Comparison of Panoramic Radiography and Cone Beam Computed Tomography for Lower Third Molar Assessment Among Different Dental Specialists.

Abstract

Background: Variations in professional training and dental specialization can substantially influence diagnostic accuracy and clinical decision-making.

Purpose: This study aimed to evaluate and compare the anatomical position and surgical indication of lower third molars (LTM) using panoramic radiography and cone beam computed tomography (CBCT) among 3 groups of dental specialists.

Study design, setting, sample: This retrospective cross-sectional study involved different profiles of dental professionals with experience in diagnostic interpretation of LTM images. The study population was composed of patients who underwent both panoramic and tomographic scans for LTM extraction between 2020 and 2023. To be included, all patients had clinical indication for third molar extraction, had both LTM, and had panoramic and CBCT scans on the same day.

Independent variable: The independent variable was dental provider, oral surgeons, general dentists, and oral radiologists.

Main outcome variable: The main outcome variable was the anatomical position of LTM, and radiographic findings associated with risk of inferior alveolar nerve injury. Anatomical positions were evaluated according to Pell & Gregory and Winter classification. The radiographic findings associated with risk of inferior alveolar nerve injury were contact of roots to mandibular canal (MC), disruption of the cortical, narrowing and deviation, deflection and dilaceration, and retromolar canal. The secondary outcome was surgical indication.

Covariates: Patient-related covariates (age and sex) were assessed.

Analysis: Statistical analysis included χ² and Z-tests for intragroup comparisons, one-way analysis of variance followed by Tukey honestly significant difference post hoc test for intergroup comparisons, and Student's t-test for surgical indication. The significance level was set at 5% (P < .05).

Results: The sample comprised 8 examiners who evaluated 30 panoramics and 30 CBCTs for a cohort of 30 patients. No statistically significant difference was identified between dental providers regarding anatomical position (P > .1). Oral and maxillofacial surgeons more frequently identified narrowing and deviation of MC compared with general dentists and oral radiologists (P < .05). Oral radiologists detected more root dilacerations and retromolar canals, and identified more probable contact with the MC using panoramics and CBCT (P < .05). Coronectomy was indicated more often by oral surgeons than general dentists (P < .05).

Conclusions and relevance: Dental specialty influenced the interpretation of both imaging modalities for the LTM.