Comparison of Mesiodistal Root Angulation Measured from Conventional and CBCT Derived Panoramic Radiographs in Orthodontic Patients

Ibrahim Nasseh1, *, Douglas Jensen2, Marcel Noujeim3
1 Department of DentoMaxillofacial Radiology and Imaging School of Dentistry, Lebanese University, Beirut, Lebanon
2 Department of developmental dentistry The University of Texas Health Science Center, San Antonio School of Dentistry, San Antonio, TX, USA
3 Oral and Maxillofacial Radiology The University of Texas Health Science Center, San Antonio School of Dentistry, San Antonio, TX, USA

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Creative Commons License
© 2017 Nasseh et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of DentoMaxillofacial Radiology and Imaging, School of Dentistry, Lebanese University, Beirut, Lebanon, Tel: 9613302232; E-mails:;



Use of cone beam computed tomography (CBCT) in orthodontics is increasing; however, some patients started treatment with conventional images. The objective of this study is to manipulate CBCT panoramic reconstruction to make it comparable to conventional panoramic image and to compare mesiodistal root angulations on both images.

Materials and Methods:

Concurrent conventional panoramics and CBCT volumes were obtained from 40 subjects. CBCT volumes were manipulated to generate pan-like images that mimic the occlusal plane angle of the corresponding panoramic, allowing comparison of mesiodistal root angulations and determination of the head-tilt required to produce the reconstruction.


Clinically meaningful differences (p < .05) in the mesiodistal root angulations between standard panoramics and CBCT reconstructions emerged for 13 out of 24 teeth (54%). Greatest variations were seen in the maxillary and mandibular sextants and in first molar regions. Ideal axial head-tilt for image acquisition was determined to be with Frankfort horizontal plane 3.3o nose down.


CBCT pan images must be used with caution due to variation between methods in specific areas of arches. The images can be useful for the assessment of mesiodistal root angulations if the volume is properly manipulated to create a pan-like image.

Keywords: CBCT, Mesiodistal root, Panoramic radiographs, Conventional images, Pan-like images.