Couto Douglas A F, Tanaka Jefferson L O, Souza Paulo H C, Ignacio Sergio A, Carneiro Everdan, Alanis Luciana R A
Oral Radiologist, Graduate Program in Dentistry, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.
Assistant Professor, Department of Oral Medicine and Pediatric Dentistry, State University of Londrina, Londrina, Paraná, Brazil.
J Oral Maxillofac Surg. 2025 Aug;83(8):1000-1011. doi: 10.1016/j.joms.2025.05.003. Epub 2025 May 13.
Variations in professional training and dental specialization can substantially influence diagnostic accuracy and clinical decision-making.
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.
The independent variable was dental provider, oral surgeons, general dentists, and oral radiologists.
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.
Patient-related covariates (age and sex) were assessed.
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).
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).
Dental specialty influenced the interpretation of both imaging modalities for the LTM.
专业培训和牙科专业的差异会显著影响诊断准确性和临床决策。
本研究旨在评估和比较3组牙科专家使用全景X线摄影和锥形束计算机断层扫描（CBCT）对下颌第三磨牙（LTM）的解剖位置和手术指征。
研究设计、设置、样本：这项回顾性横断面研究涉及不同背景的牙科专业人员，他们具有LTM图像诊断解读经验。研究人群由2020年至2023年间因LTM拔除而接受全景和断层扫描的患者组成。纳入标准为所有患者有第三磨牙拔除的临床指征，双侧均有LTM，且在同一天进行了全景和CBCT扫描。
自变量为牙科提供者，即口腔外科医生、普通牙医和口腔放射科医生。
主要结果变量是LTM的解剖位置，以及与下牙槽神经损伤风险相关的影像学表现。根据佩尔和格雷戈里分类法以及温特分类法评估解剖位置。与下牙槽神经损伤风险相关的影像学表现包括牙根与下颌管（MC）接触、皮质中断、狭窄和偏移、弯曲和移位以及磨牙后管。次要结果是手术指征。
评估了患者相关的协变量（年龄和性别）。
统计分析包括用于组内比较的χ²检验和Z检验、用于组间比较的单因素方差分析及随后的图基真实显著差异事后检验，以及用于手术指征的学生t检验。显著性水平设定为5%（P <.05）。
样本包括8名检查人员，他们对30例患者的30张全景X线片和30张CBCT进行了评估。在牙科提供者之间，解剖位置方面未发现统计学显著差异（P >.1）。与普通牙医和口腔放射科医生相比，口腔颌面外科医生更频繁地发现MC狭窄和偏移（P <.05）。口腔放射科医生检测到更多的牙根移位和磨牙后管，并且使用全景X线片和CBCT发现与MC接触的可能性更大（P <.05）。与普通牙医相比，口腔外科医生更常建议进行冠切除术（P <.05）。
牙科专业影响了对LTM两种成像方式的解读。
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