Quality assessment of ultra low dose-low dose orthopantomograms reconstructed from CBCT for orthodontic purposes

Rogier H. van Bunningen; Pieter U. Dijkstra; Arjan J.A. Dieters; Paul van der Stelt; Wicher J. van der Meer; Anne Marie Kuijpers-Jagtman

doi:10.1016/j.ajodo.2025.09.025

Quality assessment of ultra low dose-low dose orthopantomograms reconstructed from CBCT for orthodontic purposes

Rogier H. van Bunningen^*
, Pieter U. Dijkstra
, Arjan J.A. Dieters
, Paul van der Stelt
, Wicher J. van der Meer
, Anne Marie Kuijpers-Jagtman

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Introduction: This study aimed to analyze the image quality of standard dose orthopantomograms (sd-PAN), extracted PAN from standard dose cone-beam computed tomography (CBCT [extr-PAN]), and from reduced-dose ultra low dose-low dose CBCT (rd-PAN).

Methods: Image pairs, sd-CBCT and sd-PAN, of patients were selected if taken within 6 months of each other. From the sd-CBCT, an extr-PAN was extracted, and a simulated rd-PAN (sim rd-PAN) was constructed using a filtering technique. Three experienced orthodontists assessed image quality by means of 9 yes-and-no statements. For subjective statements (1-5), observers’ opinions of technical acceptability and visibility of anatomic structures, observers indicated their disagreement or agreement. For objective statements (6-9), regarding comparability to a gold standard, observers indicated the presence of dental structures. Positive response rates were calculated for the subjective statements. Agreement rates with the gold standard were calculated for the objective statements. Thresholds for acceptable image quality were if ≥2 observers agreeing with the subjective statements or agreeing with the gold standard (objective statements) for 90% for sd-PANs and 85% for both extr-PANs and sim rd-PANs.

Results: In total, images of 43 patients were included. For the subjective statements, only the sd-PAN met the threshold for technical adequacy (95.3%) and suitability for orthodontic treatment planning (95.3%). For objective statements 6, 7, and 9, extr-PAN and sim rd-PAN images met the threshold for acceptable quality, whereas the sd-PAN met the threshold for statements 6 and 9. Differences in agreement with the gold standard among images were small (85.7%-87.8%).

Conclusions: Sd-PAN images demonstrated superior image quality. Although extr-PAN and sim rd-PAN showed reduced diagnostic image quality for orthodontic diagnosis, differences among the 3 types of PAN regarding the gold standard were small.

Original language	English
Pages (from-to)	226-236
Number of pages	11
Journal	American Journal of Orthodontics and Dentofacial Orthopedics
Volume	169
Issue number	2
Early online date	12 Nov 2025
DOIs	https://doi.org/10.1016/j.ajodo.2025.09.025
Publication status	Published - Feb 2026

Bibliographical note

Publisher Copyright:
© 2025 The Authors. Published by Elsevier Inc. on behalf of the American Association of Orthodontists. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/

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10.1016/j.ajodo.2025.09.025

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Cite this

@article{6a5cc0d3da1b4a0296d246925bbdf0a6,

title = "Quality assessment of ultra low dose-low dose orthopantomograms reconstructed from CBCT for orthodontic purposes",

abstract = "Introduction: This study aimed to analyze the image quality of standard dose orthopantomograms (sd-PAN), extracted PAN from standard dose cone-beam computed tomography (CBCT [extr-PAN]), and from reduced-dose ultra low dose-low dose CBCT (rd-PAN).Methods: Image pairs, sd-CBCT and sd-PAN, of patients were selected if taken within 6 months of each other. From the sd-CBCT, an extr-PAN was extracted, and a simulated rd-PAN (sim rd-PAN) was constructed using a filtering technique. Three experienced orthodontists assessed image quality by means of 9 yes-and-no statements. For subjective statements (1-5), observers{\textquoteright} opinions of technical acceptability and visibility of anatomic structures, observers indicated their disagreement or agreement. For objective statements (6-9), regarding comparability to a gold standard, observers indicated the presence of dental structures. Positive response rates were calculated for the subjective statements. Agreement rates with the gold standard were calculated for the objective statements. Thresholds for acceptable image quality were if ≥2 observers agreeing with the subjective statements or agreeing with the gold standard (objective statements) for 90\% for sd-PANs and 85\% for both extr-PANs and sim rd-PANs.Results: In total, images of 43 patients were included. For the subjective statements, only the sd-PAN met the threshold for technical adequacy (95.3\%) and suitability for orthodontic treatment planning (95.3\%). For objective statements 6, 7, and 9, extr-PAN and sim rd-PAN images met the threshold for acceptable quality, whereas the sd-PAN met the threshold for statements 6 and 9. Differences in agreement with the gold standard among images were small (85.7\%-87.8\%).Conclusions: Sd-PAN images demonstrated superior image quality. Although extr-PAN and sim rd-PAN showed reduced diagnostic image quality for orthodontic diagnosis, differences among the 3 types of PAN regarding the gold standard were small.",

author = "\{van Bunningen\}, \{Rogier H.\} and Dijkstra, \{Pieter U.\} and Dieters, \{Arjan J.A.\} and \{van der Stelt\}, Paul and \{van der Meer\}, \{Wicher J.\} and Kuijpers-Jagtman, \{Anne Marie\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors. Published by Elsevier Inc. on behalf of the American Association of Orthodontists. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/",

year = "2026",

month = feb,

doi = "10.1016/j.ajodo.2025.09.025",

language = "English",

volume = "169",

pages = "226--236",

journal = "American Journal of Orthodontics and Dentofacial Orthopedics",

issn = "0889-5406",

publisher = "Elsevier Inc.",

number = "2",

}

Quality assessment of ultra low dose-low dose orthopantomograms reconstructed from CBCT for orthodontic purposes. / van Bunningen, Rogier H.; Dijkstra, Pieter U.; Dieters, Arjan J.A. et al.
In: American Journal of Orthodontics and Dentofacial Orthopedics, Vol. 169, No. 2, 02.2026, p. 226-236.

Research output: Contribution to Journal › Article › Academic › peer-review

TY - JOUR

T1 - Quality assessment of ultra low dose-low dose orthopantomograms reconstructed from CBCT for orthodontic purposes

AU - van Bunningen, Rogier H.

AU - Dijkstra, Pieter U.

AU - Dieters, Arjan J.A.

AU - van der Stelt, Paul

AU - van der Meer, Wicher J.

AU - Kuijpers-Jagtman, Anne Marie

N1 - Publisher Copyright: © 2025 The Authors. Published by Elsevier Inc. on behalf of the American Association of Orthodontists. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/

PY - 2026/2

Y1 - 2026/2

N2 - Introduction: This study aimed to analyze the image quality of standard dose orthopantomograms (sd-PAN), extracted PAN from standard dose cone-beam computed tomography (CBCT [extr-PAN]), and from reduced-dose ultra low dose-low dose CBCT (rd-PAN).Methods: Image pairs, sd-CBCT and sd-PAN, of patients were selected if taken within 6 months of each other. From the sd-CBCT, an extr-PAN was extracted, and a simulated rd-PAN (sim rd-PAN) was constructed using a filtering technique. Three experienced orthodontists assessed image quality by means of 9 yes-and-no statements. For subjective statements (1-5), observers’ opinions of technical acceptability and visibility of anatomic structures, observers indicated their disagreement or agreement. For objective statements (6-9), regarding comparability to a gold standard, observers indicated the presence of dental structures. Positive response rates were calculated for the subjective statements. Agreement rates with the gold standard were calculated for the objective statements. Thresholds for acceptable image quality were if ≥2 observers agreeing with the subjective statements or agreeing with the gold standard (objective statements) for 90% for sd-PANs and 85% for both extr-PANs and sim rd-PANs.Results: In total, images of 43 patients were included. For the subjective statements, only the sd-PAN met the threshold for technical adequacy (95.3%) and suitability for orthodontic treatment planning (95.3%). For objective statements 6, 7, and 9, extr-PAN and sim rd-PAN images met the threshold for acceptable quality, whereas the sd-PAN met the threshold for statements 6 and 9. Differences in agreement with the gold standard among images were small (85.7%-87.8%).Conclusions: Sd-PAN images demonstrated superior image quality. Although extr-PAN and sim rd-PAN showed reduced diagnostic image quality for orthodontic diagnosis, differences among the 3 types of PAN regarding the gold standard were small.

AB - Introduction: This study aimed to analyze the image quality of standard dose orthopantomograms (sd-PAN), extracted PAN from standard dose cone-beam computed tomography (CBCT [extr-PAN]), and from reduced-dose ultra low dose-low dose CBCT (rd-PAN).Methods: Image pairs, sd-CBCT and sd-PAN, of patients were selected if taken within 6 months of each other. From the sd-CBCT, an extr-PAN was extracted, and a simulated rd-PAN (sim rd-PAN) was constructed using a filtering technique. Three experienced orthodontists assessed image quality by means of 9 yes-and-no statements. For subjective statements (1-5), observers’ opinions of technical acceptability and visibility of anatomic structures, observers indicated their disagreement or agreement. For objective statements (6-9), regarding comparability to a gold standard, observers indicated the presence of dental structures. Positive response rates were calculated for the subjective statements. Agreement rates with the gold standard were calculated for the objective statements. Thresholds for acceptable image quality were if ≥2 observers agreeing with the subjective statements or agreeing with the gold standard (objective statements) for 90% for sd-PANs and 85% for both extr-PANs and sim rd-PANs.Results: In total, images of 43 patients were included. For the subjective statements, only the sd-PAN met the threshold for technical adequacy (95.3%) and suitability for orthodontic treatment planning (95.3%). For objective statements 6, 7, and 9, extr-PAN and sim rd-PAN images met the threshold for acceptable quality, whereas the sd-PAN met the threshold for statements 6 and 9. Differences in agreement with the gold standard among images were small (85.7%-87.8%).Conclusions: Sd-PAN images demonstrated superior image quality. Although extr-PAN and sim rd-PAN showed reduced diagnostic image quality for orthodontic diagnosis, differences among the 3 types of PAN regarding the gold standard were small.

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UR - https://www.scopus.com/pages/publications/105023863642#tab=citedBy

U2 - 10.1016/j.ajodo.2025.09.025

DO - 10.1016/j.ajodo.2025.09.025

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JO - American Journal of Orthodontics and Dentofacial Orthopedics

JF - American Journal of Orthodontics and Dentofacial Orthopedics

IS - 2

ER -

Quality assessment of ultra low dose-low dose orthopantomograms reconstructed from CBCT for orthodontic purposes

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