Agreement in Clinical Decisions Regarding Root Angulation Based on Panoramic versus Cone-Beam CT Images

Objectives: To compare clinical decisions made based on Panoramic (PAN) versus Cone-Beam Computed Tomography (CBCT) images regarding the correction of root angulation and root proximity.
Methods: A total of 864 teeth from 36 existing patient records with concurrent PAN and CBCT images were examined by two orthodontists first using PANs, then using CBCTs in a blinded manner. Each tooth was rated regarding the need for root repositioning, the direction of repositioning and existence of root proximity. Frequencies, percentage-agreement, and intra- and inter-examiner Cohen’s kappa were calculated.
Results: There was 73.7 to 84.5% agreement in clinical decisions between PANs and CBCTs. Root proximity was more frequently reported on PANs than CBCTs (p=0.048 and p<0.001). Both PANs and CBCTs had substantial intra-examiner, within-radiograph-type reliability with Kappa values of 0.686 to 0.79 for PANs, and 0.661 for CBCTs (p<0.001). Inter-examiner and inter-radiograph-type Kappa values were moderate ranging from 0.414 to 0.51 (p<0.001). Assuming CBCT decisions were correct, 78.9% of PAN decisions were classified as “correct”, 9.3% as “missed reposition”, 11.3% as “unnecessary reposition”, and 0.3% as “wrong direction”.
Conclusions: PAN-based clinical decisions regarding root angulation were as reliable as CBCT-based clinical decisions.