Optimization of exposure parameters and relationship between subjective and technical image quality in cone-beam computed tomography

PURPOSE: This study was performed to investigate the effect of exposure parameters on image quality obtained using a cone-beam computed tomography (CBCT) scanner and the relationship between physical factors and clinical image quality depending on the diagnostic task. MATERIALS AND METHODS: CBCT images of a SedentexCT IQ phantom and a real skull phantom were obtained under different combinations of tube voltage and tube current (Alphard 3030 CBCT scanner, 78–90 kVp and 2–8 mA). The images obtained using a SedentexCT IQ phantom were analyzed technically, and the physical factors of image noise, contrast resolution, spatial resolution, and metal artifacts were measured. The images obtained using a real skull phantom were evaluated for each diagnostic task by 6 oral and maxillofacial radiologists, and each setting was classified as acceptable or unacceptable based on those evaluations. A statistical analysis of the relationships of exposure parameters and physical factors with observer scores was conducted. RESULTS: For periapical diagnosis and implant planning, the tube current of the acceptable images was significantly higher than that of the unacceptable images. Image noise, the contrast-to-noise ratio (CNR), the line pair chart on the Z axis, and modulation transfer function (MTF) values showed statistically significant differences between the acceptable and unacceptable image groups. The cut-off values obtained using receiver operating characteristic curves for CNR and MTF 10 were useful for determining acceptability. CONCLUSION: Tube current had a major influence on clinical image quality. CNR and MTF 10 were useful physical factors that showed significantly associations with clinical image quality.

Recurrent symptomatic cemento-osseous dysplasia: A case report

Cemento-osseous dysplasia (COD) is a benign fibro-osseous lesion of bone, in which normal bone is replaced by fibrous tissue, followed by calcification with osseous and cementum-like tissue. COD is classified into 3 categories according to its location: periapical, focal, and florid COD (FCOD). On radiography, FCOD appears radiolucent in its early stages. As it matures, radiopacities appear within the lesion, causing them to show a mixed appearance of radiolucency and radiopacity. Because FCOD is usually asymptomatic and grows in a self-limited manner, it does not require treatment. Secondary infection is the most frequent cause of symptomatic cases. We report a case of FCOD with symptoms that appeared after a dental restoration procedure and persisted after repeated operations. The purpose of this report is to emphasize the importance of thorough radiological evaluations of patients with FCOD before treatment.

Internal derangement as a predictor of provoked pain on mouth opening: A magnetic resonance imaging study

PURPOSE: This study investigated the relationship between pain and internal derangement in temporomandibular disorder (TMD) patients using magnetic resonance imaging (MRI). MATERIALS AND METHODS: This study analyzed 356 TMD patients (712 temporomandibular joints [TMJs]). The inclusion criteria were the presence of spontaneous or provoked pain on one or both TMJs and having undergone MRI. The patients with provoked pain were divided into 3 groups: pain on palpation, pain on mouth opening, and pain on mastication. MRI was performed using a 1.5-T scanner. T1- and T2-weighted parasagittal and paracoronal images were obtained. According to the findings on the T1-weighted images, another 3 groups were created based on internal derangement: normal, disc displacement with reduction, and disc displacement without reduction. The MRI findings were independently interpreted by 2 experienced oral and maxillofacial radiologists at 2 different times. Statistical analysis was performed by the chi-square test using SPSS (version 12.0; SPSS Inc., Chicago, IL, USA). RESULTS: Provoked pain on mouth opening was found to be correlated with internal derangement in TMD patients (P .05). CONCLUSION: These results suggest that internal derangement was a significant predictor of provoked pain on mouth opening.

Gardner syndrome associated with multiple osteomas, intestinal polyposis, and epidermoid cysts

Gardner syndrome is known as a variant of familial adenomatous polyposis. This syndrome is characterized by multiple intestinal polyposes, osteomas, and epidermoid cysts. In addition, dental abnormalities include an increased frequency of multiple odontomas, as well as supernumerary and impacted teeth. The authors report the case of a 7-year-old male patient with Gardner syndrome. Radiographic findings revealed multiple osteomas in both sides of the maxilla, multiple diffuse enostoses in both jaws, and a complex odontoma in the left mandibular body. Two years later, multiple epidermoid cysts on the scalp were found. Since this patient was suspected to have Gardner syndrome, the authors recommended gastrointestinal endoscopy to check for intestinal polyposis. Gastrointestinal endoscopic examination revealed multiple polyposes in the upper gastrointestinal tract and fundus of the stomach. As a result, the final diagnosis was Gardner syndrome.

Desmoplastic variant of ameloblastoma of the maxilla: A case report

The desmoplastic variant of ameloblastoma is a rare form of ameloblastoma characterized by unique radiographic and histologic features. A 46-year-old female was referred to our hospital, complaining of swelling in the left upper lip area. Radiographic findings revealed an ill-defined multilocular lesion with a large cystic lesion and thick sclerotic trabeculae on the left anterior maxilla. After the patient underwent partial osteotomy, histologic analysis revealed a desmoplastic ameloblastoma with no evidence of a hybrid lesion or cyst formation. The radiographic findings in the present case were different from those described in previous case reports. These findings are of special importance due to the unfamiliar radiographic and histologic features of this lesion.

Relationship between pain and effusion on magnetic resonance imaging in temporomandibular disorder patients

PURPOSE: This study was performed to find the relationship between pain and joint effusion using magnetic resonance imaging (MRI) in temporomandibular disorder (TMD) patients. MATERIALS AND METHODS: The study subjects included 232 TMD patients. The inclusion criteria in this study were the presence of spontaneous pain or provoked pain on one or both temporomandibular joints (TMJs). The provoked pain was divided into three groups: pain on palpation (G1), pain on mouth opening (G2), and pain on mastication (G3). MRI examinations were performed using a 1.5-T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the T2-weighted image findings, the cases of effusions were divided into four groups: normal, mild (E1), moderate (E2), and marked effusion (E3). A statistical analysis was carried out using the chi2 test with SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). RESULTS: Spontaneous pain, provoked pain, and both spontaneous and provoked pain were significantly related to joint effusion in TMD patients (p0.05). CONCLUSION: Spontaneous pain was related to the MRI findings of joint effusion; however, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ was not related to the MRI findings of joint effusion. These results suggest that joint effusion has a significant influence on the prediction of TMJ pain.

A magnetic resonance imaging study on changes in rat mandibular bone marrow and pulp tissue after high-dose irradiation

PURPOSE: This study was designed to evaluate whether magnetic resonance imaging (MRI) is appropriate for detecting early changes in the mandibular bone marrow and pulp tissue of rats after high-dose irradiation. MATERIALS AND METHODS: The right mandibles of Sprague-Dawley rats were irradiated with 10 Gy (Group 1, n=5) and 20 Gy (Group 2, n=5). Five non-irradiated animals were used as controls. The MR images of rat mandibles were obtained before irradiation and once a week until week 4 after irradiation. From the MR images, the signal intensity (SI) of the mandibular bone marrow and pulp tissue of the incisor was interpreted. The MR images were compared with the histopathologic findings. RESULTS: The SI of the mandibular bone marrow had decreased on T2-weighted MR images. There was little difference between Groups 1 and 2. The SI of the irradiated groups appeared to be lower than that of the control group. The histopathologic findings showed that the trabecular bone in the irradiated group had increased. The SI of the irradiated pulp tissue had decreased on T2-weighted MR images. However, the SI of the MR images in Group 2 was high in the atrophic pulp of the incisor apex at week 2 after irradiation. CONCLUSION: These patterns seen on MRI in rat bone marrow and pulp tissue were consistent with histopathologic findings. They may be useful to assess radiogenic sclerotic changes in rat mandibular bone marrow.

Recurrent simple bone cyst of the mandibular condyle: a case report

Cysts of the mandibular condyle are rare and can be difficult to diagnose and treat. Clinically, a simple bone cyst is asymptomatic and often discovered incidentally on routine radiographic examination. This report shows an atypical simple bone cyst occurring in the mandibular condyle showing recurrence after surgical curettage. Radiologically, this lesion involving the mandibular condyle should be distinguished from other similar lesions such as a chondroma, a central giant cell granuloma, and an aneurysmal bone cyst. Radiographic assessment was useful for forecasting the prognosis of a simple bone cyst. Possible reasons for the recurrence were discussed radiographically.

Relationship between anterior disc displacement with/without reduction and effusion in temporomandibular disorder patients using magnetic resonance imaging

PURPOSE: This study was performed to evaluate the relationship between anterior disc displacement and effusion in temporomandibular disorder (TMD) patients using magnetic resonance imaging (MRI). MATERIALS AND METHODS: The study subjects included 253 TMD patients. MRI examinations were performed using a 1.5 T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the MRI findings, temporomandibular joint (TMJ) disc positions were divided into 3 subgroups: normal, anterior disc displacement with reduction (DWR), and anterior disc displacement without reduction (DWOR). The cases of effusion were divided into 4 groups: normal, mild (E1), moderate (E2), and marked effusion (E3). Statistical analysis was made by the Fisher's exact test using SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). RESULTS: The subjects consisted of 62 males and 191 females with a mean age of 28.5 years. Of the 253 patients, T1- and T2-weighted images revealed 34 (13.4%) normal, DWR in 103 (40.7%), and DWOR in 116 (45.9%) on the right side and 37 (14.6%) normal, DWR in 94 (37.2%), and DWOR in 122 (48.2%) joints on the left side. Also, T2-images revealed 82 (32.4%) normal, 78 (30.8%) E1, 51 (20.2%) E2, and 42 (16.6%) E3 joints on the right side and 79 (31.2%) normal, 85 (33.6%) E1, 57 (22.5%) E2, and 32 (12.7%) E3 on the left side. There was no difference between the right and left side. CONCLUSION: Anterior disc displacement was not related to the MRI findings of effusion in TMD patients (P>0.05).

Prediction of age-related osteoporosis using fractal analysis on panoramic radiographs

PURPOSE: This study was performed to evaluate the trabecular pattern on panoramic radiographs to predict age-related osteoporosis in postmenopausal women. MATERIALS AND METHODS: Thirty-one postmenopausal osteoporotic women and 25 postmenopausal healthy women between the ages of 50 and 88 were enrolled in this study. The bone mineral density (BMD) of the lumbar vertebrae and femur were calculated using dual-energy X-ray absorptiometry (DXA), and panoramic radiographs were obtained. Fractal dimension (FD) was measured using the box counting method from 560 regions of interest (51x51 pixels) in 6 sites on the panoramic radiographs. The relationships between age and BMD and between FD and BMD were assessed, and the intraobserver agreement was determined. RESULTS: There was a significant difference in the FD values between the osteoporotic and normal groups (p<0.05). There was a significant difference in the FD values at three sites in the jaws (p<0.05). Age was significantly correlated with the BMD measurements, with an odds ratio of 1.25. However, the FD values were not significantly correlated with the BMD measurements, with an odds ratio of 0.000. The intraobserver agreement showed relatively higher correlation coefficients at the upper premolar, lower premolar, and lower anterior regions than the other sites. CONCLUSION: Age was an important risk factor for predicting the presence of osteoporosis in postmenopausal women. The lower premolar region was the most appropriate site for evaluating the FD value on panoramic radiographs. However, further investigation might be needed to predict osteoporosis using an FD value on panoramic radiographs.

Utility of the computed tomography indices on cone beam computed tomography images in the diagnosis of osteoporosis in women

PURPOSE: This study evaluated the potential use of the computed tomography indices (CTI) on cone beam CT (CBCT) images for an assessment of the bone mineral density (BMD) in postmenopausal osteoporotic women. MATERIALS AND METHODS: Twenty-one postmenopausal osteoporotic women and 21 postmenopausal healthy women were enrolled as the subjects. The BMD of the lumbar vertebrae and femur were calculated by dual energy X-ray absorptiometry (DXA) using a DXA scanner. The CBCT images were obtained from the unilateral mental foramen region using a PSR-9000N(TM) Dental CT system. The axial, sagittal, and coronal images were reconstructed from the block images using OnDemend3D(TM). The new term "CTI" on CBCT images was proposed. The relationship between the CT measurements and BMDs were assessed and the intra-observer agreement was determined. RESULTS: There were significant differences between the normal and osteoporotic groups in the computed tomography mandibular index superior (CTI(S)), computed tomography mandibular index inferior (CTI(I)), and computed tomography cortical index (CTCI). On the other hand, there was no difference between the groups in the computed tomography mental index (CTMI: inferior cortical width). CONCLUSION: CTI(S), CTI(I), and CTCI on the CBCT images can be used to assess the osteoporotic women.

The relationship between age and the mandibular cortical bone thickness by using panoramic radiograph / 대한구강악안면방사선학회지

PURPOSE: This study was to determine the relationship between age and the mandibular cortical bone thickness on panoramic radiograph. MATERIALS AND METHODS: Panoramic radiographs of 360 patients (180 men and 180 women) over 20 years old, who visited the Chonbuk National University Hospital from January to December in 2007, were assessed. The subjects were divided into 5 age groups. Five indices such as cortical bone thickness at the gonion (GI), antegonion (AI), and below the mental foramen (MI), the panoramic mandibular index (PMI), the mandibular cortical index (MCI) were measured on panoramic radiographs. RESULTS: All five indices including GI, AI, MI, PMI, and MCI showed significant differences between third decade and over 8 decade groups (p<0.05). PMI, MI and GI showed significant differences with gender statistically (p<0.05). CONCLUSION: The mandibular cortical bone thickness showed negative correlation with age, and the value of the thickness (PMI, MI, and GI) was greater in men than in women.

Multiple brown tumors of the jaws in primary hyperparathyroidism / 대한구강악안면방사선학회지

Brown tumor is usually diagnosed at the terminal stage of hyperparathyroidism. Diagnosis of this tumor is confirmed by endocrinologic investigations along with clinical and radiographic examination. Radiographical differential diagnosis of this tumor includes central giant cell granuloma, aneurysmal bone cyst, metastatic tumor, multiple myeloma, and Paget disease. This report presents a rare case of multiple brown tumors occurring at the maxilla and mandible, which was initially misdiagnosed as central giant cell granuloma. Plain radiographs demonstrated multiple well-defined multilocular radiolucency. CT images showed soft tissue mass with low attenuated lesions, perforation of the lingual cortical plate, and a heterogeneous mass at the right thyroid lobe. These findings were consistent with parathyroid adenoma. The patient had hypercalcemia, hypophosphatemia, and elevated alkaline phosphatase level. Surgical excision of the tumor was performed. No recurrence was observed during a 28-month follow-up.

Effects of 2-deoxy-D-glucose and quercetin on the gene expression of bone sialoprotein and osteocalcin during the differentiation in irradiated MC3T3-E1 osteoblastic cells / 대한구강악안면방사선학회지

PURPOSE: To investigate the effects of 2-deoxy-D-glucose (2-DG) and quercetin (QCT) on gene expression of bone sialoprotein (BSP) and osteocalcin (OC) during the differentiation in irradiated MC3T3-E1 osteoblastic cells. MATERIALS AND METHODS: When MC3T3-E1 osteoblastic cells had reached 70-80% confluence, cultures were transferred to a differentiating medium supplemented with 5 mM 2-DG or 10 micrometer QCT, and then irradiated with 2, 4, 6, and 8 Gy. At various times after irradiation, the cells were analyzed for the synthesis of type I collagen, and expression of BSP and OC. RESULTS: The synthesis of type I collagen in cells exposed to 2 Gy of radiation in the presence of 2-DG or QCT showed no significant difference compared with the control group within 15 days post-irradiation. When the cells were irradiated with 8 Gy, 2-DG facilitated the irradiation mediated decrease of type I collagen synthesis, whereas such decrease was inhibited by treating with QCT. During MC3T3-E1 osteoblastic cell differentiation, the mRNA expression of BSP and OC showed the peak value at 14 days and 21 days, respectively. 2-DG or QCT treatment alone decreased the level of BSP mRNA, but increased the OC mRNA level only at early time of differentiation (day 7). In the cells irradiated with 2, 4, 8 Gy, the mRNA expression of BSP and OC decreased at 7 days after the irradiation. The cells were treated with various dose of radiation in the presence of 2-DG or QCT, the mRNA level of both BSP and OC increased although this increase was observed at low dose of radiation (2 Gy) and at the early stage of differentiation. However, when the cells were exposed to 4, 6, or 8 Gy, the increase of BSP and OC mRNAs was detected only in cells co-incubated with QCT. CONCLUSION: This study demonstrates that 2-DG and QCT affect differently the expression of bone formation related factors, type I collagen, BSP, and OC in the irradiated MC3T3-E1 osteoblasic cells, according to the dose of radiation and the times of differentiation. Overall, the present findings suggest that 2-DG and QCT could have the regulatory roles as radiation-sensitizer and -protector, respectively.

Observation of the anterior loop and mental foramen of the mandibular canal using cone beam computed tomography / 대한구강악안면방사선학회지

PURPOSE : To evaluate the anteroposterior length and buccal angle of the anterior loop, and the size and location of the mental foramen using cone beam computed tomography (CBCT). MATERIALS AND METHODS : 100 CBCT images from 87 adults (43 males and 44 females) ranging in age from 20 to 73 years (average 50 years) with edentulous ridge of the mandibular premolar region were obtained. Axial, sagittal, coronal images were reconstructed from Dental and Block Images of CBCT. The anteroposterior length, shape and buccal angle of the anterior loop, and the size and location of the mental foramen were calculated from reconstructed images of axial, sagittal and coronal CBCT. RESULTS : The anteroposterior length and buccal angle of the mental canal was 4.0+/-1.2 mm, 37.8+/-11.6 degrees respectively. The loop type with straight course was the most common shape of the mental canal. The location of the mental foramen below the apex of the lower second premolar (78%) was the most common. The maximum size of the mental foramen was 4.6+/-1.0 mm in width and 3.0+/-0.6 mm in height. The inner size of the mental canal was 2.6+/-0.6 mm in width and 2.1mm+/-0.4 mm in height. CONCLUSION : CBCT is useful to evaluate the anterior loop and mental foramen of the mandibular canal. Safe guideline of 4 mm from the most anterior point of the mental foramen is recommended for implant and surgical treatment.

Radiological study of the mandibular fractures / 대한구강악안면방사선학회지

PURPOSE : To classify and evaluate mandibular fractures. MATERIALS AND METHODS : The author classified mandibular fractures of 284 patients who were referred to the Chonbuk National University Dental Hospital during the period from March 2004 to June 2007. This study was based on the conventional radiographs as well as computed tomographs which were pertained to the 284 patients who have had the mandibular fractures including the facial bone fractures. And mandibular fractures were classified with respect to gender, age, site and type of the fractures. RESULTS : More frequently affected gender with mandibular fracture was male with the ratio of 3.3 : 1. The most frequently affected age with mandibular fracture was third decade (38%), followed by fourth decade (16%), second decade (15%), fifth decade (11%), sixth decade (7%), seventh decade (5%), eighth decade (4%), first decade (4%), and ninth decade (0.3%). The most frequent type of mandibular fracture was single fracture (58%), followed by double fracture (39%), triple fracture (3%). The most common site of mandibular fracture was mandibular condyle as 113 cases (27.7%) and the next was mandibular symphysis as 109 cases (26.7%), mandibular angle as 103 cases (25.3%), mandibular body as 83 cases (20.3%) in order. The sum of fracture sites were 408 sites and there were 1.4 fracture sites per one patient. The number of mandible fractures accompanied with facial bone fractures were 41 cases (14.4%). CONCLUSION : The results showed the most frequent type and common site of mandibular fracture was single fracture and mandibular condyle respectively.

Effects of 2-deoxy-D-glucose and quercetin on the expression of osteonectin and osteopontin during the differentiation of irradiated MC3T3-E1 osteoblastic cells / 대한구강악안면방사선학회지

PURPOSE: To characterize the effects of 2-deoxy-D-glucose (2-DG) and quercetin (QCT) on gene expression of osteonectin (ON) and osteopontin (OP) in irradiated MC3T3-E1 cells. MATERIALS AND METHODS: When MC3T3-E1 osteoblastic cells had reached 70-80% confluence, cultures were transferred to a differentiating medium supplemented with 5 mM 2-DG or 10 micrometer QCT and then irradiated with 2, 4, 6, and 8 Gy. At various times after irradiation, the cells were analyzed for the expression of bone mineralization genes such as ON and OP. RESULTS: The mRNA expression of both ON and OP was increased according to the culture time in the differentiation medium, and the increase of the genes peaked at 14 days after the differentiation induction. In the case of OP, the increase of mRNA expression was maintained to 28 days after the differentiation, while the mRNA level of ON was reduced to the basal level at the same time. Irradiation adding 2-DG showed a significant peak value in the expression pattern of ON at 4 Gy 7 days after irradiation. Irradiation adding QCT increased the mRNA expression of ON and OP in a dose-dependant manner, but irradiation adding 2-DG did not show any differences between the control and experiments 14 days after irradiation. Irradiation adding QCT increased significantly the expression patterns of ON 21 days after irradiation. CONCLUSION: The results showed that QCT acted as a radiosensitizer in the gene expression of ON and OP during differentiation of the late stage of irradiated MC3T3-E1 osteoblastic cells in vitro.

Positional relationship between the maxillary sinus floor and the apex of the maxillary first molar using cone beam computed tomograph / 대한구강악안면방사선학회지

PURPOSE: To assess the positional relationship between the maxillary sinus floor and the apex of the maxillary first molar using cone beam computed tomograph (CBCT). MATERIALS AND METHODS: CBCTs from 127 subjects were analysed. A total of 134 maxillary first molars were classified according to their vertical and horizontal positional relationship to the maxillary sinus floor and measured according to the distance between the maxillary sinus floor and the maxillary first molar. RESULTS: Type III (The root projected laterally on the sinus cavity but its apex is outside the sinus boundaries) was dominated between 10 and 19 years and type I (The root apex was not in contact with the cortical borders of the sinus) was dominated (P<0.05) between 20 and 72 years on the vertical relationship between the maxillary sinus floor and the apex of the maxillary first molar. The maxillary sinus floor was located more at the apex (78.2%) than at the furcation (21.3%) for the palatal root. The distance from the root apex to the maxillary sinus floor confined to type I was increased according to the ages (P<0.05). Type M (The maxillary sinus floor was located between the buccal and the palatal root) was most common (72.4%) on the horizontal relationship between the maxillary sinus floor and the apex of the maxillary first molar. CONCLUSION: CBCT can provide highly qualified images for the maxillary sinus floor and the root apex of the maxillary first molar.

Effects of irradiation on TGF-beta1 mRNA expression and calcific nodule formation in MC3T3-E1 osteoblastic cell line / 대한구강악안면방사선학회지

PURPOSE: To investigate the effects of irradiation on transforming growth factor beta1 (TGF-beta1) mRNA expression and calcific nodule formation in MC3T3-E1 osteoblastic cell line. MATERIALS AND METHODS: Cells were cultured in alpha-minimum essential medium (alpha-MEM) supplemented with 10% fetal bovine serum and antibiotics. When the cells reached the level of 70-80% confluence, culture media were changed with alpha-MEM supplemented with 10% FBS, 5 mM beta-glycerol phosphate, and 50 microgram/mL ascorbic acid. Thereafter the cells were irradiated with a single dose of 2, 4, 6, 8 Gy at a dose rate of 1.5 Gy/min. The expression pattern of TGF-beta1 mRNA, calcium content and calcific nodule formation were examined on day 3, 7, 14, 21, 28, respectively, after the irradiation. RESULTS: The amount of TGF-beta1 mRNA expression decreased significantly on day 7 after irradiation of 4, 6, 8 Gy. It also decreased on day 14 after irradiation of 6, 8 Gy, and decreased on day 21 after irradiation of 8 Gy. The amount of calcium deposition decreased significantly on day 7 after irradiation of 4, 8 Gy (P.0.01) and showed a decreased tendency on day 14, 21 after irradiation of 4, 6, 8 Gy. The number of calcific nodules was decreased on day 7 after irradiation of 4, 8 Gy. CONCLUSION: Irradiation with a single dose of 4, 6, 8 Gy influences negatively the bone formation at the molecular level by affecting the TGF-beta1 mRNA expression that was associated with proliferation and the production of extracellular matrix in MC3T3-E1 osteoblastic cell line.

Positional relationship between mandibular third molar and mandibular canal in cone beam computed tomographs / 대한구강악안면방사선학회지

PURPOSE: To provide diagnostic information by evaluation of the positional relationship between the mandibular third molar and the mandibular canal. MATERIALS AND METHODS: Eighty-nine mandibular third molars were classified as mesioangular, horizontal, vertical, distoangular groups. The distances between the mandibular third molar and the mandibular canal were measured in cone-beam computed tomographs. The height and width ratios of distances from the mandibular third molar and the mandibular canal to the mandibular inferior border and to the lingual cortical plate were calculated. RESULTS: The vertical and buccolingual distances between the mandibular third molar and the mandibular canal were 0.03 mm, 2.96 mm in the mesioangular, 0.37 mm, 3.38 mm in the horizontal, -1.50 mm, 1.38 mm in the vertical, -1.10 mm, 4.20 mm in the distoangular group. There were significant differences in vertical (P0.05). The height and width ratios of distances on the mandibular third molar were 47.1%, 36.1% in the mesioangular, 47.4%, 34.4% in the horizontal, 37.0%, 46.7% in the vertical, 40.9%, 37.4% in the distoangular group. There were significant differences between the mesioangular and the vertical group, and the horizontal and the vertical group in height ratio (P0.05). CONCLUSION: The mesioangular group showed the nearest distance between the mandibular third molar and the mandibular canal vertically. The root apex of the mandibular third molar was positioned more buccally in the vertical group than in the mesioangular group.