Diagnostic predictability of digital versus conventional panoramic radiographs in the presurgical evaluation of impacted mandibular third molars

Panoramic radiographs are the most widely used radiological diagnostic technique in dental practice, offering full vision of the maxillas and adjacent regions, but there are shortcomings regarding detailed dentoalveolar exploration. This study compared the precision of digital versus conventional panoramic radiographs in the presurgical evaluation of impacted lower third molars. 390 mandibular third molars were studied in 287 patients; their position, morphology and surgical technique used were recorded. 84 molars were evaluated with digital panoramic radiographs, and 306 with conventional panoramic radiographs. Four observers compared the presurgical data with the surgical findings and the diagnostic precision was established. There were statistically significant differences between the techniques; digital panoramic radiographs were more precise than conventional radiographs in providing the correct presurgical evaluation of the impacted third molars. Surgeon experience had a statistically significant influence on planning the presurgical study. Panoramic radiographs distort the position and morphology of the lower third molar, which may affect the presurgical strategy used. In this context, and because of their lesser experience, first year residents consider the operation to be more complicated, and tend to act less conservatively and cause increased trauma. In conclusion, digital panoramic radiographs offer significantly greater diagnostic precision than conventional panoramic radiographs.