Clinical Research
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Year 2024, Volume: 51 Issue: 2, 67 - 73, 31.08.2024
https://doi.org/10.52037/eads.2024.0008

Abstract

References

  • Carter K, Worthington S. Predictors of third molar impaction: a systematic review and meta-analysis. J Dent Res. 2016;95(3):267–276. doi:10.1177/0022034515615857.
  • Bui CH, Seldin EB, Dodson TB. Types, frequencies, and risk factors for complications after third molar extraction. J Oral Maxillofac Surg. 2003;61(12):1379–1389. doi:10.1016/j.joms.2003.04.001.
  • Sammartino G, Gasparro R, Marenzi G, Trosino O, Mariniello M, Riccitiello F. Extraction of mandibu- lar third molars: proposal of a new scale of difficulty. Br J Oral Maxillofac Surg. 2017;55(9):952–957. doi:https://doi.org/10.1016/j.bjoms.2017.09.012.
  • Horner K, Rushton V, Tsiklakis K, Hirschmann P, van der Stelt P, Glenny A, et al. European guidelines on radiation protection in dental radiology; the safe use of radiographs in dental practice. European Commission, Directorate-General for Energy and Transport. Radiation Protection. J Dent. 2004.
  • Bollen A, Taguchi A, Hujoel P, Hollender L. Fractal dimension on dental radiographs. DMFR. 2014. doi:10.1038/sj/dmfr/4600630.
  • Dagistan S, Bilge O. Comparison of antegonial index, mental index, panoramic mandibular index and mandibular cortical index values in the panoramic radiographs of normal males and male patients with osteoporosis. DMFR. 2010;39(5):290–294. doi:10.1259/dmfr/46589325.
  • Leite AF, de Souza Figueiredo PT, Barra FR, de Melo NS, de Paula AP. Relationships between mandibular cortical in- dexes, bone mineral density, and osteoporotic fractures in Brazilian men over 60 years old. OOOO. 2011;112(5):648–656. doi:10.1016/j.tripleo.2011.06.014.
  • Eninanc I, Yeler DY, Cinar Z. Evaluation of the effect of bruxism on mandibular cortical bone using radiomorphometric indices on panoramic radiographs. Niger J Clin Pract. 2021;24(11):1742– 1748. doi:10.4103/njcp.njcp7121.
  • Stramotas S, Geenty JP, Petocz P, Darendeliler MA. Accuracy of linear and angular measurements on panoramic radiographs taken at various positions in vitro. EJO. 2002;24(1):43–52. doi:https://doi.org/10.1093/ejo/24.1.43.
  • Xie Q, Soikkonen K, Wolf J, Mattila K, Gong M, Ainamo A. Effect of head positioning in panoramic radiography on vertical measurements: an in vitro study. DMFR. 1996;25(2):61–66. doi:https://doi.org/10.1259/dmfr.25.2.9446974.
  • Jolley L, Majumdar S, Kapila S. Technical factors in fractal analysis of periapical radiographs. DMFR. 2006;35(6):393–397. doi:10.1259/dmfr/30969642.
  • Baksi BG, Fidler A. Fractal analysis of periapical bone from lossy compressed radiographs: a comparison of two lossy compression methods. J Digit Imaging. 2011;24:993–998. doi:10.1007/s10278-011-9383-0.
  • Baksi BG, Fidler A. Image resolution and exposure time of digital radiographs affects fractal dimension of periapical bone. Clin Oral Investig. 2012;16:1507–1510. doi:10.1007/s00784-011- 0639-3.
  • Huang C, Chen J, Chang Y, Jeng J, Chen C. A fractal dimensional approach to successful evaluation of apical healing. Int Endod J. 2013;46(6):523–529. doi:10.1111/iej.12020.
  • Sindeaux R, de Souza Figueiredo PT, de Melo NS, Guimaraes ATB, Lazarte L, Pereira FB, et al. Fractal dimension and mandibular cortical width in normal and osteo- porotic men and women. Maturitas. 2014;77(2):142–148. doi:https://doi.org/10.1016/j.maturitas.2013.10.011.
  • Apolinário AC, Sindeaux R, de Souza Figueiredo PT, Guimarães AT, Acevedo AC, Castro LC, et al. Dental panoramic indices and fractal dimension measurements in osteogenesis imperfecta children under pamidronate treatment. Dentomaxillofac Radiol. 2016;45(4):20150400. doi:10.1259/dmfr.20150400.
  • Gumussoy I, Miloglu O, Cankaya E, Bayrakdar IS. Fractal properties of the trabecular pattern of the mandible in chronic renal failure. Dentomaxillofac Radiol. 2016;45(5):20150389. doi:10.1259/dmfr.20150389.
  • Amer ME, Heo MS, Brooks SL, Benavides E. Anatomical variations of trabecular bone structure in intraoral radiographs using fractal and particles count analyses. Imaging Sci Dent. 2012;42(1):5. doi:10.5624/isd.2012.42.1.5.
  • Molon RSd, Paula WNd, Spin-Neto R, Verzola MHA, Tosoni GM, Lia RCC, et al. Correlation of fractal dimension with histomorphometry in maxillary sinus lifting using autogenous bone graft. Braz Dent J. 2015;26(1):11–18. doi:10.1590/0103-6440201300290.
  • Gurdal P, Hildebolt C, Akdeniz B. The effects of different image file formats and image-analysis software programs on dental radiometric digital evaluations. Dentomaxillofac Radiol. 2001;30(1):50–55. doi:10.1038/sj/dmfr/4600570.
  • White SC, Rudolph DJ. Alterations of the trabecular pattern of the jaws in patients with osteoporosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88(5):628–635. doi:10.1016/s1079-2104(99)70097-1.
  • Hwang JJ, Lee JH, Han SS, Kim YH, Jeong HG, Choi YJ, et al. Strut analysis for osteoporosis detection model using dental panoramic radiography. Dentomaxillofac Radiol. 2017;46(7). doi:10.1259/dmfr.20170006.
  • Hopkins KD, Weeks DL. Tests for normality and measures of skewness and kurtosis: Their place in research reporting. Educ Psychol Meas. 1990;50(4):717–729. doi:10.1177/0013164490504001.
  • Misch L, Misch C. Denture satisfaction–a patient perspective. Int J Oral Maxillofac Implants. 1991;7(2):43–48.
  • Bayrak S, Goller Bulut D, Orhan K, Sinanoglu EA, Kursun Cakmak ES, Misirli M, et al. Evaluation of osseous changes in dental panoramic radiography of thalassemia patients using mandibular indexes and fractal size analysis. Oral Radiol. 2020;36:18–24. doi:10.1007/s11282-019-00372-7.
  • Southard TE, Southard KA, Jakobsen JR, Hillis SL, Najim CA. Fractal dimension in radiographic analysis of alveolar process bone. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82(5):569–576. doi:10.1016/s1079-2104(96)80205-8.
  • Gonca M, Gunacar DN, Kose TE, Karamehmetoglu I. Evaluation of mandibular morphologic measurements and trabecular structure among subgroups of impacted mandibular third molars. Oral Radiol. 2021:1–9. doi:10.1007/s11282-021-00527-5.
  • Matic DB, Yazdani A, Wells RG, Lee TY, Gan BS. The effects of masseter muscle paralysis on facial bone growth. J Surg Res. 2007;139(2):243–252. doi:10.1016/j.jss.2006.09.003.
  • Secgin CK, Karslioglu H, Ozemre MO, Orhan K. Gray value measurement for the evaluation of local alveolar bone density around impacted maxillary canine teeth using cone beam computed tomography. Med Oral Patol Oral Cir Bucal. 2021;26(5) . doi:10.4317/medoral.24677.
  • Chugh T, Ganeshkar SV, Revankar AV, Jain AK. Quantitative assessment of interradicular bone density in the maxilla and mandible: implications in clinical orthodontics. Prog Orthod. 2013;14:1–8. doi:10.1186/2196-1042-14-38.
  • Hua Y, Nackaerts O, Duyck J, Maes F, Jacobs R. Bone quality assessment based on cone beam computed tomography imaging. Clin Oral Implants Res. 2009;20(8):767–771. doi:10.1111/j.1600-0501.2008.01677.x.
  • Pauwels R, Jacobs R, Singer SR, Mupparapu M. CBCT-based bone quality assessment: are Hounsfield units applicable? Dentomaxillofac Radiol. 2015;44(1):20140238. doi:10.1259/dmfr.20140238.
  • Kitai N, Fujii Y, Murakami S, Furukawa S, Kreiborg S, Takada K. Human masticatory muscle volume and zygomaticomandibular form in adults with mandibular prognathism. J Dent Res. 2002;81(11):752–756. doi:10.1177/0810752.
  • Kubota M, Nakano H, Sanjo I, Satoh K, Sanjo T, Kamegai T, et al. Maxillofacial morphology and masseter muscle thickness in adults. Eur J Orthod. 1998;20(5):535–542. doi:10.1093/ejo/20.5.535.
  • Tsouknidas A, Jimenez-Rojo L, Karatsis E, Michailidis N, Mitsiadis TA. A bio-realistic finite element model to evaluate the effect of masticatory loadings on mouse mandible-related tissues. Front Physiol. 2017;8:265436. doi:10.3389/fphys.2017.00273.
  • Servais JA, Gaalaas L, Lunos S, Beiraghi S, Larson BE, Leon-Salazar V. Alternative cone-beam computed tomography method for the analysis of bone density around impacted maxillary canines. Am J Orthod Dentofacial Orthop. 2018;154(3):442–449. doi:10.1016/j.ajodo.2018.01.008.
  • Choel L, Duboeuf F, Bourgeois D, Briguet A, Lissac M. Trabecular alveolar bone in the human mandible: A dual-energy x-ray absorptiometry study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(3):364–370. doi:10.1067/moe.2003.119.
  • Wakimoto M, Matsumura T, Ueno T, Mizukawa N, Yanagi Y, Iida S. Bone quality and quantity of the anterior maxillary trabecular bone in dental implant sites. Clin Oral Implants Res. 2012;23(11):1314–1319. doi:10.1111/j.1600-0501.2011.02347.x.
  • Gaalaas L, Henn L, Gaillard PR, Ahmad M, Islam MS. Analysis of trabecular bone using site-specific fractal values calculated from cone beam CT images. Oral Radiol. 2014;30:179–185. doi:10.1007/s11282-013-0163-z.
  • Pathak S, Mishra N, Rastogi MK, Sharma S. Significance of radiological variables studied on orthopantomogram to predict post-operative inferior alveolar nerve paresthesia after third molar extraction. J Clin Diagn Res. 2014;8(5) . doi:10.7860/JCDR/2014/8392.4399.
  • Cosman F, de Beur SJ, LeBoff M, Lewiecki E, Tanner B, Randall S, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25:2359–2381. doi:10.1007/s00198-014-2794-2.
  • Dutra V, Yang J, Devlin H, Susin C. Radiomorphometric indices and their relation to gender, age, and dental status. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(4):479–484. doi:10.1016/j.tripleo.2004.09.013.

Application of Fractal Analysis in Detecting Trabecular Bone Characteristics Around Mandibular Impacted Third Molars on Dental Panoramic Radiographs

Year 2024, Volume: 51 Issue: 2, 67 - 73, 31.08.2024
https://doi.org/10.52037/eads.2024.0008

Abstract

Purpose: Surgical extraction of third molars can be difficult for many reasons, including increased bone density, which causes bone structures to lose their elastic properties. The aim of this study is to compare the trabecular structure around the impacted mandibular third molar(M3M) and the normal alveolar trabecular pattern using the fractal analysis method.
Materials and Methods: Panoramic images of 47 patients were included in the study. ROI1 is the area between the distal root of the second molar and the mesial of the third molar tooth. On the other hand, ROI2 was selected between the distal root of the first molar tooth and the mesial root of the second molar tooth. Fractal Dimension (FD) and Bone Marrow Dimension analyzes were applied to the selected ROIs using the ImageJ software.
Results: The mean FD values of 47 patients were found to be 1.135 for ROI1 and 1.105 for ROI2, respectively (p=0,078).The mean Bone Marrow Dimension values were found to be 1.591 for ROI1 and 1.587 for ROI2(p=0.731). There was no significant difference in FD and Bone Marrow Dimension analysis when ROI1 and ROI2 were compared. It is very important to know the pattern of trabecular structure before surgical procedure on M3M. The bone density around the impacted M3M may be higher than the healthy alveolar bone, however, the fact that males have denser bone than females should not be ignored during the operation.
Conclusion: The method of FD analysis can be useful for evaluating the trabecular structure of impacted M3M.
Key words: fractal dimension; bone structure; panoramic imaging; impacted tooth; third molars

References

  • Carter K, Worthington S. Predictors of third molar impaction: a systematic review and meta-analysis. J Dent Res. 2016;95(3):267–276. doi:10.1177/0022034515615857.
  • Bui CH, Seldin EB, Dodson TB. Types, frequencies, and risk factors for complications after third molar extraction. J Oral Maxillofac Surg. 2003;61(12):1379–1389. doi:10.1016/j.joms.2003.04.001.
  • Sammartino G, Gasparro R, Marenzi G, Trosino O, Mariniello M, Riccitiello F. Extraction of mandibu- lar third molars: proposal of a new scale of difficulty. Br J Oral Maxillofac Surg. 2017;55(9):952–957. doi:https://doi.org/10.1016/j.bjoms.2017.09.012.
  • Horner K, Rushton V, Tsiklakis K, Hirschmann P, van der Stelt P, Glenny A, et al. European guidelines on radiation protection in dental radiology; the safe use of radiographs in dental practice. European Commission, Directorate-General for Energy and Transport. Radiation Protection. J Dent. 2004.
  • Bollen A, Taguchi A, Hujoel P, Hollender L. Fractal dimension on dental radiographs. DMFR. 2014. doi:10.1038/sj/dmfr/4600630.
  • Dagistan S, Bilge O. Comparison of antegonial index, mental index, panoramic mandibular index and mandibular cortical index values in the panoramic radiographs of normal males and male patients with osteoporosis. DMFR. 2010;39(5):290–294. doi:10.1259/dmfr/46589325.
  • Leite AF, de Souza Figueiredo PT, Barra FR, de Melo NS, de Paula AP. Relationships between mandibular cortical in- dexes, bone mineral density, and osteoporotic fractures in Brazilian men over 60 years old. OOOO. 2011;112(5):648–656. doi:10.1016/j.tripleo.2011.06.014.
  • Eninanc I, Yeler DY, Cinar Z. Evaluation of the effect of bruxism on mandibular cortical bone using radiomorphometric indices on panoramic radiographs. Niger J Clin Pract. 2021;24(11):1742– 1748. doi:10.4103/njcp.njcp7121.
  • Stramotas S, Geenty JP, Petocz P, Darendeliler MA. Accuracy of linear and angular measurements on panoramic radiographs taken at various positions in vitro. EJO. 2002;24(1):43–52. doi:https://doi.org/10.1093/ejo/24.1.43.
  • Xie Q, Soikkonen K, Wolf J, Mattila K, Gong M, Ainamo A. Effect of head positioning in panoramic radiography on vertical measurements: an in vitro study. DMFR. 1996;25(2):61–66. doi:https://doi.org/10.1259/dmfr.25.2.9446974.
  • Jolley L, Majumdar S, Kapila S. Technical factors in fractal analysis of periapical radiographs. DMFR. 2006;35(6):393–397. doi:10.1259/dmfr/30969642.
  • Baksi BG, Fidler A. Fractal analysis of periapical bone from lossy compressed radiographs: a comparison of two lossy compression methods. J Digit Imaging. 2011;24:993–998. doi:10.1007/s10278-011-9383-0.
  • Baksi BG, Fidler A. Image resolution and exposure time of digital radiographs affects fractal dimension of periapical bone. Clin Oral Investig. 2012;16:1507–1510. doi:10.1007/s00784-011- 0639-3.
  • Huang C, Chen J, Chang Y, Jeng J, Chen C. A fractal dimensional approach to successful evaluation of apical healing. Int Endod J. 2013;46(6):523–529. doi:10.1111/iej.12020.
  • Sindeaux R, de Souza Figueiredo PT, de Melo NS, Guimaraes ATB, Lazarte L, Pereira FB, et al. Fractal dimension and mandibular cortical width in normal and osteo- porotic men and women. Maturitas. 2014;77(2):142–148. doi:https://doi.org/10.1016/j.maturitas.2013.10.011.
  • Apolinário AC, Sindeaux R, de Souza Figueiredo PT, Guimarães AT, Acevedo AC, Castro LC, et al. Dental panoramic indices and fractal dimension measurements in osteogenesis imperfecta children under pamidronate treatment. Dentomaxillofac Radiol. 2016;45(4):20150400. doi:10.1259/dmfr.20150400.
  • Gumussoy I, Miloglu O, Cankaya E, Bayrakdar IS. Fractal properties of the trabecular pattern of the mandible in chronic renal failure. Dentomaxillofac Radiol. 2016;45(5):20150389. doi:10.1259/dmfr.20150389.
  • Amer ME, Heo MS, Brooks SL, Benavides E. Anatomical variations of trabecular bone structure in intraoral radiographs using fractal and particles count analyses. Imaging Sci Dent. 2012;42(1):5. doi:10.5624/isd.2012.42.1.5.
  • Molon RSd, Paula WNd, Spin-Neto R, Verzola MHA, Tosoni GM, Lia RCC, et al. Correlation of fractal dimension with histomorphometry in maxillary sinus lifting using autogenous bone graft. Braz Dent J. 2015;26(1):11–18. doi:10.1590/0103-6440201300290.
  • Gurdal P, Hildebolt C, Akdeniz B. The effects of different image file formats and image-analysis software programs on dental radiometric digital evaluations. Dentomaxillofac Radiol. 2001;30(1):50–55. doi:10.1038/sj/dmfr/4600570.
  • White SC, Rudolph DJ. Alterations of the trabecular pattern of the jaws in patients with osteoporosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88(5):628–635. doi:10.1016/s1079-2104(99)70097-1.
  • Hwang JJ, Lee JH, Han SS, Kim YH, Jeong HG, Choi YJ, et al. Strut analysis for osteoporosis detection model using dental panoramic radiography. Dentomaxillofac Radiol. 2017;46(7). doi:10.1259/dmfr.20170006.
  • Hopkins KD, Weeks DL. Tests for normality and measures of skewness and kurtosis: Their place in research reporting. Educ Psychol Meas. 1990;50(4):717–729. doi:10.1177/0013164490504001.
  • Misch L, Misch C. Denture satisfaction–a patient perspective. Int J Oral Maxillofac Implants. 1991;7(2):43–48.
  • Bayrak S, Goller Bulut D, Orhan K, Sinanoglu EA, Kursun Cakmak ES, Misirli M, et al. Evaluation of osseous changes in dental panoramic radiography of thalassemia patients using mandibular indexes and fractal size analysis. Oral Radiol. 2020;36:18–24. doi:10.1007/s11282-019-00372-7.
  • Southard TE, Southard KA, Jakobsen JR, Hillis SL, Najim CA. Fractal dimension in radiographic analysis of alveolar process bone. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82(5):569–576. doi:10.1016/s1079-2104(96)80205-8.
  • Gonca M, Gunacar DN, Kose TE, Karamehmetoglu I. Evaluation of mandibular morphologic measurements and trabecular structure among subgroups of impacted mandibular third molars. Oral Radiol. 2021:1–9. doi:10.1007/s11282-021-00527-5.
  • Matic DB, Yazdani A, Wells RG, Lee TY, Gan BS. The effects of masseter muscle paralysis on facial bone growth. J Surg Res. 2007;139(2):243–252. doi:10.1016/j.jss.2006.09.003.
  • Secgin CK, Karslioglu H, Ozemre MO, Orhan K. Gray value measurement for the evaluation of local alveolar bone density around impacted maxillary canine teeth using cone beam computed tomography. Med Oral Patol Oral Cir Bucal. 2021;26(5) . doi:10.4317/medoral.24677.
  • Chugh T, Ganeshkar SV, Revankar AV, Jain AK. Quantitative assessment of interradicular bone density in the maxilla and mandible: implications in clinical orthodontics. Prog Orthod. 2013;14:1–8. doi:10.1186/2196-1042-14-38.
  • Hua Y, Nackaerts O, Duyck J, Maes F, Jacobs R. Bone quality assessment based on cone beam computed tomography imaging. Clin Oral Implants Res. 2009;20(8):767–771. doi:10.1111/j.1600-0501.2008.01677.x.
  • Pauwels R, Jacobs R, Singer SR, Mupparapu M. CBCT-based bone quality assessment: are Hounsfield units applicable? Dentomaxillofac Radiol. 2015;44(1):20140238. doi:10.1259/dmfr.20140238.
  • Kitai N, Fujii Y, Murakami S, Furukawa S, Kreiborg S, Takada K. Human masticatory muscle volume and zygomaticomandibular form in adults with mandibular prognathism. J Dent Res. 2002;81(11):752–756. doi:10.1177/0810752.
  • Kubota M, Nakano H, Sanjo I, Satoh K, Sanjo T, Kamegai T, et al. Maxillofacial morphology and masseter muscle thickness in adults. Eur J Orthod. 1998;20(5):535–542. doi:10.1093/ejo/20.5.535.
  • Tsouknidas A, Jimenez-Rojo L, Karatsis E, Michailidis N, Mitsiadis TA. A bio-realistic finite element model to evaluate the effect of masticatory loadings on mouse mandible-related tissues. Front Physiol. 2017;8:265436. doi:10.3389/fphys.2017.00273.
  • Servais JA, Gaalaas L, Lunos S, Beiraghi S, Larson BE, Leon-Salazar V. Alternative cone-beam computed tomography method for the analysis of bone density around impacted maxillary canines. Am J Orthod Dentofacial Orthop. 2018;154(3):442–449. doi:10.1016/j.ajodo.2018.01.008.
  • Choel L, Duboeuf F, Bourgeois D, Briguet A, Lissac M. Trabecular alveolar bone in the human mandible: A dual-energy x-ray absorptiometry study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(3):364–370. doi:10.1067/moe.2003.119.
  • Wakimoto M, Matsumura T, Ueno T, Mizukawa N, Yanagi Y, Iida S. Bone quality and quantity of the anterior maxillary trabecular bone in dental implant sites. Clin Oral Implants Res. 2012;23(11):1314–1319. doi:10.1111/j.1600-0501.2011.02347.x.
  • Gaalaas L, Henn L, Gaillard PR, Ahmad M, Islam MS. Analysis of trabecular bone using site-specific fractal values calculated from cone beam CT images. Oral Radiol. 2014;30:179–185. doi:10.1007/s11282-013-0163-z.
  • Pathak S, Mishra N, Rastogi MK, Sharma S. Significance of radiological variables studied on orthopantomogram to predict post-operative inferior alveolar nerve paresthesia after third molar extraction. J Clin Diagn Res. 2014;8(5) . doi:10.7860/JCDR/2014/8392.4399.
  • Cosman F, de Beur SJ, LeBoff M, Lewiecki E, Tanner B, Randall S, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25:2359–2381. doi:10.1007/s00198-014-2794-2.
  • Dutra V, Yang J, Devlin H, Susin C. Radiomorphometric indices and their relation to gender, age, and dental status. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(4):479–484. doi:10.1016/j.tripleo.2004.09.013.
There are 42 citations in total.

Details

Primary Language English
Subjects Oral and Maxillofacial Radiology
Journal Section Original Research Articles
Authors

Elif Polat Balkan 0000-0001-9952-0548

Hatice Ahsen Deniz 0000-0001-8477-6807

Mehmet Hakan Kurt 0000-0001-8312-5674

Erçin Samunahmetoğlu 0000-0002-5727-6310

Sevilay Karahan 0000-0002-8692-7266

Early Pub Date August 30, 2024
Publication Date August 31, 2024
Submission Date September 26, 2023
Published in Issue Year 2024 Volume: 51 Issue: 2

Cite

Vancouver Polat Balkan E, Deniz HA, Kurt MH, Samunahmetoğlu E, Karahan S. Application of Fractal Analysis in Detecting Trabecular Bone Characteristics Around Mandibular Impacted Third Molars on Dental Panoramic Radiographs. EADS. 2024;51(2):67-73.