Evaluation of the diagnostic accuracy of CBCT-based interpretations of maxillary impacted canines compared to those of conventional radiography: An in vitro study.

BACKGROUND: Cone-beam computed tomography (CBCT) imaging has become widespread in diagnosing impacted teeth in the context of orthodontic treatment. However, the diagnostic accuracy of this 3D imaging tool has not been comprehensively evaluated yet. The objectives of this study were: (1) to investigate the diagnostic accuracy of employing CBCT imaging in the three-dimensional (3D) localization of maxillary impacted canines compared to the use of traditional two-dimensional (2D) imaging, and (2) to calculate sensitivity, specificity and diagnostic accuracy values for specific variables assessed in 3D and 2D. MATERIAL AND METHODS: An adult cadaver skull with permanent dentition was employed and 15 simulations of maxillary canine impactions were created. Two sets of 2D and 3D radiographic images were obtained. The two sets of images were evaluated by eleven postgraduate orthodontic students. Cochran's Q tests, Friedman's tests, and then McNemar's, McNemar-Bowker's and Wilcoxon tests were used to compare Observers' responses in 3D and 2D with the gold standard values. RESULTS: Insignificant differences were found between the CBCT-based interpretations and the gold standard (GS) concerning the labiopalatal position (P=0.34), labiopalatal and mesiodistal inclination (P=0.66 and P=0.194, respectively), whereas the mesiodistal and vertical positioning showed significant differences (P=0.002 and P<0.001, respectively). The percentages of agreement between the 2D- and 3D-based interpretations were acceptable in terms of labiopalatal and mesiodistal inclinations (71.5% and 77.5%, respectively). Remarkably higher values of sensitivity, specificity and diagnostic accuracy for the CBCT-based interpretations were observed. CONCLUSIONS: The diagnostic accuracy of CBCT outweighed that of 2D radiography in the labiopalatal localization of maxillary impacted canines, contact relationship with adjacent teeth and resorption diagnosis. 3D-based assessments and the gold standard had high percentages of agreement especially for the labiopalatal position evaluation and the proximity diagnosis.

An Evaluation of Inter- and Intraobserver Reliability of Cone-beam Computed Tomography- and Two Dimensional-based Interpretations of Maxillary Canine Impactions using a Panel of Orthodontically Trained Observers.

OBJECTIVES: To assess intra- and interobserver agreement when evaluating maxillary impacted canines using cone beam computed tomography (CBCT) and two-dimensional (2D) images through a panel of orthodontically trained observers. MATERIALS AND METHODS: An adult skull with permanent dentition was employed to perform 15 simulated maxillary canine impactions. Two sets of 2D and three-dimensional (3D) radiographic images were acquired. A panel of assessors including 11 PhD and MSc postgraduate orthodontic students evaluated maxillary impacted canines using a standard questionnaire with 11 categorical variables. Kappa (K) statistics as well as Krippendorff's alpha (α) coefficients were used for the analysis of reliability. RESULTS: A high level of intraobserver agreement was found for both the CBCT- and 2D-based interpretations. The 11 observers demonstrated a higher interobserver agreement for the CBCT-based interpretations than that of the 2D-based interpretations (α = 0.68 and 0.38 respectively). The employed 3D classifications canines was found to be reliable among observers on CBCT images for the labiopalatal position (K = 0.87), mesiodistal position, vertical position, labiopalatal inclination and mesiodistal inclination (α = 0.95, 0.83, 0.84 and 0.92 respectively). The 2D-based interpretations were not in agreement among the 11 observers, except for the mesiodistal position (α = 0.88) and mesiodistal inclination (α = 0.88). CONCLUSION: The intraobserver agreement was high for both the 2D- and the CBCT-based interpretations. The interobserver agreement for the CBCT-based interpretations was remarkably higher than that of the 2D-based interpretations. The utilized CBCT-based 3D classifications for the location and inclination of maxillary impacted canines were found reliable among observers.