OBJECTIVE: The aim of this study was to compare the agreement between cone beam computed tomography (CBCT) and panoramic radiographs for initial orthodontic evaluation. This study was not meant to test differences between imaging modalities or to indicate superiority of one technique.

STUDY DESIGN: Thirty-eight subjects with both panoramic and CBCT images were retrospectively collected. Eight observers answered 14 observational questions. The observation was repeated after 4 weeks.

RESULTS: CBCT images yielded better agreement between 2 observer groups (orthodontic residents and radiologists) and better inter- and intraobserver agreement. The agreement between panoramic radiographs and CBCT scans was moderate.

CONCLUSIONS: If CBCT is a priori present in a case with justified indications, it has the potential to provide valuable diagnostic information for initial orthodontic evaluation and extra information for treatment planning. The moderate agreement between panoramic and CBCT images may indicate that the nature and amount of information gained from both imaging sources is deviant.