DENTIST AGREEMENT ON ASSESSING IMPACTED THIRD MOLARS' ANGLES VIA ORTHOPANTOMOGRAMS
Main Article Content
Keywords
Impacted third molars, orthopantomogram, Winter’s classification, inter-rater reliability, panoramic radiography, mandibular molar angulation
Abstract
Introduction: Assessing the angulation of third molar teeth in the mandible is critical in diagnosis, pre-surgical planning, and even surgery of the impacted tooth. Orthopantomograms (OPGs) are preferred for this purpose due to their ease of application and panoramic view.
Objective: The aim of this study was to assess the degree of inter-observer variability of dentists in identifying the angulation of impacted third molars using orthopantomograms and to assess the repeatability of panoramic radiographs for diagnostic purposes.
Materials and Method: This cross-sectional study was conducted at Oral and Maxillofacial Surgery Department, Foundation University Islamabad, Pakistan from April to September 2024. All the OPGs collected were initially reviewed, and 120 images were further independently rated by three calibrated dentists using the Winter classification. Therefore, Cohen's Kappa was computed as a measure of inter-rater reliability.
Results: Mesioangular was the prevailing type of impaction. Cohen’s Kappa values ranged from 0.78 to 0.81, describing the level of agreement between the two raters as substantial to almost perfect. The percentage of total agreement in the last observations was 76.7%.
References
2. Liaqat, F., Gakhar, A., Siddiqui, Z.W., Jabbar, M., Fatima, S. and Butt, H., 2023. Inter-Rater Reliability among Dentists for Assessment of Depth of Impacted Third Molars on Orthopantomograms. Pakistan Journal of Medical & Health Sciences, 17(01), pp.388-388.
3. Mummolo, S., Gallusi, G., Strappa, E.M., Grilli, F., Mattei, A., Fiasca, F., Bambini, F. and Memè, L., 2023. Prediction of Mandibular Third Molar Impaction Using Linear and Angular Measurements in Young Adult Orthopantomograms. Applied Sciences, 13(7), p.4637.
4. Ayub, I., Rehman, M., Nawaz, M., Jabbar, M., Butt, H. and Jamil, F., 2023. Inter-Rater Reliability to the Assessment of Ramus Relationship of Mandibular Impacted Third Molar Among Denitsts: An Orthopantomographic Study. Pakistan Journal of Medical & Health Sciences, 17(01), pp.394-394.
5. Joshi, J., Dudhia, B., Mehta, D., Thaker, N. and Patel, H., 2025. Comparative Analysis of Impacted Mandibular Third Molar Root Proximity to the Mandibular Canal using Orthopantomography and Cone-beam Computed Tomography Imaging Modalities: A Pilot Study. Advances in Human Biology, 15(1), pp.113-117.
6. Afridi, S.U., Baseer, N., Durrani, Z., Afridi, M.I. and Jehan, S., 2022. Association between angulation of mandibular third molar impactions with facial skeletal types and cephalometric landmarks. Khyber Medical University Journal, 14(1), pp.47-55.
7. Sujon, M.K., Alam, M.K., Rahman, S.A. and Noor, S.N.F.M., 2022. Third molar impactions prevalence and pattern among adults using 5923 digital orthopantomogram. Bangladesh Journal of Medical Science, 21(3), pp.717-729.
8. Khan, S.Q., Khabeer, A., Alyousef, N.I., Benrashed, M.A., AlMaimouni, Y., Al-Thobity, A., Gad, M.M. and Akhtar, S., 2021. Radiographic evaluation of third molar impaction: A digital panoramic stud. Saudi Journal for Health Sciences, 10(1), pp.34-37.
9. Timme, M., Viktorov, J., Steffens, L., Streeter, A., Karch, A. and Schmeling, A., 2023. Third molar eruption in orthopantomograms as a feature for forensic age assessment—a comparison study of different classification systems. International Journal of Legal Medicine, 137(3), pp.765-772.
10. Moreira-Souza, L., Butini Oliveira, L., Gaêta-Araujo, H., Almeida-Marques, M., Asprino, L. and Oenning, A.C., 2022. Comparison of CBCT and panoramic radiography for the assessment of bone loss and root resorption on the second molar associated with third molar impaction: a systematic review. Dentomaxillofacial Radiology, 51(3), p.20210217.
11. Ahmed, H.A., López-López, J., Egido-Moreno, S., Llabrés, X.R., Hameed, M. and Estrugo-Devesa, A., 2024. Mandibular Third Molar Impaction and Bone Change Distal to the Second Molar: A Panoramic Radiographic Study. Journal of Clinical Medicine, 13(3), p.906.
12. Skitioui, M., Jaoui, D., Haj Khalaf, L. and Touré, B., 2023. Mandibular second molars and their pathologies related to the position of the mandibular third molar: a radiographic study. Clinical, Cosmetic and Investigational Dentistry, pp.215-223.
13. Jacques, E., Ebogo, M., Eng, Y.C., Donald, N. and Odile, Z., 2023. Radiographic Evaluation of Impacted Third Mandibular Molar According to the Classification of Winter, Pell and Gregory in a Sample of Cameroonian Population. Ethiopian Journal of Health Sciences, 33(5), pp.851-858.
14. ASSIRI, H., Estrugo-Devesa, A., Egido-Moreno, S., Rosello-LLabres, X., Hameed, M.S., Alqarni, A. and Lopez, J.L., 2024. Prevalence of mandibular third molar impaction, associated pathologies, and correlation with Temporomandibular joint morphology in Spanish Population: A panoramic radiography study.
15. Gopalaiah, H., Gurram, A., Chaitanya, N.C., Sharma, S., Gattu, A., Rathore, K., Ali, S.H., Parvathala, P., Reesu, G.V., Mula, A.P. and Balla, S.B., 2022. Is there any difference in the development of mandibular third molars according to the type of impaction: An orthopantomographic study in south Indian children and adolescents. Legal Medicine, 57, p.102055.