Impact of CBCT on treatment decision related to surgical removal of impacted maxillary third molars: does CBCT change the surgical approach?

Abstract

Objectives: To assess factors influencing treatment decision for maxillary third molars referred for cone beam CT (CBCT). Parameters influencing the decision to treat and to remove either the maxillary second molar or third molar were pursued. Methods: 111 impacted maxillary third molars, clinically examined including a panoramic image, in 86 patients (mean age 26 years, range 15–55) were referred for CBCT on suspicion of pathology/root resorption in the second molar, based on information in the panoramic image. The following parameters were assessed from the patient’s file, including the radiographic images: (1) third molar angulation; (2) initial treatment plan based on clinical examination and the panoramic image; (3) diagnoses based on information from CBCT; (4) treatment decision after additional CBCT information was available; (5) pre-/post-operative complications; (6) treatment of the maxillary second molar. Results: 70 cases (63.1%) underwent treatment, while 41 (36.9%) received no treatment. Change in treatment plan was registered in 65 cases (58.6%) after CBCT. In 12 cases (10.8%), treatment changed from removal of the third to removal of the second molar, while 25 (22.5%) were scheduled for removal in the initial treatment plan; but after CBCT, the decision was not to treat. If external root resorption involved the pulp of the second molar, there was an almost 17 times higher risk that this tooth was removed instead of the third molar (logistic regression analysis: odds ratio 16.8; p < 0.001). Conclusions: Findings in CBCT often changed the treatment plan. Severe external root resorption observed in CBCT was the main decisive factor for removing the second instead of the third molar.

Planning of Large Odontogenic Cysts Treatment Using Panoramic and CBCT Images.

“…In previous studies, the authors compared CBCT and OPG on many different aspects such as: surgical technique of maxillary and mandibular third molar, classifying of lower third molar, upper molar root protrusion into maxillary sinus, relation of impacted mandibular third molars to the inferior alveolar nerve, presurgical evaluation of bony implant sites, impacted maxillary canines, and anatomical characteristics and visibility of mental foramen and accessory mental foramen (Ghaeminia et al,2009;Aravindaksha et al, 2015;Lorenzo et al, 2015;Pico et al, ;Araujo et al, 2019;Hermann et al, 2019;Brasil et al, 2019;Themkumkwun et al, 2019;Nirmalendu et al, 2019;Fortes et al, 2019). None of the prior studies compared CBCT and OPG films taken after the marsupialization of odontogenic cysts in terms of evaluating whether the odontogenic cyst volume allows enucleation.…”

“…Nevertheless, Ghaeminia et al (2009) reported that CBCT images before mandibular third molar surgery had a dramatic effect in surgical planning in the direction of tooth removal regarding buccolingual relationship between tooth and mandibular canal. Also, Hermann et al (2019) determined that CBCT images changed the treatment plan regarding external root resorption compared to panoramic images. According to Hermann el al.…”

Guidelines for oral and maxillofacial imaging: COVID-19 considerations

“…47 CBCT of impacted maxillary canines should be evaluated both by multiplanar reconstruction (MPR) and by -curved‖ reconstructions and not just by one. 48 CBCT has now been extensively applied to a wide range of lesions arising within or affecting the jaw bones. 21,49,50 Large field-of-view cone-beam computed tomography CBCT imparts a larger radiation dose to the patient than conventional radiography, including panoramic radiographs.…”

“…Furthermore, CBCT was invaluable in the discernment of the more complicated root pattern of maxillary molars not only for endodontic purposes, 40 but also presurgical planning that contemplates extraction. 48 Observation of severe external root resorption of the maxillary second molar by the impacted third molar often resulted in the removal of the former and retention of the latter. 47 CBCT of impacted maxillary canines should be evaluated both by multiplanar reconstruction (MPR) and by “curved” reconstructions and not just by one.…”

“… 47 CBCT of impacted maxillary canines should be evaluated both by multiplanar reconstruction (MPR) and by “curved” reconstructions and not just by one. 48 CBCT has now been extensively applied to a wide range of lesions arising within or affecting the jaw bones. 21 , 49 , 50…”