Comparative Evaluation of Panoramic and Occlusal Radiographs for the Localization of Impacted Mesiodens Based on Cone-Beam Computed Tomography

This study aimed to quantitatively assess positional discrepancies in mesiodens localization on two-dimensional radiographs (panoramic and occlusal views) by comparing them with cone-beam computed tomography (CBCT) as the reference standard and identify influencing factors. Vertical measurements on panoramic images (occlusal plane) and horizontal measurements on occlusal images (incisive canal) were obtained for mesiodens. These values were compared with CBCT measurements to evaluate positional discrepancies and assess influencing factors. Statistical analyses included paired t-tests, analysis of variance, linear regression, and multiple regression. Panoramic radiographs consistently overestimated vertical distances and showed strong linear correlation with CBCT measurements, regardless of the mesiodens position or other factors. Occlusal radiographs exhibited variable horizontal discrepancies depending on mesiodens position, with the highest observed 1 – 5 mm posterior to the incisive canal. Linear regression analysis demonstrated a strong correlation between occlusal and CBCT values. Multiple regression analysis identified mesiodens direction and patient sex as significant influencing factors. Quantitative analysis of positional differences between 2D radiographs and CBCT revealed identifiable trends that may assist clinical interpretation of mesiodens location. Panoramic views tended to provide consistent vertical estimations, whereas occlusal images showed variable horizontal assessments influenced by depth and orientation. These findings may provide insight at the initial diagnostic stage and in situations where CBCT is not available.