Does 3-dimensional imaging of the third molar reduce the risk of experiencing inferior alveolar nerve injury owing to extraction?

Clé-Ovejero, Adrià; Sánchez‐Torres, Alba; Camps‐Font, Octavi; Gay‐Escoda, Cosme; Figueiredo, Rui; Valmaseda‐Castellón, Eduard

doi:10.1016/j.adaj.2017.04.001

Cited by 39 publications

(38 citation statements)

References 30 publications

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“…[7][8][9][10][11] Recently, a meta-analysis including the five RCTs has been published. 12 In the meta-analysis, the RCTs were assessed for risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions, and in general, the RCTs were assessed with low risks of bias although four of the five RCTs were assessed as having high risk of bias in their blinding process which was one out of the seven parameters that were assessed. In total, 1178 third molars had been removed in the studies with a systematic set-up for inclusion and test methods for sensory disturbances.…”

Section: Does Cbct Reduce the Number Of Post-operative Sensory Disturmentioning

confidence: 99%

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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Section: Does Cbct Reduce the Number Of Post-operative Sensory Disturmentioning

confidence: 99%

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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“…During the past decade, several research groups have investigated the use of CBCT before surgical intervention of mandibular third molars. 6,7 Conclusively, studies at all six levels of efficacy are available, which have shown that CBCT does not change the outcome for the patient when compared with PAN. 6,7 On the other hand, studies on the use of CBCT for maxillary third molars are missing.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Conclusively, studies at all six levels of efficacy are available, which have shown that CBCT does not change the outcome for the patient when compared with PAN. 6,7 On the other hand, studies on the use of CBCT for maxillary third molars are missing. Like mandibular third molars, maxillary third molars can be associated with pathology, which often leads to removal of the tooth.…”

Section: Introductionmentioning

confidence: 99%

Marginal bone loss and resorption of second molars related to maxillary third molars in panoramic images compared with CBCT

Hermann

Wenzel

Schropp

et al. 2019

Dentomaxillofacial Radiology

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Objectives: Compare findings among observers in panoramic images (PAN) and cone beam CT (CBCT); and assess findings in PAN as indicators for marginal bone loss and resorption observed in CBCT. Methods: 120 impacted maxillary third molars with PAN and CBCT were included. Four observers assessed morphological features: (1) tooth angulation; (2) number of roots; (3) bony impaction (yes/no) and pathology; (4) marginal bone level at the second molar (normal/>3 mm = bone loss); (5) resorption in the second molar (no/superficial/< half way through the dentin/≥ half way through the dentin/involving the pulp); (6) size of follicular space (normal/> 4 mm(cyst)). Percentage accordance and κ statistics described observer variation in PAN and CBCT. Logistic regression analyses tested findings in PAN as indicators for marginal bone loss or resorption observed in CBCT. Results: κ values were fair and interobserver accordance was marginally higher in CBCT than PAN. Agreement between PAN and CBCT was 81-88% for marginal bone loss and 68-81% for resorption. Severe resorption was more often observed in CBCT. Mesio-angulated third molars and marginal bone loss interpreted in PAN significantly indicated marginal bone loss observed in CBCT (odds ration 17-34; p < 0.012; 8.8-52.8; p < 0.02). In contrast, findings in PAN were not significant indicators for resorption observed in CBCT (p > 0.05). conclusion: In general, there was a fair agreement for marginal bone loss between PAN and CBCT, and PAN could significantly predict bone loss observed in CBCT. However, presence of resorption observed in CBCT could not be determined from PAN, and more severe resorption was observed in CBCT. CBCT is indicated if resorption in the second molar needs to be assessed.

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“…It was found that CBCT was superior to panoramic imaging in predicting neurovascular bundle exposure 10. However, in a recent meta-analysis,6 it was concluded that 3-dimensional imaging neither reduces patients' risk of experiencing IAN injuries nor affects their prognosis. It might only be useful for the diagnosis and surgical plan of LM3s.…”

Section: Discussionmentioning

confidence: 99%

“…Although panoramic radiographs (PRs) are the most widely used method by oral surgeons to determine the risk of IAN injury,1 cone-beam computed tomography (CBCT) provides excellent localization of the IAC and LM3 in 3 dimensions without overlapping, distortion, and magnification,24 with lower radiation exposure than medical CT 5. However, CBCT has higher costs, less availability, and a higher radiation dose than PR 6…”

Section: Introductionmentioning

confidence: 99%

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

Taşsöker

2019

Imaging Sci Dent

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Purpose: The aim of this study was to evaluate the relationship between the mandibular canal and impacted mandibular third molars using cone-beam computed tomography (CBCT) and to compare the CBCT findings with signs on panoramic radiographs (PRs). Materials and Methods: This retrospective study consisted of 200 mandibular third molars from 200 patients who showed a close relationship between the mandibular canal and impacted third molars on PRs and were referred for a CBCT examination of the position of the mandibular canal. The sample consisted of 124 females and 76 males, with ages ranging from 18 to 47 years (mean, 25.75±6.15 years). PRs were evaluated for interruption of the mandibular canal wall, darkening of the roots, diversion of the mandibular canal, and narrowing of the mandibular canal. Correlations between the PR and CBCT findings were statistically analyzed. Results: In total, 146 cases (73%) showed an absence of canal cortication between the mandibular canal and impacted third molar on CBCT images. A statistically significant relationship was found between CBCT and PR findings (P<0.05). The absence of canal cortication on CBCT images was most frequently accompanied by the PR sign of diversion of the mandibular canal (96%) and least frequently by interruption of the mandibular canal wall (65%). Conclusion: CBCT examinations are highly recommended when diversion of the mandibular canal is observed on PR images to reduce the risk of mandibular nerve injury, and this sign appears to be more relevant than other PR signs.

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Does 3-dimensional imaging of the third molar reduce the risk of experiencing inferior alveolar nerve injury owing to extraction?

Cited by 39 publications

References 30 publications

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

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

Marginal bone loss and resorption of second molars related to maxillary third molars in panoramic images compared with CBCT

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

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