X-ray angulation, which facilitated improved observation of the proximal surfaces of teeth in the posterior region in this pilot study.