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

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. 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. 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. 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. 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.