PANORAMIC RADIOGRAPHY IN ORTHODONTIC DECISION-MAKING: A FOCUS ON MANDIBULAR THIRD MOLAR IMPACTION
Authors:   PhD Research Scholar, Department of Anatomy, National Institute of Medical Sciences and Research, Jaipur, Rajasthan, India., Waghanna Surekha , Gupta U.K. ,   Professor, Department of Anatomy, National Institute of Medical Sciences and Research, Jaipur, Rajasthan, India., Patil Neelkant ,   Professor, Department of Oral Medicine and Radiology, Rajasthan Dental College and Hospital Jaipur, Rajasthan, India., Adyanthaya B.R. ,   Professor, Department of Conservative, Rajasthan Dental College and Hospital Jaipur, Rajasthan, India., Sharma Rohit ,   Professor, Department of Oral Medicine and Radiology, NIMS Dental College and Hospital Jaipur, Rajasthan, India.
Published: December 2024

Background:Impaction is defined as the failure of complete eruption of a tooth into a normal functional position within normal time due to lack of space in the dental arch caused by obstruction by another tooth or development in an abnormal position. Radiographic imaging plays a pivotal role in the evaluation, diagnosis, and management planning of third molar impactions. It provides critical information regarding tooth position, angulation, proximity to vital structures, and surrounding bone quality.

Objective: Hence present study was conducted to evaluate the pattern of mandibular third molar impaction and also assess the predictive validity of different linear measurements between the impacted and erupted mandibular third molars on digital panoramic radiographs.

Method: A comparative cross-sectional study has included 350 subjects from the patients coming to the Department of Oral Medicine and Radiology of NIMS Dental College and Rajasthan Dental College.All participants were exposed to digital panoramic radiograph with SIRONA ORTHOPHOS XG using exposing parameters of 68kvp, 11m PmA, and 18 second/Carestream 8000C.

Results:This age group has a relatively high frequency of impaction, with 69 subjects, accounting for 26.54% of the total cases of impaction.The AUC for LES-R is 0.858, indicating a high level of accuracy in predicting mandibular third molar impaction. The p-value (< 0.001) confirms that the result is statistically significant, indicating LES-R is a reliable predictor of impaction.The AUC for LES-Xi is 0.746, which represents a moderate level of accuracy in predicting impaction. The p-value (< 0.001) indicatesstatistical significance, meaning LES-Xi is a useful predictor, though slightly less accurate compared to LES-R.LES-R at the cut-off level of 19.45 mm has moderate sensitivity, indicating that it correctly identifies 61.20% of the impacted molars.The high specificitymeans LES-R accurately identifies 91.08% of erupted molars, minimizing false positives.Overall, LES-R has a high diagnostic accuracy, suggesting it is a reliable tool for predicting impaction, with a better performance in confirming non-impacted cases.

Conclusion:Our study provides a comprehensive evaluation of the spatial and angular factors contributing to mandibular third molar impaction, utilizing a robust dataset of linear and angular measurementsby using digital panoramic radiographs.Ultimately, this research supports a more proactive approach to third molar management, aimed at preventing the complications associated with impaction.