Radiographic methods used before removal of mandibular third molars among randomly selected general dental clinics

Abstract

Objectives: To assess radiographic methods and diagnostically sufficient images used before removal of mandibular third molars among randomly selected general dental clinics. Furthermore, to assess factors predisposing for an additional radiographic examination. Methods: 2 observers visited 18 randomly selected clinics in Denmark and studied patient files, including radiographs of patients who had their mandibular third molar(s) removed. The radiographic unit and type of receptor were registered. A diagnostically sufficient image was defined as the whole tooth and mandibular canal were displayed in the radiograph (yes/no). Overprojection between the tooth and mandibular canal (yes/no) and patient-reported inferior alveolar nerve sensory disturbances (yes/no) were recorded. Regression analyses tested if overprojection between the third molar and the mandibular canal and an insufficient intraoral image predisposed for additional radiographic examination(s). Results: 1500 mandibular third molars had been removed; 1090 had intraoral, 468 had panoramic and 67 had CBCT examination. 1000 teeth were removed after an intraoral examination alone, 433 after panoramic examination and 67 after CBCT examination. 90 teeth had an additional examination after intraoral. Overprojection between the tooth and mandibular canal was a significant factor (p , 0.001, odds ratio 5 3.56) for an additional examination. 63.7% of the intraoral images were sufficient and 36.3% were insufficient, with no significant difference between images performed with phosphor plates and solid-state sensors (p 5 0.6). An insufficient image predisposed for an additional examination (p 5 0.008, odds ratio 5 1.8) but was only performed in 11% of the cases. Conclusions: Most mandibular third molars were removed based on an intraoral examination although 36.3% were insufficient. Dentomaxillofacial Radiology (2016Radiology ( ) 45, 20150226. doi: 10.1259 Cite this article as: Matzen LH, Petersen LB, Wenzel A. Radiographic methods used before removal of mandibular third molars among randomly selected general dental clinics. Dentomaxillofac Radiol 2016; 45: 20150226.

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

“…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.…”

“…Intraoral imaging is an alternative, but it has been shown that in around 25-36% of the cases, the full third molar and adjacent anatomical structures are not imaged by this method. 5,6 The debate on when to perform CBCT prior to surgical removal of mandibular third molars continues. Recently, is has been shown in a prospective clinical study that CBCT changed the treatment of the patients only in a minority of cases.…”

Economic and health implications of routine CBCT examination before surgical removal of the mandibular third molar in the Danish population

“…From the patient's point of view, the total price for surgical removal of a mandibular third molar in DK most probably will double if CBCT imaging becomes the routine. 6,22 The consequences for the treatment accept by the mostly young patients are not predictable. Some patients would maybe avoid proper treatment owing to the increase in costs.…”

Teeth Impaction and Structural Teeth Anomalies

“…12 After 2007, many researchers analyzed the role of CBCT in revealing the position of the third mandibular molars in relation to anatomical landmarks while others focused on the economical and health implications of the use of CBCT. [13][14][15] In 2015, Maglione et al described a CBCT classification of mandibular impacted third molars, to present the correlation between anatomical variations and clinical practice and help surgeons choose the correct surgical technique. This classification follows the different aspects of the position of the mandibular canal reported to the roots of the impacted tooth, highlighting the difficulty in cases when the mandibular canal runs between the roots touching them or when it runs between fused roots.…”

“…1). 15,17 Impacted Maxillary Third Molars Using CBCT for treatment planning of impacted maxillary third molars has been analyzed in different studies, but the latest retrospective study conducted by a team of experienced oral and maxillofacial radiologists concluded that a CBCT examination is indicated when external root resorption of the second molar is suspected on panoramic radiography. Hermann et al reported that CBCT findings regarding the second maxillary molar's severe root resorption (►Fig.…”