Panoramic Infrazygomatic Crest Length: A Craniofacial Physiology-Based Analysis of Skeletal Class (I-III) and Sex in...

Objective: This retrospective cross-sectional radiographic study evaluated panoramic infrazygomatic crest (IZC) length and compared values according to skeletal class and sex. The term panoramic IZC length was used to describe a two-dimensional linear measurement obtained on panoramic radiographs, rather than a three-dimensional bone corridor for miniscrew insertion. Methods: A total of 180 archived digital panoramic radiographs of patients aged 16-30 years were retrospectively collected and grouped equally by skeletal class and sex. Skeletal class was determined using previously recorded lateral cephalometric tracings based on ANB angle criteria: Class I, 0-4°; Class II, >4°; and Class III, <0°. Panoramic IZC length was measured bilaterally on calibrated panoramic images using ImageJ, and the bilateral mean was used for subgroup comparisons. Group differences were analyzed using one-way ANOVA, independent-samples t-tests, and two-way ANOVA. Results: Panoramic IZC length differed significantly across skeletal classes, with the highest values found in Class III and the lowest values found in Class II (p < 0.001). Mean panoramic IZC length was 5.81 ± 0.38 mm in Class III females and 6.16 ± 0.41 mm in Class III males, compared with 4.99 ± 0.36 mm in Class II females and 5.51 ± 0.40 mm in Class II males. Males showed significantly greater values than females (p < 0.01). The sex-by-class interaction was significant (p = 0.04). Intra-observer repeatability was excellent (ICC = 0.95). Conclusions: Panoramic IZC length varies according to skeletal class and sex, with higher values in Class III individuals and males. These findings provide preliminary comparative morphometric information from routinely available panoramic radiographs. However, panoramic IZC length should not be interpreted as a three-dimensional insertion corridor, and CBCT remains necessary when comprehensive anatomical planning, sinus proximity assessment, or extra-alveolar miniscrew trajectory evaluation is required.