Assessing the length of the mandibular ramus and the condylar process: a comparison of OPG, CBCT, CT, MRI, and lateral cephalometric measurements.

Background/Objectives: To compare different imaging procedures [cone beam computed tomography (CBCT), computed tomography (CT), magnetic resonance imaging (MRI), orthopantomography (OPG), and lateral cephalometry (LC)] for assessing the mandibular height [ramus height (RH)] and condylar process (CondProc) length as they reflect mandibular growth. Materials/Methods: The RH and CondProc of eight cadaver heads (each side separately) were measured using CBCT, CT, MRI, OPG, and LC. They were measured twice by two independent observers parallel to the posterior border of the mandibular ramus. An intraclass correlation coefficient (ICC) was used to assess the inter-and intraobserver reliability. The coefficient of variation was used to elucidate precision. Bland-Altman (BA) plots were used to assess the agreement between the procedures and the intra-and interobserver measurements. Results: All procedures, with the exception of LC, showed good intra-and interobserver agreement (maximum range of agreement: 5.3 mm) and excellent reliability (ICC > 0.9). The BA plot analysis for the CondProc and RH showed similar ranges of agreement between MRI, CT, and CBCT (maximum 6.4 mm) but higher ranges for OPG and LC. The MRI and OPG values were generally smaller. Conclusions/Implications: All 3D imaging procedures yielded nearly equal results when used to measure the CondProc and RH. MRI is recommended because it avoids ionizing radiation and has higher sensitivity in the detection of inflammation. A 2-year threshold for detecting growth in the follow-up period should be taken into account for all 3D imaging methods. Measuring the RH is recommended for the follow-up of condylar growth because reference values for annual increments are published.