Does the addition of cone-beam CT to panoral imaging reduce inferior dental nerve injuries resulting from third molar surgery? A systematic review

Abstract

Objective This systematic review aims to examine whether cone-beam CT (CBCT) assessment influences the incidence of nerve injury following high-risk mandibular third molar (MTM) surgery. Study Design Randomised controlled trials comparing two and three-dimensional imaging for assessing high-risk MTMs were included. MEDLINE, EMBASE, CENTRAL and the Dentistry and Oral Science Source (DOSS) were systematically searched along with extensive grey literature searches, hand searching of web sites, and detailed citation searching up to 3 September 2022. Risk of bias was assessed against the Cochrane Risk of Bias Tool (RoB 2.0). Certainty of the evidence was assessed using GRADE. Results Two authors independently screened 402 abstracts prior to full text screening of 27 articles, which culminated in seven RCTs for inclusion. Two studies were assessed as high risk of bias overall. The other five raised some concerns largely due to unblinded patients and lack of prior trial registration. Just one study reported significantly less nerve injuries following CBCT. The remaining six articles found no significant difference. Conclusion The seven RCTs included in this systematic review offered moderate quality evidence that CBCT does not routinely translate to reduced incidence of nerve injury in MTM removal. A single study provided low quality evidence for a consequent change in the surgical approach. Low quality evidence from 3 studies suggested CBCT does not influence the duration of third molar surgery.

Evaluating the Reliability of Opg Indicators and Correlating Surgical Outcomes With CBCT Findings in Cases of Tooth-Canal Proximity- A Prospective Study"

“…The information gleaned from such assessments plays a pivotal role in treatment planning, aiding oral and maxillofacial surgeons in making informed decisions regarding the approach to extraction procedures (6). It allows for the identification of potential risk factors, guiding clinicians in determining the optimal technique, such as odontectomy methods, and the need for additional precautions to minimize the likelihood of nerve injuries (7).…”

Radiographic imaging in relation to the mandibular third molar: tooth characteristics, modality choice, optimization, and absorbed dose

“…Several studies, however, have found that pre-surgical use of CBCT in cases of surgical removal of the M3 has little to no effect on decision making and, at best, only marginally modifies treatment strategy (Araujo et al, 2019;Aravindaksha et al, 2015;Baqain et al, 2020;. Occasionally, post-operative complications such as permanent sensory disturbances are just as frequent when CBCT is used pre-surgically, compared with panoramic imaging (Clé-Ovejero et al, 2017;Ghaeminia et al, 2015;Klatt et al, 2021;Korkmaz et al, 2017;Robbins et al, 2022).…”

“…A large body of literature, however, has found that postoperative complications -including sensory disturbances -do not decrease when CBCT is used compared to panoramic imaging. Surgery time, number of analgesics, and resources used post-surgically are other items that do not decrease with CBCT usage (Clé-Ovejero et al, 2017;Klatt et al, 2021;Robbins et al, 2022). Thus, clinicians should carefully evaluate the necessity of a supplemental CBCT scan.…”