Clinical relevance of cone beam computed tomography in mandibular third molar removal: A multicentre, randomised, controlled trial

Ghaeminia, Hossein; Gerlach, N.L.; Hoppenreijs, T.J.M.; Kicken, M; Dings, J.P.; Borstlap, W.A.; Haan, Ton de; Bergé, Stefaan; Meijer, G.J.; Maal, T.J.J.

doi:10.1016/j.jcms.2015.10.009

Cited by 72 publications

(86 citation statements)

References 36 publications

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“…6,[8][9][10][11][12][13] Another reason to perform CBCT may be to clarify the presence of pathology in relation to the third molar, which could be decisive for removal, even in lack of patient symptoms. This study has focused on the association between findings in PAN and CBCT in terms of resorption and marginal bone loss in/at the distal surface on the second molar and increased periodontal space around the crown of the third molar.…”

Section: Discussionmentioning

confidence: 99%

“…7 Further, it has been shown in randomized controlled clinical trials that CBCT before removal did not decrease the number of sensory disturbances to the inferior alveolar nerve compared with panoramic imaging. [8][9][10] On the other hand, it was speculated that CBCT could be indicated in cases of doubt after interpreting the panoramic image (PAN) with regard to the presence of root resorption in the distal surface of the second molar, if this was indicative for removal of the tooth. 11 The aim of this study was to compare pathological findings observed in a PAN and CBCT taken prior to removal of a mandibular third molar, in the assessment of resorption in the distal surface of the second molar, marginal bone loss at the distal root surface of the second molar and the presence of an increased periodontal space around the crown of the third molar.…”

Section: Introductionmentioning

confidence: 99%

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Radiographic signs of pathology determining removal of an impacted mandibular third molar assessed in a panoramic image or CBCT

Matzen¹,

Schropp²,

Spin‐Neto³

et al. 2017

Dentomaxillofacial Radiology

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Objectives: To (1) compare pathological findings related to the mandibular third molar in panoramic images (PAN) and CBCT; (2) estimate the frequency of removals if pathological findings were indicative; and (3) assess factors in PAN associated with resorption and marginal bone loss at the second molar as observed in CBCT. Methods: 379 mandibular third molars were examined with PAN and CBCT. Four observers registered resorption and marginal bone loss at the second molar and increased periodontal space at the third molar in both imaging modalities. Agreement between PAN and CBCT, frequency of removals based on pathological findings in either of the two modalities and interobserver reproducibility was calculated. Logistic regression analyses assessed factors in PAN, which could predict marginal bone loss and resorption observed in CBCT. Results: Agreement between PAN and CBCT: resorption 54-74%; marginal bone loss 66-85%; and increased periodontal space 92-97%. Removals based on CBCT and PAN: 58-71% and 36-65%. Interobserver percentage accordance and kappa values ranged from 57 to 98% and 0.10-0.91 for PAN and 61-97% and 0.22-0.78 for CBCT, respectively. Mesioangulated/horizontally positioned third molars were associated with marginal bone loss [odds ratio (OR) 5 7.0-31.3; p , 0.001] and resorption (OR 5 2.9-35.6; p , 0.001) in CBCT. Overprojection between the third and the second molars in PAN predicted resorption observed in CBCT (OR 5 5.6-21.2; p , 0.001). Conclusions: Pathology associated with the third molar is more often observed in CBCT than in PAN. More third molars would be removed if pathological findings are based on CBCT. Mesioangulated/horizontally positioned third molars overprojecting the cervical/root part of the second molar in PAN are strongly associated with pathology observed in CBCT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiographic signs of pathology determining removal of an impacted mandibular third molar assessed in a panoramic image or CBCT

Matzen¹,

Schropp²,

Spin‐Neto³

et al. 2017

Dentomaxillofacial Radiology

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“…Since subjects with a pre-operative CBCT were evenly distributed between both study arms in this part of the study, it can be expected that this co-intervention did not influence the results. Furthermore, a pre-operative CBCT had no influence on the outcome of postoperative complications, pain, quality of life, and duration of surgery [16]. Due to the selection criteria of the CBCT study, mainly third molars with deep impactions where included.…”

Section: Discussionmentioning

confidence: 99%

“…The procedure of selecting patients and eligibility criteria are described in detail in a previous article [16]. Prior to surgery, the patients characteristics were recorded at baseline in a secured website designed for this study.…”

Section: Methodsmentioning

confidence: 99%

Postoperative socket irrigation with drinking tap water reduces the risk of inflammatory complications following surgical removal of third molars: a multicenter randomized trial

Ghaeminia

Hoppenreijs

et al. 2016

Clin Oral Invest

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ObjectivesThe primary aim of the present study was to evaluate the effectiveness of postoperative irrigation of the socket with drinking tap water on inflammatory complications following lower third molar removal.Material and methodsA multicenter randomized controlled trial was carried out from June 2013 to June 2014. In one arm of the study, patients were instructed to irrigate the tooth socket and surgical site with a Monoject® Curved 412 Tip Syringe (Tyco/healthcare-Kendall, Mansfield, MA, USA) with tap water. In a second arm of the study, the standard postoperative instructions did not include irrigation instructions. The incidences of alveolar osteitis and wound infection were recorded for each group and analyzed by the Fisher’s exact test.ResultsA total of 280 patients with 333 mandibular third molars were analyzed. According to the intention-to-treat (ITT) analysis, inflammatory complications occurred in 18 cases in the Monoject® group (11.4 %) compared to 34 cases (19.1 %) in the control group (p = 0.04). These complications were associated with significant worse outcomes regarding quality of life, pain, and trismus and caused significantly more missed days of work or study. Female gender, age >26, bone removal, deep impacted third molars, less experienced surgeons, and a high amount of debris at the surgical site were also identified as risk factors for developing inflammatory complications following lower third molar removal.ConclusionIrrigation of the surgical site with drinking tap water using a curved syringe following removal of third molars is effective in reducing the risk of inflammatory complications.Clinical relevanceWater is a very accessible, cost-effective irrigant without side effects and the results from this study have proven that it can be used to reduce the risk of inflammatory complications and associated morbidity following lower third molar removal.

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“…Further investigations with a CBCT can be performed to confirm the three dimensional association of third molar roots to the inferior alveolar canal and surgery can be modified to minimize risk of injury. [15][16][17] Intentional and partial coronectomy can be performed for roots which show radiographic signs most associated with nerve injuries. 18,19 In our clinical experience, if there is presence of radiographic signs that suggest anatomical proximity of inferior alveolar canal with third molar roots, it is always prudent to make sure that the tooth is elevated gently from the socket and root apex visualized, before complete removal from the socket.…”

Section: Radiographic Signs Showing Proximity Of Third Molar Roots Tomentioning

confidence: 99%

Proximity of mandibular third molar roots with inferior alveolar canal: a radiographic study

Singh

Khanal²,

Dhungel³

2020

JCMC

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Background: Mandibular third molar's roots have close proximity to the inferior alveolar canal (IAC) and nerve. Inferior alveolar nerve injuries have been observed to occur more frequently when there is radiographic evidence of close contact of third molar roots to the IAC. Orthopantomogram is one of the commonly used diagnostic tools for evaluating the relationship between these two structures. There is lack of data regarding prevalence of these radiographic signs in Nepalese population. It was required to assess the reliability on the radiographic signs of relationship between the IAC and the third molar roots, to establish IAC as risk indicators for IAC exposure during extraction.Methods: A single centre cross-sectional descriptive study was designed where demographic data and radiographic signs of third molar roots proximity to IAC were obtained from imaging software records and descriptive analysis was performed with SPSS version 20.Results: One or more radiographic signs were observed in 49.6% of mandibular third molars. Interruption of white line followed by narrowing of canal and darkening of roots was observed in decreasing order of frequency and no statistically significant association between sex, age and side of impacted third molar with presence of radiographic signs.Conclusions: Presence of one or more radiographic signs of proximity of mandibular third molar roots with IAC in nearly half of the cases. Clinicians should be aware of risk of nerve injury on presence of these signs. Further investigation with cone beam computed tomography to rule out any nerve injury risk should be adopted into practice.

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Clinical relevance of cone beam computed tomography in mandibular third molar removal: A multicentre, randomised, controlled trial

Cited by 72 publications

References 36 publications

Radiographic signs of pathology determining removal of an impacted mandibular third molar assessed in a panoramic image or CBCT

Radiographic signs of pathology determining removal of an impacted mandibular third molar assessed in a panoramic image or CBCT

Postoperative socket irrigation with drinking tap water reduces the risk of inflammatory complications following surgical removal of third molars: a multicenter randomized trial

Proximity of mandibular third molar roots with inferior alveolar canal: a radiographic study

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