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Background <p>The red line measurement in Winter’s classification is a widely adopted method for estimating the impaction depth of mandibular third molars. However, its reliance on non-standardized anatomical landmarks and limited intra-observer repeatability underscores the need for more consistent and reproducible assessment techniques.</p> Aim <p>To evaluate and compare the intra-observer repeatability of the Red line measurement with two novel anatomical landmark-based techniques, using the mandibular plane and interorbitale line for assessing the depth of impacted mandibular third molars on panoramic radiographs.</p> Methods <p>This prospective observational study was conducted in the Department of Dentistry at the All India Institute of Medical Sciences (AIIMS), Raipur, between January and July 2022. Thirty panoramic radiographs depicting the mandibular third molar impactions classified as Position B and C according to Pell and Gregory were selected for analysis. Fifteen oral and maxillofacial surgeons independently evaluated the depth of impaction using three techniques: the conventional red line method (C-method), the mandibular plane-based method (M-method), and the interorbitale line-based method (O-method), at two distinct time points separated by a one-month interval to assess intra-observer repeatability. The primary predictor variable was the measurement method employed. The primary outcome variable was intra-observer repeatability of impaction depth measurements across the two time points. Radiographic image quality and observer variability in landmark identification were considered as covariates. Intra-observer repeatability for each technique was analyzed using <i>p</i> &lt; 0.05 and a 95% confidence interval.</p> Results <p>The M-method showed high reliability (ICC: 0.987 single, 0.999 average), and the O-method demonstrated the highest consistency (ICC: 0.998 single, 1.000 average), both remaining stable after one month. In contrast, the conventional C-method exhibited only moderate reliability (ICC: 0.508 single, 0.939 average). These findings confirm the superior and consistent repeatability of the anatomically anchored M- and O-methods, supporting their clinical utility in assessing impaction depth on panoramic radiographs.</p> Conclusion <p>The mandibular plane-based (M-method) and interorbitale line-based (O-method) techniques exhibited significantly greater intra-observer reliability than the conventional Red line approach. The use of anatomically anchored reference lines enables precise radiographic assessment of impaction depth, thereby supporting consistent preoperative surgical planning and potentially improving postoperative outcomes.</p>

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Can Novel Measurements Improve Intra-observer Repeatability Compared to the Red Line of Winter’s Classification of Impacted Mandibular Third Molars? A Prospective Observational Study

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Frijo Xavier,
  • Subham S. Agarwal,
  • Santhosh Rao,
  • Rakhi M R

摘要

Background

The red line measurement in Winter’s classification is a widely adopted method for estimating the impaction depth of mandibular third molars. However, its reliance on non-standardized anatomical landmarks and limited intra-observer repeatability underscores the need for more consistent and reproducible assessment techniques.

Aim

To evaluate and compare the intra-observer repeatability of the Red line measurement with two novel anatomical landmark-based techniques, using the mandibular plane and interorbitale line for assessing the depth of impacted mandibular third molars on panoramic radiographs.

Methods

This prospective observational study was conducted in the Department of Dentistry at the All India Institute of Medical Sciences (AIIMS), Raipur, between January and July 2022. Thirty panoramic radiographs depicting the mandibular third molar impactions classified as Position B and C according to Pell and Gregory were selected for analysis. Fifteen oral and maxillofacial surgeons independently evaluated the depth of impaction using three techniques: the conventional red line method (C-method), the mandibular plane-based method (M-method), and the interorbitale line-based method (O-method), at two distinct time points separated by a one-month interval to assess intra-observer repeatability. The primary predictor variable was the measurement method employed. The primary outcome variable was intra-observer repeatability of impaction depth measurements across the two time points. Radiographic image quality and observer variability in landmark identification were considered as covariates. Intra-observer repeatability for each technique was analyzed using p < 0.05 and a 95% confidence interval.

Results

The M-method showed high reliability (ICC: 0.987 single, 0.999 average), and the O-method demonstrated the highest consistency (ICC: 0.998 single, 1.000 average), both remaining stable after one month. In contrast, the conventional C-method exhibited only moderate reliability (ICC: 0.508 single, 0.939 average). These findings confirm the superior and consistent repeatability of the anatomically anchored M- and O-methods, supporting their clinical utility in assessing impaction depth on panoramic radiographs.

Conclusion

The mandibular plane-based (M-method) and interorbitale line-based (O-method) techniques exhibited significantly greater intra-observer reliability than the conventional Red line approach. The use of anatomically anchored reference lines enables precise radiographic assessment of impaction depth, thereby supporting consistent preoperative surgical planning and potentially improving postoperative outcomes.