DOI: 10.66702/ejoms.2028899 ISSN: 2687-5497

Influence of Surgical Experience on Panoramic Radiographic Assessment of the Relationship Between Impacted Mandibular Third Molars and the Inferior Alveolar Canal: A CBCT-Based Observer Study

Gaye Pamukçu, Selahaddin Başyıldız, Gaye Sezin Önal
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Objective: To evaluate the diagnostic accuracy of oral and maxillofacial surgery clinicians with different levels of surgical experience in assessing the relationship between impacted mandibular third molars and the inferior alveolar canal (IAC) on panoramic radiographs, using cone-beam computed tomography (CBCT) as the reference standard, and to investigate the influence of surgical experience on diagnostic performance.Methods: In this cross-sectional observer performance study, 88 oral and maxillofacial surgery clinicians (46 junior residents, 22 senior residents, and 20 practicing surgeons) evaluated 10 anonymized panoramic radiographs of impacted mandibular third molars presented through an online questionnaire. Participants classified the relationship between the third molar roots and the IAC as present, absent, or unsure. CBCT images of the corresponding cases were independently evaluated by two experienced oral and maxillofacial surgeons and served as the reference standard. Diagnostic performance was compared among the three groups.Results: Participants correctly classified a mean of 5.11 ± 1.56 of the 10 cases. The mean number of correct responses was 4.91 ± 1.63 for junior residents, 5.60 ± 1.19 for senior residents, and 5.21 ± 1.67 for practicing oral and maxillofacial surgeons, with no statistically significant difference among the groups (p = 0.289). Diagnostic accuracy varied substantially across individual cases, ranging from 20.5% to 83.0%.Conclusion: Clinicians with different levels of surgical experience demonstrated comparable diagnostic performance when interpreting panoramic radiographs for assessing the relationship between impacted mandibular third molars and the inferior alveolar canal. The substantial variation in diagnostic accuracy among individual cases suggests that radiographic characteristics may influence interpretation more than clinical experience alone. These findings support panoramic radiography as the initial imaging modality while reinforcing the selective use of CBCT when panoramic findings are equivocal or indicate a high-risk canal–root relationship.

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