3-Dimensional Imaging for Lower Third Molars: Is There an Implication for Surgical Removal?

Abstract

IntroductionSurgical removal of impacted third molars is maybe the most frequent procedure in oral surgery. Damage to the inferior alveolar nerve (IAN) is a typical complication of the procedure with incidence rates reported at between 1 and 22%. The aim of this study was to identify factors that lead to a higher risk of IAN impairment after surgery. MethodA total of 515 surgical wisdom tooth removals having 3D imaging prior to surgical removal were retrospectively evaluated for IAN impairment, along with 3D imaging signs that were supposed predictors for postoperative IAN disturbance. Influence of each predictor was evaluated in univariate and multivariate analyses and reported as odds ratio (OR) with 95% confidence interval (CI). ResultsThe overall IAN impairment rate seen in this study was 9.4%. The low IAN impairment rate seen in this study -when compared to similar selected study groups in the literature of the pre-3D-imaging era -is indicating that the availability of 3D information is actually reducing the risk for IAN impairment after lower third molar removal.

Influence of cone beam CT on treatment plan before surgical intervention of mandibular third molars and impact of radiographic factors on deciding on coronectomyvssurgical removal

“…CBCT imaging is a relatively new modality that has the advantage of displaying the bucco-oral aspect of the relation between the molar and the canal, and several studies have assessed the use of CBCT before surgical removal of mandibular third molars and found CBCT to be superior to panoramic images to display the relation between the molar and the mandibular canal. [15][16][17][18][19]25,34 However, no previous study has examined whether the treatment plan will change when CBCT is available compared with merely a panoramic image and scanograms, or which factors that have an impact on deciding on coronectomy vs surgical removal of the entire tooth.…”

“…34 Another study used absence of bony separation between the roots and the canal on CBCT as an eligible reason for deciding on coronectomy instead of surgical removal. It was suggested that coronectomy should be the treatment of choice when there was a high risk for IAN injury.…”

Evaluation of the Relationship between Mandibular Third Molar and Mandibular Canal by Different Algorithms of Cone-beam Computed Tomography

“…1 Third molar surgery is the most common cause of injury to the inferior alveolar nerve, 2 so the knowledge of the exact location of the nerve can reduce surgical complications. 3 If you decide to make a third molar surgery the radiographic examination of the teeth and surrounding structures is required.…”

“…1 The open extraction of third molars is one of the most commonly used procedures in dentoalveolar surgery, and after the surgery several complications can occur, 2 therefore, location of the IAN in the surgical field is important because it can improve the reduction of complications, surgical planning, and quality of care. 3 A preoperative evaluation of the exact location of the IAN and the roots of the mandibular third molar would help avoiding sensory deficiencies.…”

No plane is the best one—the volume is!

“…We do not agree that any conventional technique, such as tube shift, can provide the amount of information about risk factors necessary for informed consent and safe surgical procedures. 6 Of course, the additional radiation dose has to be justified by an individual indication and risk assessment.…”