Assessing the diagnostic performance of MediXpar texture analysis for C-shaped canal morphology on panoramic radiographs: a pilot study

OBJECTIVES: This study evaluated whether panoramic radiographs could help identify C-shaped canal configurations in mandibular first premolars and offer preliminary diagnostic indicators using the MediXpar bioinformatic platform by examining pixel density and grayscale depth, in a way that approaches the diagnostic value of cone-beam computed tomography (CBCT) while minimizing radiation exposure. METHODS: Panoramic radiographs were retrospectively analyzed with the MediXpar system, a pixel-based quantitative image analysis platform that extracts grayscale density and texture-related parameters from digital radiographs. Three quantitative measures—Xpar, Power Xpar, and Pixel Count—were recorded under zoomed and non-zoomed conditions at two-pixel resolutions (1023 × 496 and 1023 × 593). Logistic regression and receiver operating characteristic (ROC) analyses were used to assess the diagnostic performance of each parameter in identifying C-shaped canals C-shaped canals, with statistical significance set at p < 0.05. RESULTS: Teeth with C-shaped canals showed a significantly larger dentin–pulp complex volume (p = 0.001), whereas pulp length did not differ (p = 0.653). Digital zoom produced higher pixel-based values (p ≤ 0.01), reflecting resampling effects rather than added anatomy. Among all metrics, Power Xpar demonstrated the strongest diagnostic performance (AUC = 0.917 in zoomed and 0.950 in non-zoomed images), showing consistent discrimination across resolutions. CONCLUSIONS: Digital magnification alters the appearance of panoramic images but does not improve diagnostic accuracy. Power Xpar performed best at higher native resolution and remained highly discriminative despite on-screen zoom, indicating that its usefulness depends on true image resolution rather than digital enlargement. CLINICAL RELEVANCE: Although zooming enhances visual comfort, it may distort quantitative interpretation. MediXpar-based analysis, especially using Power Xpar—offers a practical and reproducible option when CBCT is unavailable.