The reliability of dental panoramic tomographs in determining the upper and lower third molar root morphology
Abstract
Background/Aim. The shortcomings of the orthopantomography (OPG) method and radiographic misinterpretations may lead to poor treatment planning and complications during or after the third molar extraction. The aim of this study was to determine the validity and reliability of OPG findings concerning post-extraction wisdom tooth root morphology, as well as whether the degree of clinical expertise affects assessment accuracy. Methods. The cross-sectional study included 200 patients who were referred for third molar extraction. Preoperative OPGs were evaluated by the examiners, who were classified by their level of experience into three groups: students, residents, and professors. True root morphologies were recorded after the extraction, and the accuracy of the assessment was evaluated using various statistical tests. Results. The majority of assessments were accurate for the lower and upper third molars with a single root. The professor group was the most accurate when compared to the assessments made by the students and residents (p = 0.0015). Weighted Cohen’s kappa (kw) values for intra-respondent accuracy gradually increased from the student to professor group (0.06, 0.28, 0.34, respectively). The highest discrepancy in inter-respondent accuracy was determined between the student and professor groups (poor; kw = 0.25584). Conclusion. In this study, the results that confirm the reliability of the OPG scan for the detection of accurate third molars root morphology have not been achieved. The level of clinical experience affects diagnostic accuracy, but complex clinical cases should be evaluated using different methods.
References
Bell GW, Rodgers JM, Grime RJ, Edwards KL, Hahn MR, Dorman ML, et al. The accuracy of dental panoramic tomographs in determining the root morphology of mandibular third molar teeth before surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 95(1): 119‒25.
Ali S, Geelani R, Shah SAA. Assessment of diagnostic accuracy of orthopantomogram in determining the root morphology of impacted mandibular third molars. Pak Oral Dent J 2015; 35(3): 390‒4.
Vishal, Khaitan T, Ranjan R, Sharma N. Primary closure after surgical extraction of mandibular third molar with or without tube drain: A prospective study. J Family Med Prim Care 2020; 9(2): 637‒41.
Duarte-Rodrigues L, Miranda EFP, Souza TO, de Paiva HN, Falci SGM, Galvão EL. Third molar removal and its impact on quality of life: systematic review and meta-analysis. Qual Life Res 2018; 27(10): 2477‒89.
Cederhag J, Truedsson A, Alstergren P, Shi XQ, Hellén-Halme K. Radiographic imaging in relation to the mandibular third molar: a survey among oral surgeons in Sweden. Clin Oral Investig 2022; 26(2): 2073‒83.
Cederhag J, Lundegren N, Alstergren P, Shi XQ, Hellén-Halme K. Evaluation of Panoramic Radiographs in Relation to the Mandibular Third Molar and to Incidental Findings in an Adult Population. Eur J Dent 2021; 15(2): 266‒72.
Kim YS, Park YM, Cosola S, Riad A, Giammarinaro E, Covani U, et al. Retrospective analysis on inferior third molar position by means of orthopantomography or CBCT: Periapical band-like radiolucent sign. Appl Sci 2021; 11(14): 6389.
Saraswati FK, Balajirao B, Mamatha GP. Clinical and orthopantomographic evaluation of mandibular third molar. Contemp Clin Dent 2010; 1(1): 27‒30.
Zhang W, Tang Y, Liu C, Shen Y, Feng X, Gu Y. Root and root canal variations of the human maxillary and mandibular third molars in a Chinese population: A micro-computed tomographic study. Arch Oral Biol 2018; 95: 134‒40.
Tomaszewska IM, Skinningsrud B, Jarzębska A, Pękala JR, Tarasiuk J, Iwanaga J. Internal and external morphology of mandibular molars: An original micro-CT study and meta-analysis with review of implications for endodontic therapy. Clin Anat 2018; 31(6): 797‒811.
Vesala T, Ekholm M, Ventä I. Is dental panoramic tomography appropriate for all young adults because of third molars? Acta Odontol Scand 2021; 79(1): 52‒8.
Shivpuri A, Mitra R, Hema R. A Retrospective Analysis of the Root Morphology of Maxillary and Mandibular Third Molars. Acta Sci Dent Sci 2018; 2(5): 32‒4.
D’Costa ZV, Ahmed J, Ongole R, Shenoy N, Denny C, Binnal A. Impacted Third Molars and Its Propensity to stimulate External Root Resorption in Second Molars: Comparison of Orthopantomogram and Cone Beam Computed Tomography. World J Dent 2017; 8(4): 281‒7.
Sarica I, Derindag G, Kurtuldu E, Naralan ME, Çağlayan F. A retrospective study: Do all impacted teeth cause pathology? Niger J Clin Pract 2019; 22(4): 527‒33.
Richter J, Scheiter K, Eder TF, Huettig F, Keutel C. How massed practice improves visual expertise in reading panoramic radiographs in dental students: An eye tracking study. PLoS One 2020; 15(12): e0243060.
Djordjević A, Todić J, Arsić Z, Ilić A, Jovanović R, Vlahović Z. Predictive value of the specific radiographic signs at panoramic radiography indicating possible close relationship of posterior teeth and surrounding anatomical structures: A CBCT study. Vojnosanit Pregl 2021; 78(11): 1133‒9.
Różyło-Kalinowska I. Panoramic radiography in dentistry. Clin Dent Rev 2021; 5(1): 26.
Demirtas N, Mihmanli A, Aytuğar E, Bayer S. Limitations of Panoramic Radiographs: Report of Two Cases. Bezmialem Sci 2014; 2: 82‒5.
Suomalainen A, Ventä I, Mattila M, Turtola L, Vehmas T, Peltola JS. Reliability of CBCT and other radiographic methods in preoperative evaluation of lower third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109(2): 276‒84.
Eder TF, Richter J, Scheiter K, Keutel C, Castner N, Kasneci E, et al. How to support dental students in reading radiographs: effects of a gaze-based compare-and-contrast intervention. Adv Health Sci Educ Theory Pract 2021; 26(1): 159‒81. Erratum in: Adv Health Sci Educ Theory Pract 2021; 26(3): 1185‒6.
GraphPad. Randomly assign subjects to treatment groups [In-ternet]. Dotmatics; 2023 [accessed on 2023 Sep 20]. Available from: http://www.graphpad.com/quickcalcs/randomize1.cfm