DISCREPANCIES BETWEEN PREDICTED AND ACTUAL TREATMENT OF MAXILLARY CANINE IMPACTION BASED ON THE CBCT-MCI GUIDELINE

Abstract

This study aimed to explore discrepancies between CBCT-based predicted treatment, using the CBCT-MCI guideline, and actual clinical outcomes, as well as to identify factors associated with these discrepancies in maxillary impacted canines (MICs). A retrospective analytical study was conducted on 100 MICs with pre-treatment CBCT imaging and documented treatment outcomes. Each case was evaluated using the CBCT-MCI guideline, which comprises 10 radiographic items used to generate a cumulative score and predict treatment modality. Predicted treatment was compared with actual treatment, and cases were categorized into agreement and disagreement groups. The results showed that 53% demonstrated agreement, while 47% showed disagreement between predicted and actual treatment outcomes. The CBCT-MCI guideline consistently overestimated treatment severity, with all cases classified as surgical removal. Chi-square analysis demonstrated that several CBCT sub-items were significantly associated with agreement, including palatal position (p = 0.048), the condition of the primary canine retained with root resorption (p = 0.006), missing primary canine (p = 0.044), and the relationship to the nasal cavity (p = 0.001), which showed the strongest association. Ankylosis-related findings were also significantly associated (p = 0.031). Multivariable logistic regression identified the relationship to the nasal cavity as the only independent predictor of disagreement (p = 0.012), suggesting its dominant role in prediction error. These findings indicate that while the CBCT-MCI guideline provides a structured assessment framework, it has limited discriminatory ability and may not fully reflect clinical decision-making. Discrepancies were influenced by specific anatomical characteristics, highlighting the need for more refined, data-driven predictive models.

Keywords: Maxillary Impacted Canine (MICs), CBCT, Treatment Prediction, Agreement, Guideline