Skip to main content

Advertisement

SpringerLink
Log in

Radiographic evaluation of mandibular third molars: an ex vivo comparative study between multilayer and conventional panoramic radiography

  • Research
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

To compare the multilayer panoramic radiography (MPAN) and conventional panoramic radiography (CPAN) in the evaluation of mandibular third molars using cone-beam computed tomography (CBCT) as a reference.

Methods

CPAN, MPAN, and CBCT scans from 33 dry human mandibles were acquired using the OP300 Maxio unit, totalizing 56 mandibular third molars to be evaluated. Three examiners evaluated each third molar according to their position, depth of impaction in the mandibular ramus, proximity between the dental root apexes and the mandibular canal, and the presence of radiographic signs of proximity to the mandibular canal. In addition, when there was a distance between the root apexes and the mandibular canal, it was measured. As a reference, these same parameters were assessed in the CBCT scans by a fourth examiner. For the statistical analysis, the weighted Kappa, Bland Altman, and Wilcoxon tests were performed (α = 0.05).

Results

The agreement between the assessments performed in the panoramic modalities with the CBCT ranged from 66.1% to 100.0% for the categorical variables. Overall, the agreement values of CPAN and MPAN with CBCT were similar. The distances between the dental root apex and the mandibular canal for both CPAN and MPAN were significantly underestimated compared to CBCT (p < 0.05). The intra- and interexaminer agreements of the examiners ranged from poor to almost perfect; in general, the agreements were higher in the evaluation performed in the MPAN than in the CPAN.

Conclusions

The MPAN performs similarly to CPAN for evaluating mandibular third molars and their proximity relationship to the mandibular canal.

Clinical Relevance

Preoperative evaluation of lower mandibular third molars is usually performed using CPAN. Recently, a new tool, MPAN, was developed, which has not yet been tested for the evaluation of mandibular third molars and showed similar performance to CPAN in the present study. Future studies using MPAN are encouraged to evaluate other diagnostic tasks.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Gu L, Zhu C, Chen K, Liu X, Tang Z (2018) Anatomic study of the position of the mandibular canal and corresponding mandibular third molar on cone-beam computed tomography images. Surg Radiol Anat 40(6):609–614. https://doi.org/10.1007/s00276-017-1928-6

    Article  PubMed  Google Scholar 

  2. de Almeida Barros RQ, de Melo NB, de Macedo Bernardino Í, ArêaLeão Lopes AraújoArruda MJ, Meira Bento P (2018) Association between impacted third molars and position of the mandibular canal: a morphological analysis using cone-beam computed tomography. Br J Oral Maxillofac Surg 56(10):952–955. https://doi.org/10.1016/j.bjoms.2018.10.280

    Article  Google Scholar 

  3. Brasil DM, Nascimento EHL, Gaêta-Araujo H, Oliveira-Santos C, Maria de Almeida S (2019) Is panoramic imaging equivalent to cone-beam computed tomography for classifying impacted lower third molars? J Oral Maxillofac Surg 77(10):1968–1974. https://doi.org/10.1016/j.joms.2019.03.04

    Article  PubMed  Google Scholar 

  4. Freire BB, Nascimento EHL, Vasconcelos KF, Freitas DQ, Haiter-Neto F (2019) Radiologic assessment of mandibular third molars: an ex vivo comparative study of panoramic radiography, extraoral bitewing radiography, and cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 128(2):166–175. https://doi.org/10.1016/j.oooo.2018.11.002

    Article  PubMed  Google Scholar 

  5. Khojastepour L, Khaghaninejad MS, Hasanshahi R, Forghani M, Ahrari F (2019) Does the Winter or Pell and Gregory Classification System Indicate the Apical Position of Impacted Mandibular Third Molars? J Oral Maxillofac Surg 77(11):2222.e1-2222.e9. https://doi.org/10.1016/j.joms.2019.06.004

    Article  PubMed  Google Scholar 

  6. Lagos de Melo LP, Oenning ACC, Nadaes MR, Nejaim Y, Neves FS, Oliveira ML, Freitas DQ (2017) Influence of acquisition parameters on the evaluation of mandibular third molars through cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 124(2):183–190. https://doi.org/10.1016/j.oooo.2017.03.008

    Article  PubMed  Google Scholar 

  7. Matzen LH, Wenzel A (2015) Efficacy of CBCT for assessment of impacted mandibular third molars: a review - based on a hierarchical model of evidence. Dentomaxillofac Radiol 44(1):20140189. https://doi.org/10.1259/dmfr.20140189

    Article  PubMed  Google Scholar 

  8. Matzen LH, Petersen LB, Schropp L, Wenzel A (2019) Mandibular canal-related parameters interpreted in panoramic images and CBCT of mandibular third molars as risk factors to predict sensory disturbances of the inferior alveolar nerve. Int J Oral Maxillofac Surg 48(8):1094–1101. https://doi.org/10.1016/j.ijom.2019.03.898

    Article  PubMed  Google Scholar 

  9. Matzen LH, Berkhout E (2019) Cone beam CT imaging of the mandibular third molar: a position paper prepared by the European Academy of DentoMaxilloFacial Radiology (EADMFR). Dentomaxillofac Radiol 48(5):20190039. https://doi.org/10.1259/dmfr.20190039

    Article  PubMed  PubMed Central  Google Scholar 

  10. SEDENTEXCT Project (2012) European Commission. Radiation Protection NO. 172 SedentexCT. Guidelines on CBCT for Dental and Maxillofacial Radiology. Luxembourg: Office for Official Publications of the European Communities. https://sedentexct.eu/files/radiation_protection_172.pdf. Accessed 20 Feb 2023

  11. Del Lhano NC, Ribeiro RA, Martins CC, Assis NMSP, Devito KL (2020) Panoramic versus CBCT used to reduce inferior alveolar nerve paresthesia after third molar extractions: a systematic review and meta-analysis. Dentomaxillofac Radiol 49(4):20190265. https://doi.org/10.1259/dmfr.20190265

    Article  PubMed  PubMed Central  Google Scholar 

  12. Araujo GTT, Peralta-Mamani M, Silva AFMD, Rubira CMF, Honório HM, Rubira-Bullen IRF (2019) Influence of cone beam computed tomography versus panoramic radiography on the surgical technique of third molar removal: a systematic review. Int J Oral Maxillofac Surg 48(10):1340–1347. https://doi.org/10.1016/j.ijom.2019.04.003

    Article  PubMed  Google Scholar 

  13. Elkhateeb SM, Awad SS (2018) Accuracy of panoramic radiographic predictor signs in the assessment of proximity of impacted third molars with the mandibular canal. J Taibah Univ Med Sci 13(3):254–261. https://doi.org/10.1016/j.jtumed.2018.02.006

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nakamori K, Tomihara K, Noguchi M (2014) Clinical significance of computed tomography assessment for third molar surgery. World J Radiol 6(7):417–423. https://doi.org/10.4329/wjr.v6.i7.417

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rood JP, Shehab BA (1990) The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg 28(1):20–25. https://doi.org/10.1016/0266-4356(90)90005-6

    Article  PubMed  Google Scholar 

  16. Neves FS, Souza TC, Almeida SM, Haiter-Neto F, Freitas DQ, Bóscolo FN (2012) Correlation of panoramic radiography and cone beam CT findings in the assessment of the relationship between impacted mandibular third molars and the mandibular canal. Dentomaxillofac Radiol 41(7):553–557. https://doi.org/10.1259/dmfr/22263461

    Article  PubMed  PubMed Central  Google Scholar 

  17. Martins LAC, Nascimento EHL, Gaêta-Araujo H, Oliveira ML, Freitas DQ (2022) Mapping of a multilayer panoramic radiography device. Dentomaxillofac Radiol 51(4):20210082. https://doi.org/10.1259/dmfr.20210082

    Article  PubMed  Google Scholar 

  18. Rahmel S, Schulze RKW (2019) Accuracy in detecting artificial root resorption in panoramic radiography versus tomosynthetic panoramic radiographs. J Endod 45(5):634-639.e2. https://doi.org/10.1016/j.joen.2019.01.009

    Article  PubMed  Google Scholar 

  19. Jeon KJ, Han SS, Lee C, Choi YJ, Jung HI, Kim YH (2020) Application of panoramic radiography with a multilayer imaging program for detecting proximal caries: a preliminary clinical study. Dentomaxillofac Radiol 49(8):20190467. https://doi.org/10.1259/dmfr.2019046733:159-174

    Article  PubMed  PubMed Central  Google Scholar 

  20. Winter GB (1926) Principles of exodontia as Applied to the impacted third molar. American medical Books, St Louis

    Google Scholar 

  21. Pell GJ, Gregory GT (1933) Impacted mandibular third molars: Classification and modified techinique for removal. Dent Dig 39:330

    Google Scholar 

  22. Bell GW (2004) Use of dental panoramic tomographs to predict the relation between mandibular third molar teeth the inferior alveolar nerve. Br J Oral Maxillofac Surg 42:21–27

    Article  PubMed  Google Scholar 

  23. Landis JR, Koch GG (1977) The measurement of the observer agreement for categorical data. Biometrics 33:159–174

    Article  PubMed  Google Scholar 

  24. Sim J, Wright CC (2005) The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther 85(3):257–268

    Article  PubMed  Google Scholar 

  25. Dobbins JT 3rd, Godfrey DJ (2003) Digital x-ray tomosynthesis: current state of the art and clinical potential. Phys Med Biol 48(19):R65-106. https://doi.org/10.1088/0031-9155/48/19/r01

    Article  PubMed  Google Scholar 

  26. Kitai N, Mukai Y, Murabayashi M, Kawabata A, Washino K, Matsuoka M, Shimizu I, Katsumata A (2013) Measurement accuracy with a new dental panoramic radiographic technique based on tomosynthesis. Angle Orthod 83(1):117–126. https://doi.org/10.2319/020412-100.1

    Article  PubMed  Google Scholar 

  27. Hasani A, Ahmadi Moshtaghin F, Roohi P, Rakhshan V (2017) Diagnostic value of cone beam computed tomography and panoramic radiography in predicting mandibular nerve exposure during third molar surgery. Int J Oral Maxillofac Surg 46(2):230–235. https://doi.org/10.1016/j.ijom.2016.10.003

    Article  PubMed  Google Scholar 

  28. Uzun C, Sumer AP, Sumer M (2020) Assessment of the reliability of radiographic signs on panoramic radiographs to determine the relationship between mandibular third molars and the inferior alveolar canal. Oral Surg Oral Med Oral Pathol Oral Radiol 129(3):260–271. https://doi.org/10.1016/joooo.2019.09.008

    Article  PubMed  Google Scholar 

Download references

Funding

This research was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001.

Author information

Authors and Affiliations

  1. Department of Oral Diagnosis - Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil

    Alessiana Helena Machado, Deborah Queiroz Freitas & Amanda Farias-Gomes

  2. OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium

    Rocharles Cavalcante Fontenele

  3. Department of Forensic Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil

    Luiz Francesquini Júnior

  4. Department of Health Sciences and Pediatric Dentistry - Biostatistics Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil

    Gláucia Maria Bovi Ambrosano

Authors
  1. Alessiana Helena Machado
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deborah Queiroz Freitas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rocharles Cavalcante Fontenele
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amanda Farias-Gomes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luiz Francesquini Júnior
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gláucia Maria Bovi Ambrosano
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

To qualify for authorship, we indicate the contribution of each author to this manuscript:

Machado, AH: design, conceptualization of the study, acquisition, analysis, and interpretation of data, writing and revising the manuscript for intellectual content and final approval of the version to be published.

Freitas, DQ: design, conceptualization of the study, analysis, and interpretation of the data, drafting, revising the manuscript for intellectual content and final approval of the version to be published.

Fontenele, RC: analysis interpretation of data, revising the manuscript and final approval of the version to be published.

Farias-Gomes, A: analysis interpretation of data, revising the manuscript and final approval of the version to be published.

Francesquini Junior, L: revising the manuscript and final approval of the version to be published.

Ambrosano, GMB: analysis statistical and interpretation of the data, revising the manuscript and final approval of the version to be published.

Corresponding author

Correspondence to Alessiana Helena Machado.

Ethics declarations

Ethical Approval

All procedures performed in this study were conducted in accordance with the ethical standards of the local (#4.201.011#), and with the 1976 Helsinki Declaration and its later amendments for comparable ethical standards.

Informed Consent

For this type of study, formal consent is not applicable.

Competing interests

The authors declare no competing interests.

Conflict of Interest

The authors declare they have no conflict of interest related to the present research.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Machado, A.H., Freitas, D.Q., Fontenele, R.C. et al. Radiographic evaluation of mandibular third molars: an ex vivo comparative study between multilayer and conventional panoramic radiography. Clin Oral Invest 27, 6451–6460 (2023). https://doi.org/10.1007/s00784-023-05249-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-023-05249-y

Keywords

Search

Navigation