Identifying the Polo^® mint mandibular third molar: a case series

Abstract

Aim: Perforation of mandibular third molars (MTMs) by the inferior dental nerve (IDN) is an uncommon finding. Such cases are thought to carry the highest risk for IDN injury (IDNI) due the entrapment of the nerve within the tooth. This case series aims to highlight the lack of consistency through varying radiographic signs, a perforated MTM may present on 2D imaging. Methods: In this series, 22 cases of perforated MTMs were identified prospectively by cone beam CT. The plain film radiographic images for these cases were retrospectively analysed to determine if any of the 2D radiographic features could help to identify a perforated MTM. Results: In 86% (19/22) of the cases at least three IDNI 'at risk' radiographic signs were present, 91% (20/22) of the cases superimposition of the IDN canal was seen and in 86% (19/22) of the cases banding of the root was evident. Deviation and narrowing of the canal was only identified in 59% (13/22) of the cases. Conclusion: In this study no single or repeated multiple 2D 'at risk' sign was predictive of perforation of the tooth by the IDN. Most cases show multiple 'at risk' signs but there remains no consistency even within these signs. Clinical relevanceScientific rationale for study Inferior dental nerve injury remains the most important complication associated with mandibular third molars (MTM). Surgical intervention requires assessment via 2D imaging. This study highlights perforated MTM, which carry the highest risk of nerve injury, and their varying radiographic appearances on basic imaging. Principal findingsPerforated third molars present with a mixture of radiographic presentation and there appears to be no exclusive sign or signs that can help identify such cases. Practical implicationsCone beam CT has been shown to be superior for anatomy and therefore would remain the only imaging technique that can identify perforated MTM predictably. Such imaging should be considered in these 'high-risk' cases for surgical planning when it provides a clinical advantage.Oral Surgery 12 (2019) 89--95.

Assessment of Panoramic Radiographic Variables as Predictors of Inferior Alveolar Nerve Injury During Third Molar Extraction

“…They found that upward diversion was significantly associated with IAN entrapment; however, the downward diversion was insignificant. Similarly, Pippi [27] and Chopra et al [28] in their respective studies, suggested the upward deviation of the mandibular canal to be highly predictive of IAN injury.…”

Precisión diagnóstica de la tomografía volumétrica de haz de cono en terceros molares impactados en relación con el canal mandibular. Revisión de la literatura

“…Otros estudios revelan que la desviación hacia arriba del CM era bastante predictiva de IANE (Pippi, 2010). Chopra et al sin embargo, concluyó que independientemente de los signos que presente, es imposible detectar estos casos de manera confiable con base en imágenes radiográficas bidimensionales (Chopra, 2019). Si se presentan estos signos, es necesario solicitar una Research, Society and Development, v. 11, n. 8, e55011831276, 2022 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v11i8.31276 9 CBCT.…”