The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 17 , ISSUE 10 ( October, 2016 ) > List of Articles


Assessment of Interexaminer Agreement in the Detection of Condyle Morphology and positioning with Two Methods: Radiographic and Tomographic

Ana CCF Conti, JS de Almeida Giunco, PV Pedron Oltramari-Navarro, TM Freire Fernandes, R de Lima Navarro, MR de Almeida

Citation Information : Conti AC, Giunco JD, Oltramari-Navarro PP, Fernandes TF, Navarro RD, de Almeida M. Assessment of Interexaminer Agreement in the Detection of Condyle Morphology and positioning with Two Methods: Radiographic and Tomographic. J Contemp Dent Pract 2016; 17 (10):837-843.

DOI: 10.5005/jp-journals-10024-1940

Published Online: 01-02-2017

Copyright Statement:  Copyright © 2016; The Author(s).



This study aims at evaluating the interexaminer agreement between radiographic and tomographic methods to determine condyle morphological variations and positioning.

Materials and methods

The sample comprised 100 individuals aged 13 to 30 years, from the patient files of University of North Paraná. The assessment of condyles morphology and positioning was performed in images of digital panoramic radiography (DPR) and reconstructed panoramic images from the cone beam computed tomography (CBCT) scans, by using the Dolphin three-dimensional (3D) program. The condyle morphology was categorized as flat, convex, and angular as well as its positioning classified into anterior, posterior, and concentric. Three calibrated examiners performed this subjective evaluation. After that, another examiner performed an objective assessment of the condyles positioning using tomographic sagittal scans of the condyles, applying the same 3D program. This objective evaluation of the condyle position, considered the gold standard (GS), was achieved by using a formula based on the measurement values of the joint spaces, anterior and posterior. The kappa test was used to assess the interexaminer agreement in determining the condyles morphology and positioning, as well as between the condyle positioning results determined by the examiners and the GS.


The results showed poor agreement among examiners and between the subjective and objective condyle positioning evaluation.


It was concluded that the panoramic radiography (PR), either digitalized or reconstructed from CBCT scans, is not suitable for determining variations in condyle morphology and position.

Clinical significance

Whenever it is necessary to evaluate the mandibular condyle during the orthodontic screening, the orthodontist should consider another image modality better than the PR.

How to cite this article

de Almeida Giunco JS, Oltramari-Navarro PVP, Freire Fernandes TMF, de Lima Navarro R, de Almeida MR, de Castro Ferreira Conti AC. Assessment of Interexaminer Agreement in the Detection of Condyle Morphology and positioning with Two Methods: Radiographic and Tomographic. J Contemp Dent Pract 2016;17(10):837-843.

PDF Share
  1. Morphologic, radiologic and thermometric assessment of degenerative and inflammatory temporomandibular joint disease. An autopsy and clinical study. Swed Dent J Suppl 1987;52:1-110.
  2. Comparison of condylar positions at intercuspal and reference positions in patients with condylar bone change. J Oral Rehabil 2004 Jul;31(7):640-646.
  3. Imaging of the temporomandibular joint: a position paper of the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997 May;83(5):609-618.
  4. Accuracy of linear temporomandibular joint measurements with cone beam computed tomography and digital cephalometric radiography. Am J Orthod Dentofacial Orthop 2005 Dec;128(6):803-811.
  5. The utility of panoramic imaging of the temporomandibular joint in patients with temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001 Aug;92(2):236-239.
  6. Temporomandibular joint imaging: a comparative study of diagnostic accuracy for the detection of bone change with biplanar multidirectional tomography and panoramic images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995 Dec;80(6):735-743.
  7. Radiology of the temporomandibular joint and condylar head. Br Dent J 1970 Oct;129(8):361-368.
  8. Ressonância magnética e tomografia computadorizada da articulação temporomandibular: além da disfunção. Radiol Bras 2008 Sep-Oct;41(5):337-342.
  9. A tomographic study of mandibular condyle position in an asymptomatic population. J Prosthet Dent 1985 May;53(5):706-713.
  10. Dose reduction in maxillofacial imaging using low dose Cone Beam CT. Eur J Radiol 2005 Dec;56(3):413-417.
  11. Variation condyle-fossa relationships according to different methods of evaluation in tomograms. Oral Surg Oral Med Oral Pathol 1986 Dec;62(6):719-727.
  12. The measurement of observer agreement for categorical data. Biometrics 1977 Mar;33(1):159-174.
  13. Condyle and fossa shape in Class II and Class III skeletal patterns: a morphometric tomographic study. Am J Orthod Dentofacial Orthop 2005 Sep;128(3):337-346.
  14. Imagens da ATM - Técnicas de exame. J Bras Ortodon Ortop Facial 2001;6(36):502-507.
  15. Mandibular asymmetry diagnosis with panoramic imaging. Am J Orthod Dentofacial Orthop 2008 Aug;134(2):183-192.
  16. Radiographic evaluation. In: Ogus D, Toller A, editors. Common disorders of temporomandibular joint. 2nd ed. Bristol: John Wright, 1986. p. 40-62.
  17. Temporomandibular joint imaging. Clin Radiol 1996 Jan;51(1):1-10.
  18. Panoramic fadiography fo basic information and supplemental examination using special radiographys. In: Color atlas of dental medicine. Radiology. New York, NY: Thieme; 1993. p. 9-124.
  19. Radiographic evaluation of the TMJ. In: Clinical management of temporomandibular disorders and orofacial pain. 1995. p. 161-174.
  20. Assessing the length of the mandibular ramusand the condylar process: a comparison of OPG, CBCT, CT, MRI, and lateral cephalometric measurements. Eur J Orthod 2015 Feb;37(1):13-21.
  21. Digital panoramic radiography for diagnosis of the temporomandibular joint: CBCT as the gold standard. Braz Oral Res 2015;29(1):1-7.
  22. Role of different imaging modalities in assessment of temporomandibular joint erosions and osteophytes: a systematic review. Dentomaxillofac Radiol 2008 Feb;37(2):63-71.
  23. Comparison of diagnostic accuracy of film and digital tomograms for assessment of morphological changes in the TMJ. Dentomaxillofac Radiol 2007 Jan;36(1):12-17.
  24. Avaliação da posição condilar e disfunção temporomandibular em pacientes com má oclusão de Classe II submetidos à protrusão mandibular ortopédica. Dental Press Ortodon Ortop Facial, Maringá 2008 mar-abr;13(2):57-69.
  25. Tomographic evaluation of the temporomandibular joint in malocclusion subjects: condylar morphology and position. Braz Oral Res 2016 Mar;30:e17.
  26. Assessment of optimal condylar position with limited cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2009 Apr;135(4):495-501.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.