Adela Botezatu

Moldova

“Analysis of iatrogenic errors in dental treatment based on digital orthopantomography data.”

Botezatu Adela USMF “Nicolae Testimițanu” , Moldova
Postolachi Alexandru USMF “Nicolae Testimițanu” , Moldova

Abstract

Background

Radiographs are considered an essential aid in diagnosing and planning the treatment of various oro-dental pathologies. Changes in radiograph quality can lead to misinterpretations, resulting in incorrect diagnosis and treatment planning. Technical and processing errors can greatly influence radiographic interpretation. [1] Awareness of common radiographic errors and their prevention could help avoid unnecessary radiation exposure, as well as time and financial costs for both the patient and the dentist. [2]

Imaging errors may lead to misdiagnosis, inadequate treatment planning, or iatrogenic complications, with significant impact on prosthetics, implantology, endodontics, and oral and maxillofacial surgery. Particularly in prosthetics, misinterpretation of images can affect the assessment of bone dimensions, the identification of root canals, or the accurate determination of the available prosthetic space. In this context, recognizing and preventing imaging errors becomes a priority in dental practice, ensuring better diagnostic accuracy and increased predictability of interdisciplinary treatments.

Methods

This study analyzed 100 radiographic and CBCT images from patients treated at the Department of Prosthetic Dentistry “Ilarion Postolachi,” Nicolae Testemițanu State University of Medicine and Pharmacy (2010–2025). Inclusion criteria targeted images used in prosthetic treatment planning; incomplete or low-quality images were excluded. Imaging errors were classified by specialty: prosthetics—incorrect alveolar ridge assessment, occlusal plane errors, metallic/digital artifacts, misinterpretation of intermaxillary relationships; endodontics—underestimation of periapical lesions, confusion with periodontal space, post-obturation errors; orthodontics/periodontology—misjudgment of dental mobility, bone loss, and root–canal relationships. Awareness and prevention of such errors improve diagnostic accuracy, treatment planning, and reduce iatrogenic complications. Strategies emphasizing tissue preservation and tooth vitality, particularly for novice clinicians, are recommended.

Results

Analysis of radiographic and CBCT images in dentistry revealed that the most frequent errors stem from incorrect assessment of bone structures, misinterpretation of prosthetic spaces, and interference from metallic materials. In prosthetics, these errors affect evaluation of alveolar ridge dimensions, occlusal plane identification, and estimation of available prosthetic space. In endodontics, periapical lesions are often underestimated or confused with other anatomical structures. In orthodontics and periodontology, misinterpretation of dental mobility and bone loss remains critical. Metallic artifacts compromise image quality and directly impact diagnostic accuracy. Overall, imaging errors influence both diagnosis and treatment planning, reducing predictability of outcomes.

Conclusions

Radiographic and CBCT imaging are essential tools for diagnosis and treatment planning in dentistry; however, interpretation errors can significantly compromise diagnostic accuracy and treatment effectiveness. The most common errors include incorrect assessment of bone structures, misinterpretation of prosthetic spaces, underestimation of endodontic lesions, anatomical confusions, and interference from metallic artifacts. Across all specialties—prosthetics, endodontics, orthodontics, and periodontology—preventing these errors is crucial to improve treatment predictability, reduce iatrogenic complications, and enhance clinical outcomes. Implementing proper imaging analysis strategies and providing adequate training for novice clinicians contribute to safer and more successful dental interventions.