Mandibular canal-related parameters interpreted in panoramic images and CBCT of mandibular third molars as risk factors to predict sensory disturbances of the inferior alveolar nerve

Matzen, Louise Hauge; Petersen, Lars B; Schropp, Lars; Wenzel, Ann

doi:10.1016/j.ijom.2019.03.898

Cited by 26 publications

(31 citation statements)

References 22 publications

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“…One patient (0.9%) reported a permanent sensory deficit (lasted >6 months). 15 The 16.1% (n=20) patients of the OPG group in the current study reported nerve deficit which is a finding quite (n=21). Another study was conducted on a sample comprised of 135 patients (161 impacted teeth), to assess the diagnostic accuracy of cone-beam CT scan in comparison to panoramic radiographs to predict the exposure of neurovascular bundle during surgical removal of lower 3 rd molar (p<0.5 ).…”

Section: Discussionsupporting

confidence: 42%

“…A study was conducted to assess whether cone-beam computed tomography (CBCT) can improve the risk assessment for injury of the inferior alveolar nerve (IAN) compared to panoramic radiography. 15 Total 106 lower 3 rd molars (59 on left-side and 47 right-sided) in 72 females and 34 male patients (mean age 29 years, range 19 56 years) were enrolled & treated in this study. 21 patients (19.8%) reported a neurosensory deficit of the Inferior Alveolar Nerve one week postoperatively.…”

Section: Discussionmentioning

confidence: 99%

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The outcome of postoperative paresthesia of inferior alveolar nerve after surgical removal of mandibular third molar using Orthopantomogram (OPG) versus Cone-beam CT

Sajid¹

2021

J Fatima Jinnah Med Univ

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Background: Periapical and Orthopantomogram (OPG) are the most commonly used radiographs for assessment of the relationship of lower 3rd molar roots with the inferior alveolar canal. Panoramic radiographs provide inadequate information of the buccolingual relationship between the roots of the 3rd molar & mandibular canal being two-dimensional (2D) in nature. To verify the relationship in three (3D) dimensions and to make a predictable treatment plan, traditional investigations may be supplemented by using CBCT. Cone-beam computerized tomography (CBCT) is an office-based radiography technique used to assess the three-dimensional relationship of lower 3rd molar roots with inferior alveolar nerve. Patients and methods: This comparative-cross sectional study was conducted at the Department of Oral and Maxillofacial Surgery, Fatima Memorial Hospital (FMH), Lahore from 1st January 2019 till 30th June 2019. A total of 124 patients requiring removal of lower wisdom tooth were enrolled and then divided into two groups (62 in each) randomly. OPG was used for diagnosis of impacted lower 3rd molars in Group A patients while CBCT for diagnosis in Group B patients. A self-designed Performa was used to collect the data and final information was collected after 3 months of follow-up. Data analysis was performed using SPSS 20. A chi-square test was used to compare the postoperative paraesthesia between the OPG group and CBCT group patients. A p-value <0.05 was taken as significant. Results: The occurrence of postoperative paresthesia between the two groups is significantly different; being a low percentage in the CBCT group at 2nd, 7th day and after 3 months follow-up visits with a p-value of 0.019, 0.019, and 0.005 respectively. On 3 months follow up, the distribution of paraesthesia between the two groups is significantly different; 20 patients (32.25%) in OPG group A and those of 7 (11.29%) in CBCT group B experienced paresthesia with a p-value of 0.005. Conclusion: It is better to use CBCT to improve the postoperative paraesthesia for lower third molar surgical extraction.

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Section: Discussionsupporting

confidence: 42%

Section: Discussionmentioning

confidence: 99%

The outcome of postoperative paresthesia of inferior alveolar nerve after surgical removal of mandibular third molar using Orthopantomogram (OPG) versus Cone-beam CT

Sajid¹

2021

J Fatima Jinnah Med Univ

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“…It can be concluded from several previous studies that radiographic signs observed in CBCT are not more valid as predictors for a sensory disturbance of the IAN compared to signs seen in panoramic radiographs. 9 , [21][22][23] Particularly, the sign "no bony separation between the roots of the third molar and the mandibular canal" seen in CBCT had a low positive predictive value, which was not higher than some of the seven signs for a close relationship between the tooth and the IAN in panoramic radiographs suggested in 1990. 24 We conclude from these findings that the decision to perform a coronectomy may be achieved as well from a panoramic radiograph as from CBCT.…”

Section: Can Cbct Predict the Risk For A Post-operative Sensory Distumentioning

confidence: 88%

Cone beam CT imaging of the mandibular third molar: a position paper prepared by the European Academy of DentoMaxilloFacial Radiology (EADMFR)

Matzen

Berkhout

2019

Dentomaxillofacial Radiology

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Objectives: Lack of evidence on the use of CBCT for management of mandibular third molars in Radiation Protection guideline no. 172 of the European Commission made the European Academy of DentoMaxilloFacial Radiology (EADMFR) decide to update the recommendations of the guideline. Methods and materials: A literature search was performed addressing the following questions: (1) does CBCT change the treatment of the patient?; (2) does CBCT reduce the number of post-operative sensory disturbances of the inferior alveolar nerve?; and (3) can CBCT predict the risk for a post-operative sensory disturbance of the inferior alveolar nerve? Results: Since the European Commission published the guideline in 2012 several high-evidence studies on the use of CBCT before removal of mandibular third molars have been conducted including five randomized controlled clinical trials and one meta-analysis. Present literature allows to propose recommendations with highest level of evidence. Conclusion: New and up-to-date evidence-based recommendations advocate that CBCT imaging of the mandibular third molar should not be applied as a routine method before removal of mandibular third molars and therefore, CBCT imaging should only be applied when the surgeon has a very specific clinical question in an individual patient case that cannot be answered by conventional (panoramic and/or intraoral) imaging.

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“…Results from very recent studies, including panoramic images and CBCT of the same patients, have shown that the positive predictive values of radiographic markers for an intimate relation between the mandibular third molar and the IAN seen in CBCT, were not higher than the values for radiographic markers seen in panoramic images. 23,24 Based on these results, a new guideline from the European Association of DentoMaxilloFacial Radiology concluded that CBCT is not a stronger predictive method than panoramic imaging for risk assessment of sensory disturbances of the IAN. 11 The argument that CBCT is needed to decide on a coronectomy may therefore not be robust, and it could be speculated that the decision to perform a coronectomy may just as well be taken based on a panoramic image (e.g.…”

Section: Discussionmentioning

confidence: 99%

Cone beam CT and treatment decision of mandibular third molars: removal vs. coronectomy—a 3-year audit

Matzen

Villefrance

Nørholt

et al. 2020

Dentomaxillofacial Radiology

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Objectives: To assess: (1) the workflow in the treatment decision process of mandibular third molars based on a panoramic image and CBCT and (2) the impact of radiographic markers in CBCT on the decision to perform coronectomy. Methods: 1437 teeth in 917 patients (mean age 27.8 years, range 18–72) underwent clinical and panoramic examination. If there was an indication for removal of the tooth, and signs of a close relation to the inferior alveolar nerve were present in the panoramic image, a CBCT was performed. Treatment decision based on panoramic image and CBCT was calculated. Statistical analyses were performed to assess whether signs in CBCT had an impact on the treatment decision “coronectomy”. Moreover, the actually operated teeth and post-operative sensory disturbances were assessed and discussed in relation to the radiographic method. Results: Based on the panoramic image, in 462 cases it was decided not to treat, 553 were scheduled for surgery, and 422 referred for a CBCT examination. “No bony separation between the tooth and mandibular canal” seen in CBCT was the main factor influencing the decision to perform a coronectomy (odds ratio = 56.8, p < 0.001). 840 mandibular third molars had undergone surgical intervention, 152 had a coronectomy and 688 were fully removed. Six patients perceived a sensory disturbance of the inferior alveolar nerve: one permanent and five temporary. Conclusion: 29% of the examined cases were referred for a CBCT and of these, the majority were scheduled for coronectomy based on the sign “no bony separation between the tooth and mandibular canal” seen in CBCT.

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Mandibular canal-related parameters interpreted in panoramic images and CBCT of mandibular third molars as risk factors to predict sensory disturbances of the inferior alveolar nerve

Cited by 26 publications

References 22 publications

The outcome of postoperative paresthesia of inferior alveolar nerve after surgical removal of mandibular third molar using Orthopantomogram (OPG) versus Cone-beam CT

The outcome of postoperative paresthesia of inferior alveolar nerve after surgical removal of mandibular third molar using Orthopantomogram (OPG) versus Cone-beam CT

Cone beam CT imaging of the mandibular third molar: a position paper prepared by the European Academy of DentoMaxilloFacial Radiology (EADMFR)

Cone beam CT and treatment decision of mandibular third molars: removal vs. coronectomy—a 3-year audit

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