Evaluation of Panoramic X-Ray Versus Cone Beam Computerized Tomography in Surgical Removal of Horizontally Impacted Mandibular Third Molars

Abstract

INTRODUCTION: Computerized scanning technology has been in use for 30 years. Originally, it was called Computerized Axial Tomography or CAT. Today, with advances in miniaturization and computer software and a revolution in imaging, CAT scan technology has been moved from the hospital to the private dental office in the form of Cone Beam Computerized Tomography (CBCT), which will be an alternative radiographic study over the standard panoramic images. OBJECTIVES: This study evaluated the advantage of CBCT over panoramic X-ray in surgical removal of horizontally impacted mandibular third molars. MATERIALS AND METHODS: This study was conducted on twenty patients selected from the Outpatient Clinic of the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, diagnosed by horizontally impacted mandibular third molar class II position B. All patients were diagnosed clinically and radiographically. Patients were divided randomly in two groups, 10 patients were diagnosed preoperatively by CBCT film (study group) and the other 10 patients were diagnosed by panoramic radiographic film (control group). Intraoperative and postoperative evaluation was carried out to monitor postoperative pain, inferior alveolar nerve paresthesia, trismus and postoperative edema at 3 rd , 7 th and 15 th day. RESULTS: Patients in the study group experienced statistically significant less pain and less postoperative edema than those in the control group (p=0.05, and p=0.048 respectively). There was no statistically significant difference between the two groups regarding the trismus and no patients in both groups suffered of alveolar nerve paresthesia. Less postoperative pain was diagnosed in the study group than in the control group. No inferior alveolar nerve paresthesia was found in the two groups. There was no significant difference between the two groups regarding the trismus. Less postoperative edema was found in the study group than in the control group. CONCLUSIONS: CBCT showed higher specificity to the inferior alveolar nerve localization as compared to panoramic x-ray. Hence, it is recommended that CBCT imaging is to be considered included in the diagnostic work-up prior to surgical removal of deeply impacted third molars.

Radiographic assessment of impacted mandibular third molars

“…Unfortunately, conventional x-rays, periapical and panoramic radiographs to exemplify, can simply offer restrained anatomical data and facts in relation to approximation of IAN to the 3rd molars, including and their association to the IAN canals. 8,11 A comparison of the computed tomographic scan and panoramic radiography before mandibular third molar extraction surgery was done by Luo et al 12 They aptly demonstrated that preoperative panoramic radiography, Computed Tomography (CT) scan, age, and the expertise of the health care provider can influence commonly expected postoperative sequelae after extraction of a mandibular 3rd molar. Panoramic radiography by itself is not sufficient to predict hypoesthesia of lips and/or chin.…”

“…It gives a much-decreased dose of radiation to the patient, has a low cost as compared to conventional CT, gives a higher quantity reconstruction and high-precision bone details. 5,8 With CBCT, the impacted 3 r d molar may be visible in numerous views (coronal, sagittal, axial or horizontal), which is obviously lacking in the panoramic view. This makes it feasible to attain the correct vicinity of the impacted 3 r d molar, and its relation to the adjoining IAN.…”

“…CBCT makes it feasible to outline the form of impaction, the follicle size, the axial inclination of the 3 r d molar, the relative buccal and palatal positions, the quality and quantity of bone encompassing the enamel and its approximation and relation to adjoining 2 nd molar and anatomical systems. 8,11,14 The use of CBCT gives a detailed information of the anatomic association of 3rd molar roots and the inferior alveolar canal (IAC). However, only skilled and experienced surgeons coping with impacted 3rd molars with proof of proximity to the IAC on OPG may be able to determine the best remedy modality without CBCT.…”

“…These diverse problems can result in malpractice issues for oral surgeons. [6][7][8] To lessen these complications, pre-operative radiographic exam is crucial to assess the orientation of impaction, deflection of the root, vicinity of the canal, courting of the canal to the roots, and thickness of the cortical plates. 8…”

Cone Beam Computer Tomography and Histological Evaluation of Dental Follicle of Impacted Lower Third Molar Germs in Teens: A Histo-Radiographic Correlation Study in a Case Series

“…Indeed, the DF is considered normal when its maximum width is lower than 2.5 mm [3][4][5][6][7][8][9][11][12][13][14]22,23]. At present, it is increasingly common to have a pre-surgical evaluation using tridimensional radiographic exams (e.g., cone beam computer tomography, CBCT) [22,[24][25][26][27][28][29][30][31][32][33][34]. Because of the low dosage of X-rays associated with this method, it represents the foremost technique administered in pediatric patients [35,36].…”