Diagnostic Value of Panoramic Radiography in Determining the Position of Impacted Permanent Maxillary Canines

Background: This study was performed to assess the diagnostic accuracy of panoramic radiography in determining the position of impacted permanent maxillary canines. Methods: This was a diagnostic study to define how accurate panoramic radiography is in determining the position of impacted permanent maxillary canines. In panoramic radiographs of 33 patients (with 44 total impacted maxillary canines), α and β angulation, magnification and superimposition were assessed. The long axis of the impacted canine to the occlusal line was named α angle. The long axis of the impacted canine to the vertebral line was named β angle. The real position of the teeth was determined by CBCT. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of panoramic radiography were calculated. Kappa test was used to assess the agreement between panoramic radiography and CBCT. Roc curves were used to define cut-off point values. Results: α angulation showed 84.3% of palatal impacted maxillary canines and 41.6% of buccal teeth in their real position. β angulation showed these positions in 81.8% and 87.5% of cases, magnification in 37.5% and 58.3% of cases and superimposition in 53.6% and 100% of cases. The degree of agreement between CBCT and α angulation, β angulation, magnification, and superimposition was 0.275, 0.526, 0.03 and 0.224, respectively. Cut-off point values forαangulation, β angulation and CII were 65 degrees, 63 degrees and 1.11, respectively. Conclusions: Among different methods, β angulation showed the highest accuracy in the localization of impacted maxillary canines. α angulation and superimposition ranked second and third in terms of accuracy. Magnification had the least accuracy.