OBJECTIVES: To evaluate the geometric distortion of tilting of mandibular third molars with respect to second molars on panoramic reconstruction. METHODS: Cone-beam CT (CBCT) reconstructions of 160 third molars, obtained due to an indication of risk of inferior alveolar nerve damage during surgery, were used. CBCT-reconstructed panoramic images were used as bi-dimensional (2D) images, to avoid distortions other than geometric distortions. The angle between the second and the third molar was measured in 2D and three-dimensional (3D) images. Student's t-test was used to assess the null-hypothesis of no difference between 2D and 3D measurements. RESULTS: A significant mean difference (-2.3° ± 6.3°) between 2D and 3D measurements was found, with an absolute error of 3.6° ± 5.7° and a relative error of 10%. These findings comprehensively explain the geometric distortion on panoramic radiographs. CONCLUSIONS: Although a widely used and undoubtedly useful tool for diagnosis and surgical planning of mandibular third molar extractions, panoramic reconstruction are biased from geometric distortion that may influence surgical planning.
Lupi, Saturnino Marco
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