Analysis of Occlusal Stresses Transmitted to the Inferior Alveolar Nerve by Multiple Threaded Implants

Sammartino, Gilberto; Wang, Hom Lay; Citarella, Roberto; Lepore, Marcello Antonio; Marenzi, Gaetano

doi:10.1902/jop.2013.120611

Cited by 16 publications

(11 citation statements)

References 36 publications

(107 reference statements)

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“…However, a certain rate of risk can be observed also when the distance is higher. Infact, physical, toxic, ischemic, inflammatory processes, act as principal factor or co-factor in developing of peripheral neuropathy ( 20 - 21 ). In particular, the laceration of vasa vasorum or compression of nerve fibres due to the force applied during extraction or to the postsurgical edema, can elicit a neuropraxia.…”

Section: Discussionmentioning

confidence: 99%

Classification of impacted mandibular third molars on cone-beam CT images

Maglione¹,

Costantinides²,

Bazzocchi³

2015

J Clin Exp Dent

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Background Neurological involvement is a serious complication associated to the surgical removal of impacted mandibular third molars and the radiological investigation is the first mandatory step to assess the risk of a possible post-operative injury to the inferior alveolar nerve (IAN). The aim of this study was to introduce a new radiological classification that could be normally used in clinical practice to assess the relationship between an impacted third molar and mandibular canal on cone beam CT (CBCT) images. Material and Methods CBCT images of 80 patients (133 mandibular third molars) were independently studied by three members of the surgical team to draw a classification that could describe all the possible relationships between third molar and IAN on the cross-sectional images. Subsequently, the study population was subdivided according to this classification. The SPSS software, version 15.0 (SPSS® Inc., Chicago, Illinois, USA) was used for the statistical analysis. Results Eight different classes were proposed (classes 0-7) and six of them (classes 1-6) were subdivided in two subtypes (subtypes A-B). The distribution of classes showed a prevalence of buccal or apical course of the mandibular canal followed by lingual position and inter-radicular one. No differences have resulted in terms of anatomic relationship between males and females apart from a higher risk of real contact without corticalization of the canal when the IAN had a lingual course for female group. Younger patients showed an increased rate of direct contact with a reduced calibre of the canal and/or without corticalization. Conclusions The use of this classification could be a valid support in clinical practice to obtain a common language among operators in order to define the possible relationships between an impacted third molar and the mandibular canal on CBCT images. Key words:CBCT, classification, inferior alveolar nerve, third molars.

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Section: Discussionmentioning

confidence: 99%

Classification of impacted mandibular third molars on cone-beam CT images

Maglione¹,

Costantinides²,

Bazzocchi³

2015

J Clin Exp Dent

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“…The risk increases dramatically when there is a contact between an impacted molar and the mandibular canal [26,27]. Sammartino et al [28] proposed a safety distance from the mandibular canal of 1.5 mm during implant placement to avoid indirect lesions of the IAN. Consequently, a cut-off of 1.5 mm was chosen in our classification as a safety distance to differentiate the cases with higher risk of lesion (distance <1.5 mm) from those with a lesser one (distance >1.5 mm).…”

Section: Discussionmentioning

confidence: 99%

Classification of impacted mandibular third molars using cone beam computed tomography based on neurological risks: N.R.C.

Nemsi

Tellili

Bouanène

et al. 2017

Med Buccale Chir Buccale

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--Introduction: Considering the close proximity of the third molar roots and the mandibular canal, also the location of the lingual nerve and its anatomic variations, both nerves may be injured during extraction. The aim of this observational study was to optimize a classification of the relationship between the third molar and its neuroanatomical environment, mandibular canal and lingual bone plate, which is inspired from the neurological risks involving cone beam CT (CBCT) images, and to apply this classification to our sample. Materials and methods: A retrospective, observational study was performed involving 100 CBCT (171 mandibular third molars). Two medical doctors, qualified in human anatomy, independently evaluated all CBCT using coronal oblique sections. The classification was approved by agreement between both observers. After that, it was applied to our sample by one of them. The SPSS software, version 21.0 (SPSS® Inc., Chicago, Illinois, USA) was used for the statistical analysis. Results: The final consensual classification presented three Classes (A, B, L) with their four subclasses (from 1 to 4). The rare cases found in our sample were grouped separately under the name of "uncommon", and were divided into four specific subclasses. The status of the lingual bone plate was assessed by the presence or the absence of a fenestration or a cortical thinning. In the current study, when the mandibular canal presented a direct contact with the third molar with a reduced calibre, lingual course was the most frequent anatomical situation in both genders (males 66.7%/ females 70.5%). There is not a significant correlation between the proximity of the third molar to the mandibular canal neither with age nor with gender. In contrast, the proximity to the third molar is significantly associated with the course of the canal. The highest significance was found with the lingual course. Statistical analysis showed a nonsignificant correlation between the status of the lingual bone plate and the age then the gender. Discussion and conclusion: The use of the proposed classification (NRC) could be a support for clinical practice. We suggested a common language among operators and during collaboration with radiologists in order to facilitate the clinical discussion and to correlate the surgery outcomes to the CBCT classes for more adjustment of the surgical procedures.

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“…To avoid these complications it is necessary to perform a careful radiographic evaluation of mandibular anatomy. In the posterior region of the mandible attention should be paid to evaluate the distance to the inferior alveolar nerve in order to avoid neurosensory disturbance [17] as well as the angulation of implant placement to prevent the lingual cortical perforation and consequently the damage to the arteries of the mouth floor, mainly the mylohyoid artery [18]. In order to obtain an optimal implant primary stability, during split crest technique, it is necessary to place the implant apical to the osteotomic vertical lines, so greater attention needs to be paid to these structures.…”

Section: Discussionmentioning

confidence: 99%