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Accuracy of measurements of mandibular anatomy and prediction of asymmetry in panoramic radiographic images

¹ Raleigh, North Carolina, USA; ² Department of Diagnostic Sciences and General Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA; ³ Department of Orthodontics, University of North Carolina, Chapel Hill, North Carolina, USA

*Correspondence to: John B Ludlow, 198 Dental Office Bldg., UNC School of Dentistry, Chapel Hill, NC 27599-7450, USA; E-mail: jbl{at}email.unc.edu

Received 9 May 2005; accepted 26 June 2005

Objectives: Measurements of ideally positioned and systematically mis-positioned skulls were used to evaluate errors in linear measurements and symmetry ratios made with panoramic X-ray images.

Methods: Digital panoramic images of 30 skulls placed in ideal, shifted and rotated positions, were assessed by measuring distances between anatomic points and fiducial references. Differences between photographic measurements (control) and radiographic measurements were compared. Horizontal measurements included a 20 mm wire and the distance from gonion to mental foramen (G-MF). Vertical distances measured included a 40 mm wire, condyle to sigmoid notch length, and condyle to gonion (posterior mandibular height or PMH). A relative symmetry ratio comparing the difference between right and left PMH was also calculated. Distances measured in panoramic images were corrected using the left vertical wire distance or the panoramic unit's stated magnification factor (1.25x).

Results: Greatest differences were noted for horizontal measurements and shifted skull positions. Use of an arbitrary magnification correction was consistently less accurate than use of an internal calibration and resulted in general underestimation of actual dimensions. Measures of PMH varied significantly from expected values for each of the three skull positions (P<0.005). Panoramic accuracy for detecting asymmetry was 67% for ideal, 70% for rotated, and 47% for shifted skull positions when an internal reference was used.

Conclusions: Panoramic radiographs should be used with caution in making absolute measurements or relative comparisons. Even when internal fiducial calibration for image distortion of anatomy is used, measurements such as those assessing posterior mandibular facial symmetry may be unreliable.

Keywords: radiography; panoramic; measurement; mandible

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