Diagnostic Concordance of Panoramic Radiographs and Cone-Beam Computed Tomography and their Influence on Treatment...

To evaluate the diagnostic concordance between panoramic radiographs and cone-beam computed tomography (CBCT) and to determine their comparative diagnostic performance in relation to the treatment decision of impacted maxillary canines.

Radiographic records of 51 impacted maxillary canines in 44 patients (37 unilateral and 7 bilateral cases) were analyzed. Panoramic radiographic evaluations included sector classification, the α angle, and the d distance. The KPG index was used in CBCT assessments to determine impaction severity.

All imaging parameters showed high intra- and interrater reliability (intraclass correlation coefficients ≥0.927; κ≥0.658; p<0.001). Significant associations were found between the panoramic radiographic parameters (sector, α angle, and d distance) and the CBCT-based KPG index, and between sector classification and buccopalatal position (p<0.05). Regarding treatment decisions, higher parameter values were significantly associated with the choice of surgical extraction (p<0.05). Receiver operating characteristic analysis demonstrated acceptable to excellent discriminatory ability for panoramic radiograph-based and CBCT-based parameters [area under the curve (AUC): 0.715 to 0.843], with no differences among the AUC values (p>0.05). A d distance ≥12.3 mm and an α angle ≥46.1° were identified as thresholds associated with the decision for surgical extraction.

Panoramic radiographic parameters demonstrated diagnostic concordance with CBCT, and their performance was comparable to CBCT-based assessment for treatment decisions. The identified 2D thresholds may serve as an effective first-line screening tool for identifying complex cases likely to require surgical extraction, signaling a level of severity at which the superior anatomical detail of CBCT is warranted for precise surgical planning.