Role of CBCT in Prediction of Oro-antral Communication Post Third Molar Extraction: A Retrospective Study

Abstract

Objective Oro-antral communication (OAC) is one of the most frequently encountered complications during third molar extraction. Various radiographic factors, like excessive maxillary sinus pneumatization, long periods of edentulism, periapical lesions, etc., have been considered high-risk factors for OAC. However, a panoramic radiograph has not proven to be accurate in predicting the chances of OAC. Through this retrospective study, we evaluated the efficacy of a CBCT in predicting the incidence of OAC after maxillary third molar extraction. Materials and Methods We conducted a retrospective study in our department, which included the patients who had undergone extraction of a maxillary third molar over five years with the presence of panoramic X-rays and/or CBCT scans prior to extraction. Primary outcomes assessed from the case files were intra-operative complications like OAC, root fracture, tuberosity fracture, pterygoid plate fracture, etc. The incidence of these complications was correlated with the presence or absence of CBCT before extraction. Results Out of 920 extracted maxillary third molar, only 148 teeth (16.1%) had a CBCT record before extraction. The most commonly encountered complication was broken inaccessible root piece/s (4.9%), followed by OAC (3.5%). An inter-group comparison showed that a significantly higher percentage of patients (p < 0.001) with CBCT records had an incidence of OAC (11.5%) as against the group of patients with no CBCT record (1.9%). Conclusion A CBCT scan prior to cases with high-risk factors for OAC can be a valuable tool in accurately predicting the chances of OAC after maxillary third molar extraction.

Evaluation of clinical and radiographic warning signs for prediction of oroantral communication following tooth extractions

“…Jung & Cho reported that, contrary to the appearance of wisdom tooth roots projecting into the sinus on panoramic radiographs, CBCT scans showed that the sinus oor is often located buccally to the roots, mimicking root projection on panoramic images [16]. he risk of OAC during upper wisdom tooth removal has been examined in detail by several studies [17,[19][20][21][22], both panoramic radiographs and CBCTs were evaluated, along with clinical parameters. Iwata et al concluded that the usefulness of CT evaluation as an adjunct to panoramic radiographs in predicting OAC following upper wisdom tooth removal is limited [19].…”

“…However, these studies do not provide clinical guidance. Potential risk factors of OAC were examined most broadly in relation to upper wisdom tooth removal [17,[19][20][21][22] and mostly reported the superiority of CBCT analysis over panoramic radiographs in the prediction. While cone beam computed tomography (CBCT) has been shown to provide valuable insights into these anatomical considerations, panoramic radiographs remain a more commonly selected diagnostic tool due to their lower cost and reduced radiation exposure.…”