Comparison of Mesiodistal Root Angulation Measured from Conventional and CBCT Derived Panoramic Radiographs in Orthodontic Patients

INTRODUCTION: Use of cone beam computed tomography (CBCT) in orthodontics is increasing; however, some patients started treatment with conventional images. The objective of this study is to manipulate CBCT panoramic reconstruction to make it comparable to conventional panoramic image and to compare mesiodistal root angulations on both images. MATERIALS AND METHODS: Concurrent conventional panoramics and CBCT volumes were obtained from 40 subjects. CBCT volumes were manipulated to generate pan-like images that mimic the occlusal plane angle of the corresponding panoramic, allowing comparison of mesiodistal root angulations and determination of the head-tilt required to produce the reconstruction. RESULTS: Clinically meaningful differences (p < .05) in the mesiodistal root angulations between standard panoramics and CBCT reconstructions emerged for 13 out of 24 teeth (54%). Greatest variations were seen in the maxillary and mandibular sextants and in first molar regions. Ideal axial head-tilt for image acquisition was determined to be with Frankfort horizontal plane 3.3(o) nose down. CONCLUSION: CBCT pan images must be used with caution due to variation between methods in specific areas of arches. The images can be useful for the assessment of mesiodistal root angulations if the volume is properly manipulated to create a pan-like image.