[The recognition of mandibular asymmetries in the panoramic tomogram. An example of the need for judging the value of a diagnostic procedure].
According to Habets et al. (1988), dental rotational panoramic radiographs can be used to diagnose vertical asymmetries between the right (R) and left (L) mandibular condyle and/or ramus. The difference in vertical height between the two sides is expressed by an asymmetry index which is calculated with the formula (R - L)/(R + L) x 100%. The aim of this paper is to investigate the accuracy of this diagnostic method with the help of the parameters sensitivity and specificity. For each of 25 fully preserved and macerated skulls with a stable occlusion. Two dental rotational panoramic radiographs were made. The values obtained for condylar and rami heights as well as for the asymmetry indices as proposed by Habets and al. (1988) were compared with the values received from the corresponding measurements on the skulls. For the determination of sensitivity and specificity, the five highest asymmetry values found on the skulls were classified as "high asymmetry present". In order to achieve an acceptable sensitivity (.8), an insufficient specificity must be accepted (for ramus height .25, condyle height .2), resulting in a very high rate of false positive diagnoses. The study emphasizes the necessity of a critical evaluation of the utility of diagnostic tests and procedures.
Türp
J C
JC
Abteilung für Zahnärztliche Prothetik, Albert-Ludwigs-Universität, Freiburg i. Br., Deutschland.
Vach
W
W
Strub
J R
JR
Harbich
K
K
Alt
K W
KW
D003951:Diagnostic Errors; D005146:Facial Asymmetry / Q000000981:diagnostic imaging*; D006801:Humans; D066298:In Vitro Techniques; D008334:Mandible / Q000000981:diagnostic imaging*; D008335:Mandibular Condyle / Q000000981:diagnostic imaging; D011862:Radiography, Panoramic / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014716:Vertical Dimension