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"Retrospective Study of the Risk of Pathology in the Mandibular Second Molar Associated With an Impacted Third Molar: Development and Validation of a Semi-Automated Artificial Intelligence-Based Digitisation Platform". (SMART-M3)

8 novembre 2026 mis à jour par: Carlos Pérez-Albacete Martínez, Universidad Católica San Antonio de Murcia

Impacted mandibular third molars (wisdom teeth that cannot fully erupt) may damage the adjacent second molar, causing decay on its back surface, loss of the supporting bone or resorption of its root. These problems are often silent and are detected late. This retrospective observational study aims to identify which radiographic features of the impacted third molar are associated with a higher risk of pathology in the second molar.

The study uses panoramic radiographs (OPG) and cone-beam computed tomography (CBCT) scans that were previously obtained for clinical reasons at the UCAM Dental University Clinic (Murcia, Spain) between 2018 and 2026. No new images or procedures are performed on patients. The position, angulation, depth and contact of the third molar with the second molar are measured, and their relationship with second molar pathology is analysed. The study also compares the information provided by OPG and CBCT and develops and validates a semi-automated, artificial intelligence-based platform to help clinicians make these radiographic measurements faster and more consistently.

Aperçu de l'étude

Statut

Actif, ne recrute pas

Les conditions

Intervention / Traitement

Description détaillée

Design. Single-centre, observational, cross-sectional, retrospective study approved by the Ethics Committee of the Universidad Católica San Antonio de Murcia (code CE102517). It follows the Declaration of Helsinki. Informed consent was waived because only pre-existing images obtained for clinical purposes are used. Data are pseudonymised in accordance with Regulation (EU) 2016/679 (GDPR) and Spanish Organic Law 3/2018.

Setting and sample. Consecutive sampling of all eligible images acquired at the UCAM Dental University Clinic between February 2018 and June 2026 with an ORTHOPHOS SL 3D unit (Dentsply Sirona). The unit of analysis is the mandibular third molar, so each patient may contribute one to four records (one or two third molars, on OPG, CBCT or both). The expected sample is approximately 2,110 third molars from 1,188 patients on OPG and approximately 690 third molars from 384 patients on CBCT, with a paired OPG-CBCT subsample of 667 teeth.

Variables. Third molar variables are:

  • Winter classification
  • Pell & Gregory depth and ramus relationship
  • Retromolar space
  • Angle between the long axes of the second and third molars
  • Distance from the distal surface of the second molar to the ramus
  • Mesiodistal diameter of the third molar
  • Presence, type and level of contact between the third and second molars Covariates are age, sex and smoking status. Outcome. The primary outcome is a composite of distal pathology of the mandibular second molar, defined as the presence of at least one of the following: distal caries, distal bone loss or external root resorption. Teeth without any of the three are classified as controls. Each component is also recorded separately, with its extent or severity.

Statistical analysis. The analysis comprises:

  • Descriptive statistics, overall and by imaging modality.
  • Bivariate analysis using chi-square or Fisher's exact tests and Mann-Whitney U or Student's t tests, with odds ratios, 95% confidence intervals and correction for multiple comparisons.
  • Multivariable mixed-effects logistic regression with the patient as a random effect, to account for the clustering of teeth within patients.
  • Assessment of the model's discrimination with ROC curves and AUC.
  • Agreement between OPG and CBCT in the paired subsample, using intraclass correlation coefficients, simple and weighted kappa and Bland-Altman analysis, with 95% confidence intervals obtained by patient-clustered bootstrap.
  • Intra-observer reliability on 123 teeth per modality. AI-based platform. A semi-automated digitisation platform based on artificial intelligence (automatic landmark detection) is developed to perform the radiographic measurements. It is validated against expert manual assessment in an independent subsample of 191 third molars (103 OPG and 88 CBCT).

Type d'étude

Observationnel

Inscription (Réel)

1188

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Lieux d'étude

    • Murcia
      • Murcia, Murcia, Espagne, 30008
        • Clínica Universitaria UCAM Dental

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

18 ans et plus (Adulte, Adulte plus âgé)

Accepte les volontaires sains

Non

Sexes éligibles pour l'étude

Tout

Méthode d'échantillonnage

Échantillon non probabiliste

Population étudiée

Adult patients (18 years or older) who attended the UCAM Dental University Clinic (Murcia, Spain) between February 2018 and June 2026 and had at least one mandibular third molar visible on a panoramic radiograph (OPG) and/or cone-beam computed tomography (CBCT) scan obtained previously for clinical purposes. Patients were identified consecutively through the clinic's records management software (GESDEN).

La description

Inclusion Criteria:

  • Age 18 years or older.
  • Age and sex recorded.
  • At least one mandibular third molar present.
  • OPG and/or CBCT available.

Exclusion Criteria:

  • Absence of the adjacent second mandibular molar.
  • Insufficient diagnositc image quality.
  • Previous surgery altering the anatomy.
  • Cysts or tumours in the third molar region.

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Modèles d'observation: COHORT
  • Perspectives temporelles: RETROSPECTIVE

Cohortes et interventions

Groupe / Cohorte
Intervention / Traitement
OPG cohort

Patients with an impacted mandibular third molar assessed on panoramic radiography.

The radiographic assessment was performed on images that were already available. No additional exposure was required.

CBCT cohort

Subset of patients also assessed on CBCT.

The radiographic assessment was performed on images that were already available. No additional exposure was required.

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
Primary
Délai: At the time of the radiographic examination (single cross-sectional assessment).

Composite distal pathology of the mandibular second molar (distal caries, distal bone loss and/or external root resorption).

At the time of the radiographic examination (single cross-sectional assessment).

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Secondary
Délai: At the time of the radiographic examination (single cross-sectional assessment).

Agreement between OPG and CBCT measurements (ICC, weighted kappa, Bland-Altman).

At the time of the radiographic examination (single cross-sectional assessment).

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude (Réel)

31 octobre 2025

Achèvement primaire (Réel)

30 juillet 2026

Achèvement de l'étude (Estimé)

15 décembre 2026

Dates d'inscription aux études

Première soumission

8 novembre 2026

Première soumission répondant aux critères de contrôle qualité

8 novembre 2026

Première publication (Réel)

13 novembre 2026

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

13 novembre 2026

Dernière mise à jour soumise répondant aux critères de contrôle qualité

8 novembre 2026

Dernière vérification

1 novembre 2026

Plus d'information

Termes liés à cette étude

Autres numéros d'identification d'étude

  • CE102517

Plan pour les données individuelles des participants (IPD)

Prévoyez-vous de partager les données individuelles des participants (DPI) ?

NON

Description du régime IPD

Pseudonymised clinical images subject to GDPR; data available from the corresponding author upon reasonable request.

Informations sur les médicaments et les dispositifs, documents d'étude

Étudie un produit pharmaceutique réglementé par la FDA américaine

Non

Étudie un produit d'appareil réglementé par la FDA américaine

Non

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .