Preoperative imaging procedures for lower wisdom teeth removal

Abstract

The aims of this paper were to critically review the role of radiographic imaging before lower third molar removal and to suggest a strategy for preoperative imaging based on available scientific evidence and clinical experience. Original articles and reviews including the MESH terms "third molar" and "radiography" were selected from the Medline database. Other sources were taken from references of selected papers. It was found that the scientific evidence on the usefulness of different preoperative imaging techniques of wisdom teeth is low. Therefore, information gathered from the literature was combined with the authors' clinical experience to suggest a strategy for preoperative imaging of lower third molars. Currently available radiological techniques used for preoperative imaging of lower third molars are also presented. It is suggested that panoramic and/or intraoral radiographs are sufficient as preoperative imaging in the vast majority of cases where there is no overlap between the mandibular canal and the wisdom tooth. Supplement with a posteroanterior open mouth projection will solve most of the remaining cases. In a restricted number of cases where there is an intimate relationship between the mandibular canal and the wisdom tooth, volume tomography such as cone beam computed tomography or low-dose computed tomography is indicated.

Influence of cone beam CT on treatment plan before surgical intervention of mandibular third molars and impact of radiographic factors on deciding on coronectomyvssurgical removal

“…8,10,33 If this modality is not available, an alternative may be a posteroanterior open mouth projection, which is frequently used in other departments. 18 Even with the use of stereopsis it may not always be easy to determine the relation between the molar and the mandibular canal in stereo-scanograms. CBCT imaging is a relatively new modality that has the advantage of displaying the bucco-oral aspect of the relation between the molar and the canal, and several studies have assessed the use of CBCT before surgical removal of mandibular third molars and found CBCT to be superior to panoramic images to display the relation between the molar and the mandibular canal.…”

“…[15][16][17][18][19] It was recently reported in a pilot study that the surgical technique was changed (removal of bone, elevator placement, tooth sectioning) when CBCT was available compared with only panoramic images before surgical removal of mandibular third molars. 20 No studies, however, have examined the impact of CBCT on treatment planning before surgical intervention of mandibular third molars.…”

Case Report. Practical Advantages of CBCT in the Surgical Treatment of Impacted Lower Third Molar

“…[18] CT examination should be used only for patients in whom panoramic radiography shows one or more of the radiographic signs indicating an intimate relationship between the mandibular canal and the third molar root, but this relationship cannot be defined sufficiently using conventional radiology. [12,15,19,20] Thereby, it may substantially contribute on the planning of the surgical approach and on the evaluation of consequences and results. [16] CBCT gives undistorted three-dimensional images with a very good resolution that allows visualization of anatomical structures shape and their real size.…”

Evaluation of the Relationship between Mandibular Third Molar and Mandibular Canal by Different Algorithms of Cone-beam Computed Tomography

“…3 A preoperative evaluation of the exact location of the IAN and the roots of the mandibular third molar would help avoiding sensory deficiencies. 4 For surgical extraction of Impacted Teeth, a true radiographic examination is needed to determine the adjacent anatomical structures. The proximity of the tooth to a cortex (buccal or lingual) will determine the procedure the surgeon will take.…”