Diversion of the mandibular canal: Is it the best predictor of inferior alveolar nerve damage during mandibular third molar surgery on panoramic radiographs?

Taşsöker, Melek

doi:10.5624/isd.2019.49.3.213

Cited by 17 publications

(15 citation statements)

References 16 publications

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“…Surgical extraction of an impacted mandibular third molar, either for therapeutic or prophylactic purposes, is a common procedure in oral surgery [ 1 , 2 ]. It is often linked with complications like pain, swelling, bleeding, dry socket, infection, and trismus, which are often temporary in nature [ 3 , 4 ]. The most troublesome complication of all is temporary or permanent damage to the inferior alveolar nerve (IAN) [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is often linked with complications like pain, swelling, bleeding, dry socket, infection, and trismus, which are often temporary in nature [ 3 , 4 ]. The most troublesome complication of all is temporary or permanent damage to the inferior alveolar nerve (IAN) [ 3 ]. The known risk of transient IAN injury after mandibular third molar surgery ranges from 0.6–5.3%, whereas the risk of permanent IAN damage is <1% [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The most troublesome complication of all is temporary or permanent damage to the inferior alveolar nerve (IAN) [ 3 ]. The known risk of transient IAN injury after mandibular third molar surgery ranges from 0.6–5.3%, whereas the risk of permanent IAN damage is <1% [ 3 ]. Not only do such complications force the patients to undergo the ordeal of sensation loss, but the medicolegal implications are also extremely significant [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…A careful pre-operative radiographic examination before surgery is useful in predicting complications [ 2 ]. Commonly employed radiographic techniques for this purpose are periapical radiographs, orthopantomogram (OPG), cone-beam computed tomography (CBCT), DentaScan, and computed tomography (CT) [ 3 ]. OPG is often used for initial examination that aids in assessing the root morphology, angulation of impacted tooth, and type of impaction [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Digital OPG and CBCT in Assessment of Risk Factors Associated with Inferior Nerve Injury during Mandibular Third Molar Surgery

et al. 2021

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Background: Pre-operative radiographic assessment of the anatomical relationship between the roots of the mandibular third molar and the inferior alveolar nerve (IAN) is a must to minimize the risk of IAN injury during surgery. Objectives: To compare the radiographic signs of digital orthopantomogram (OPG) and cone-beam computed tomography (CBCT). An additional objective was to assess the cortex status between the mandibular canal and third molar on CBCT images in relation to the demographic characteristics, region (right or left side), and angulation of mandibular molar. Methodology: In this retrospective study, a total of 350 impacted mandibular third molars with a close relationship between the inferior alveolar canal (IAC) and impacted mandibular third molars on digital OPG were further referred for CBCT imaging for assessment of the position of the mandibular canal. The study was conducted between August 2018 and February 2020. Digital OPGs were evaluated for radiographic signs like interruption of the mandibular canal wall, darkening of the roots, diversion of the mandibular canal, and narrowing of the mandibular canal. The age and sex of patients, site of impacted third molar, Winter’s classification of mandibular third molar, position of IAC relative to impacted molar, and the radiographic markers of OPG were assessed for cortical integrity using CBCT. Chi square testing was applied to study the values of difference and binomial logistic regression was done to assess the factors associated with cortication. Statistical significance was set at p ≤ 0.05. Results: Among 350 patients, 207 (59.1%) were male and 143 (40.9%) were female with a mean age of 36.8 years. The most common OPG sign was interruption of white line, seen in 179 (51.1%) cases. In total, 246 cases (70.3%) showed an absence of canal cortication between the mandibular canal and the impacted third molar on CBCT images. Cortication was observed in all cases with a combination of panoramic signs which was statistically significant (p = 0.047). Cortication was observed in 85 (50.6%) cases where IAC was positioned on the buccal side, 11 (16.9%) in cases of inferiorly positioned IAC, and just 8 (7.6%) for cases of lingually positioned IAC which was statistically significant (p = 0.003). Statistically insignificant (p > 0.05) results were noted for cortex status in CBCT images with regards to the age, sex, site, and angulation of impacted third molars. Conclusion: CBCT imaging is highly recommended for those cases where diversion of the mandibular canal is observed on OPG and when the roots are present between canals.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of Digital OPG and CBCT in Assessment of Risk Factors Associated with Inferior Nerve Injury during Mandibular Third Molar Surgery

et al. 2021

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“…Moreover, Hauge et al [13] reported that CBCT more accurately identified direct contact to the mandibular canal than panoramic radiographs. Specific signs detected on panoramic radiographs can suggest a close inter-relationship and should be considered for further treatment choice [14][15][16][17]. During recent years, the Swedish Radiation Safety Authority [18] has observed an increase in registered CBCT units.…”

Section: Introductionmentioning

confidence: 99%

Radiographic imaging in relation to the mandibular third molar: a survey among oral surgeons in Sweden

et al. 2021

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Objectives To query the experience of oral surgeons concerning referral routines and preferences for radiographic imaging modality before surgical removal of mandibular third molars and investigate factors that influence imaging modality preferences. Materials and methods Members of the Swedish Association of Oral and Maxillofacial Surgeons (n = 280) were invited to participate in a web-based digital survey concerning their experiences and use of three imaging modalities in pre-surgical assessment of mandibular third molar removal. The survey comprised multiple-choice questions and four cases depicted in images; respondents reported whether they would supplement the cases with other images and, if so, from which modality. Results The response rate was 64%. Panoramic radiographs were most commonly used in pre-surgical planning (response options: always or often), significant difference between professions (p = 0.039), and considered to facilitate treatment planning (87%), as was CBCT (82%); for 51%, CBCT reduced post-operative complications. Preferred modality for localizing the mandibular canal was fairly evenly distributed and for non-complex case, significant difference between subgroups of OMFS surgeons was found (p = 0.003) as to preference for intraoral radiographs. Conclusions A majority of respondents received a report within 2 weeks of their referral for CBCT and would read the report and view the images before surgery. Image modality preference differed depending on case complexity, with a greater perceived need for CBCT. Profession and practical experience affected choice. Clinical relevance Choice of imaging modality in mandibular third molar assessment is also important from dose delivery and social economy standpoints.

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Is it possible to filter third molar cases with panoramic radiography in which roots surround the inferior alveolar canal? A comparison using cone-beam computed tomography

Janovics

Soós

Tóth

et al. 2021

Journal of Cranio-Maxillofacial Surgery

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Diversion of the mandibular canal: Is it the best predictor of inferior alveolar nerve damage during mandibular third molar surgery on panoramic radiographs?

Cited by 17 publications

References 16 publications

Comparison of Digital OPG and CBCT in Assessment of Risk Factors Associated with Inferior Nerve Injury during Mandibular Third Molar Surgery

Comparison of Digital OPG and CBCT in Assessment of Risk Factors Associated with Inferior Nerve Injury during Mandibular Third Molar Surgery

Radiographic imaging in relation to the mandibular third molar: a survey among oral surgeons in Sweden

Is it possible to filter third molar cases with panoramic radiography in which roots surround the inferior alveolar canal? A comparison using cone-beam computed tomography

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