Background: The most common radiographic examinations in orthodontic are panoramic and lateral cephalometry. In panoramic and lateral cephalometric images in adult patients, sometimes can be found a fine foreign object which sometimes confuses as it scattered the radiographic image, such as needles. The needles found in the patients are known as â€œsusukâ€ in Malay and Indonesian language or charm needles which believed to enhance beauty, charism, health, youth, luck, and to relieve pain. This case reports aim to elaborate the incidental radiographic finding of charm needle or â€œsusukâ€ in orthodontic panoramic and lateral cephalometric radiograph.
Case Description:Â There was four adult woman conducted panoramic and cephalometric radiograph as a routine procedure before orthodontic treatment. The number of susuk inserted were varied, as it considered that the more needle increases the magical potency. In Case 1, the panoramic image depicts one â€œsusukâ€ in the middle of the root of 44 (FDI notation) tooth. Besides, the cephalometric radiographs also show a â€œsusukâ€ horizontally inserted at the root of the anterior lower teeth area. The panoramic image reveals one susuk around chin area below the apex of 42 teeth on Case 2 as well as on the soft tissue chin area in front of the apex of 41 teeth on cephalometric radiographs. In Case 3, two â€œsusukâ€ were found inserted bilaterally symmetric at the upper premolar area by the panoramic image. Then, five â€œsusukâ€ in the mandible and four â€œsusukâ€ at the upper area of the maxilla were found in Case 4 by the panoramic image.Â
Conclusion:Â The susuk are often exposed as incidental findings in panoramic and lateral cephalometric radiographs that are taken before performing routine orthodontic treatments. Understanding the presence of susuk is essential to avoid misdiagnosis and mismanagement and help radiologists to prevent confusion while interpreting images.