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The Scientific World Journal
Volume 2013, Article ID 921234, 7 pages
Research Article

Reliability of a Novel CBCT-Based 3D Classification System for Maxillary Canine Impactions in Orthodontics: The KPG Index

1Department of Orthodontics, School of Dentistry, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
2Department of Medical, Surgical and Health Sciences, School of Dentistry, University of Trieste, Piazza Ospitale 1, 34129 Trieste, Italy
3Department of Orthodontics, School of Dentistry, University of Genova, Viale Benedetto XV 6, 16132 Genova, Italy
4Department of Orthodontics and Gnathology-Masticatory Function, Dental School, University of Turin, Via Nizza 230, 10100 Turin, Italy
5Department of Stomatology IV, School of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain

Received 11 August 2013; Accepted 17 September 2013

Academic Editors: C. Corsi, F. Frauscher, and B. Tomandl

Copyright © 2013 Domenico Dalessandri et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The aim of this study was to evaluate both intra- and interoperator reliability of a radiological three-dimensional classification system (KPG index) for the assessment of degree of difficulty for orthodontic treatment of maxillary canine impactions. Cone beam computed tomography (CBCT) scans of fifty impacted canines, obtained using three different scanners (NewTom, Kodak, and Planmeca), were classified using the KPG index by three independent orthodontists. Measurements were repeated one month later. Based on these two sessions, several recommendations on KPG Index scoring were elaborated. After a joint calibration session, these recommendations were explained to nine orthodontists and the two measurement sessions were repeated. There was a moderate intrarater agreement in the precalibration measurement sessions. After the calibration session, both intra- and interrater agreement were almost perfect. Indexes assessed with Kodak Dental Imaging 3D module software showed a better reliability in z-axis values, whereas indexes assessed with Planmeca Romexis software showed a better reliability in x- and y-axis values. No differences were found between the CBCT scanners used. Taken together, these findings indicate that the application of the instructions elaborated during this study improved KPG index reliability, which was nevertheless variously influenced by the use of different software for images evaluation.