title: Objectivity and reliability of panoramic radiographic signs of intimate relationship between impacted mandibular third molar and inferior alveolar nerve.
abstract: BACKGROUND
  The results of prior studies assessing the accuracy of panoramic radiographic signs of intimate relationship between inferior alveolar nerve (IAN) and impacted molars are controversial. This may be partly due to inadequate objectivity and reliability of these radiographic signs, which is evaluated in the present study.
  
  
  METHODS
  Three hundred radiographs in which impacted third molar reached the superior border of the inferior alveolar canal or was superimposed by the canal were evaluated by three examiners independently, twice 3 months apart. Inter- and intra-examiner agreements were analyzed using kappa statistics.
  
  
  RESULTS
  The inter-examiner agreement for all radiographic signs was poor (k < 0.2). The intra-examiner agreement for radiographic signs 2, 3, and 6 was poor with mean kappa values of 0.08, 0.00, and 0.09, respectively. Concerning the radiographic signs 4, 5, 7, and 8, the intra-examiner agreement was moderate with mean kappa values of 0.54, 0.49, 0.44, and 0.57, respectively. The mean kappa coefficient for the radiographic sign 1 yielded a good agreement (k = 0.65).
  
  
  CONCLUSIONS
  In the present study, the examiners were unable to reliably assess radiographic signs of intimate relationship between IAN and third molar, indicating that panoramic images should not be relied upon for preoperative prediction of IAN injury.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hamedan University of Medical Sciences, Shahid Fahmideh Street, Hamedan, Iran, zandi88m@yahoo.com.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Zandi
authors.forename: Abbas
authors.initials: A
authors.lastname: Shokri
authors.forename: Ali
authors.initials: A
authors.lastname: Heidari
authors.forename: Elham
authors.initials: E
authors.lastname: Masoud Peykar
mesh_terms: D006801:Humans; D008340:Mandibular Nerve / Q000000981:diagnostic imaging*; D008964:Molar, Third / Q000000981:diagnostic imaging*; D015588:Observer Variation; D011862:Radiography, Panoramic; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014092:Tooth Root / Q000000981:diagnostic imaging; D014095:Tooth, Impacted / Q000000981:diagnostic imaging*; D061221:Trigeminal Nerve Injuries / Q000000981:diagnostic imaging
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