scholarly journals Evaluation of Panoramic Radiographs in Relation to the Mandibular Third Molar and to Incidental Findings in an Adult Population

2020 ◽  
Author(s):  
Josefine Cederhag ◽  
Nina Lundegren ◽  
Per Alstergren ◽  
Xie-Qi Shi ◽  
Kristina Hellén-Halme
Keyword(s):  
Incidental Findings ◽  
Adult Population ◽  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Patient Positioning ◽  
Vertical Position ◽  
Surgical Removal ◽  
Third Molars ◽  
Panoramic Radiographs ◽  
The Third

Abstract Objectives The aim was to evaluate the characteristics of the mandibular third molars, especially in relation to the inferior alveolar nerve. Further aims were to investigate incidental findings in panoramic radiographs in an adult population, and to investigate image quality related to patient positioning. Materials and Methods From a previous study with 451 randomly selected adult participants who lived in Sweden, 442 panoramic radiographs from four dental public health clinics were used. The third molars’ characteristics and relation to inferior alveolar nerve were evaluated. Incidental findings and patient positioning were recorded. Statistical Analysis Frequency analysis was used to investigate the occurrence of all findings and their possible interconnections. Whether the patients’ age or gender had an impact or not was also analyzed. Results The third molars were erupted in vertical position among 73% regardless of age. When retained or semi-retained, they were most commonly in mesioangular positions. The inferior alveolar nerve was located inferior to the roots in 52%, whereas an overlapped position was most common if the third molar was retained (90%), semi-retained (83%) or the age was less than 30 years (66%). Common incidental findings were apical radiolucencies, idiopathic osteosclerosis, and tooth fragments. Suboptimal patient positioning was found in one-third of the radiographs. Conclusions Panoramic radiography is a useful method to evaluate third molar prior to surgical removal and may be the only image required. Most incidental findings on panoramic radiographs does not seem to require any further odontological management.

scholarly journals Predicting the Risk of Inferior Alveolar Nerve Injury in Impacted Lower Third Molars Using Panoramic Radiography and Cone Beam Computed Tomography

2021 ◽  
Vol 10 (34) ◽  
pp. 2910-2914
Author(s):  
Abhishek Verma ◽  
Stuti Verma ◽  
Anushikha Dhankhar ◽  
Nitin Kumar Moral ◽  
Nidhi Nagar ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Nerve Injury ◽  
Cone Beam Computed Tomography ◽  
Panoramic Radiography ◽  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Cone Beam ◽  
Third Molars ◽  
Panoramic Radiographs ◽  
Inferior Alveolar Nerve Injury

BACKGROUND A serious complication of surgical removal of impacted lower third molars is inferior alveolar nerve (IAN) injury. Evaluation of radiographic factors to predict IAN injury using CT and panoramic radiography includes root morphology assessment, follicular sac size, mandibular bone density, inferior alveolar nerve and vessels, condition of the overlying tissues, relation of the impacted tooth with the body and ramus of the mandible and the adjacent teeth. This study was done to evaluate the radiological features of the impacted lower mandibular teeth and their relationship with IAN through panoramic radiography and CT and to assess the most predictable radiological criteria for inferior alveolar nerve injury in impacted third molar surgery. METHODS All the patients indicated for lower third molar extraction were included in the study and pre-operative conventional panoramic radiographs (Planmeca Proline PM 2002 CC, Helsinki, Finland) and CBCT (Kodak CBCT) were taken. Any post-operative nerve injuries detected were followed up after 15 days or 1 month. Fisher’s exact test was done to find the association between the outcome variable and explanatory variables. RESULTS Only 11.4 % (N = 4) of all participants had IAN injury following surgical disimpaction. All the participants with IAN injury showed narrowing of the canal on their preoperative panoramic radiographs and presence of nerve approximation with the tooth in cone beam computed tomography (CBCT) reports (P < 0.05). CONCLUSIONS A statistically significant association exists between IAN injury and nerve exposure, radiographic signs of nerve involvement for panoramic radiograph, level of third molar impaction, and nerve approximation in CBCT. KEY WORDS Inferior Alveolar Nerve Injury, Lower Third Molar Impaction, Panoramic Radiography, CBCT

scholarly journals Accuracy of cone-beam computed tomography in defining spatial relationships between third molar roots and inferior alveolar nerve

2016 ◽  
Vol 10 (04) ◽  
pp. 454-458 ◽  
Author(s):  
Roberto Pippi ◽  
Marcello Santoro ◽  
Ferdinando D'Ambrosio
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Root Morphology ◽  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Root Surface ◽  
Cone Beam ◽  
Spatial Relationships ◽  
Third Molars ◽  
The Third

ABSTRACT Objective: Cone-beam computed tomography (CBCT) has been proposed in surgical planning of lower third molar extraction. The aim of the present study was to assess the reliability of CBCT in defining third molar root morphology and its spatial relationships with the inferior alveolar nerve (IAN). Materials and Methods: Intraoperative and radiographic variables of 74 lower third molars were retrospectively analyzed. Intraoperative variables included IAN exposure, number of roots, root morphology of extracted third molars, and presence/absence of IAN impression on the root surface. Radiographic variables included presence/absence of the cortex separating IAN from the third molar roots on CBCT examination, number of roots and root morphology on both orthopantomography (OPG) and CBCT. The statistical association between variables was evaluated using the Fisher's exact test. Results: In all cases of intraoperative IAN exposure, the cortex appeared discontinuous on CBCT images. All cases, in which the cortical bone was continuous on CBCT images, showed no association with nerve exposure. In all cases in which nerve impression was identified on the root surface, the IAN cortex showed interruptions on CBCT images. No nerve impression was identified in any of the cases, in which the cortex appeared continuous on CBCT images. CBCT also highlighted accessory roots and apical anomalies/curvatures, not visible on the OPG. Conclusions: CBCT seems to provide reliable and accurate information about the third molar root morphology and its relationship with the IAN.

scholarly journals Does a Preoperative Cone Beam Ct Reduce Complication Rates in the Surgical Removal of Complex Lower Third Molars? A Retrospective Study Including 486 Cases

2020 ◽  
Author(s):  
Jan Klatt ◽  
Tony Sorowka ◽  
Lan Kluwe ◽  
Ralf Smeets ◽  
Martin Gosau ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Three Dimensional ◽  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Cone Beam ◽  
Surgical Removal ◽  
Radiographic Imaging ◽  
Third Molars ◽  
Nerve Bundle ◽  
Neurological Damage

Abstract BackroundThis study was designed to analyse the value of preoperative Cone Beam CTs prior to the surgical removal of complex lower third molars. Furthermore, the aim was to assess injuries to the inferior alveolar nerve bundle and postoperative neurological disorders depending on the position of the lower third molar and theinferior alveolar nerve bundle.MethodsPreoperative Cone Beam CTs and Orthopantomographs of 324 patients were analysed concerning the location of the lower third molars in relation to the mandible and the inferior alveolar nerve bundle. Surgery protocols of all patients who underwent the surgical removal of at least one complex lower third molar were analysed concerning patient data, length of surgery, intraoperative haemorrhage, intraoperative exposure of the inferior alveolar nerve bundle, postoperative swelling and postoperative neurological disorders. The data was then compared to data from international studies.ResultsIn all 324 patients a permanent neurological damage was not found. Temporary neurological damage was recorded in 13 cases (2.6%). A caudal nerve position with no measurable distance to the root of the lower third molar was associated with the highest risk of a temporal neurological damage. A vestibular touching nerve route also correlated with postoperative sensitivity impairment.ConclusionsThree-dimensional radiographic imaging,in our patient group, does not significantly affect the risk for complications during the surgical removal of complex lower third molars,but allows the surgeon to choose the best surgical approch for a fast and most atraumatic operation. Therefore, it should only be utilized for risk assessment, especially in cases of symptom-free lower third molars. A preoperative orthopantomogram still can be accepted as standard for radiographic imaging. The interpretation of the orthopantomogram may lead to the indication for three-dimensional imaging, if signs of increased surgery risk are present.

scholarly journals Does a preoperative cone beam CT reduce complication rates in the surgical removal of complex lower third molars? A retrospective study including 486 cases

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Jan C. Klatt ◽  
Tony Sorowka ◽  
Lan Kluwe ◽  
Ralf Smeets ◽  
Martin Gosau ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Cone Beam ◽  
Surgical Removal ◽  
Complication Rates ◽  
Radiographic Imaging ◽  
Third Molars ◽  
Nerve Bundle ◽  
Neurological Damage

Abstract Backround This study was designed to analyse the value of preoperative Cone Beam CTs (CBCT) prior to the surgical removal of complex lower third molars. Furthermore, the aim was to assess injuries to the inferior alveolar nerve (IAN) bundle and postoperative neurological disorders depending on the position of the lower third molar and the inferior alveolar nerve bundle. Methods In this retrospective examination preoperative Cone Beam CTs and Orthopantomographs (OPT) of 324 patients were analysed concerning the location of the lower third molars in relation to the mandible and the inferior alveolar nerve bundle. Surgery protocols of all patients who underwent the surgical removal of at least one complex lower third molar were analysed concerning patient data, length of surgery, intraoperative haemorrhage, intraoperative exposure of the inferior alveolar nerve bundle, postoperative swelling and postoperative neurological disorders. The data was then compared to data from international studies. Results In all 324 patients a permanent neurological damage was not found. Temporary neurological damage was recorded in 13 cases (2.6%). A caudal nerve position with no measurable distance to the root of the lower third molar was associated with the highest risk of a temporal neurological damage. A vestibular touching nerve route also correlated with postoperative sensitivity impairment. If a mesioangulation (Winter) or a Pell and Gregory Type IIIC appears in the OPT, risk of neurological damage is at its highest. Conclusions Three-dimensional radiographic imaging, in our patient group, does not significantly affect the risk for complications during the surgical removal of complex lower third molars. Therefore, it should only be utilized for risk assessment, especially in cases of symptom-free lower third molars. A preoperative orthopantomogram still can be accepted as standard for radiographic imaging. An intraoperative exposure of the IAN bundle does not necessarily predict simultaneous neurological damage. Exposure of the IAN bundle is no indication for a discontinuation of the surgery.

scholarly journals Artificial Intelligence (AI)-Driven Molar Angulation Measurements to Predict Third Molar Eruption on Panoramic Radiographs

2020 ◽  
Vol 17 (10) ◽  
pp. 3716 ◽  
Author(s):  
Myrthel Vranckx ◽  
Adriaan Van Gerven ◽  
Holger Willems ◽  
Arne Vandemeulebroucke ◽  
André Ferreira Leite ◽  
...  
Keyword(s):  
Neural Network ◽  
Artificial Intelligence ◽  
Third Molar ◽  
Automated Measurement ◽  
Third Molars ◽  
Panoramic Radiographs ◽  
The Third ◽  
Clinically Significant ◽  
Reference Measurements ◽  
Third Molar Eruption

The purpose of the presented Artificial Intelligence (AI)-tool was to automatically segment the mandibular molars on panoramic radiographs and extract the molar orientations in order to predict the third molars’ eruption potential. In total, 838 panoramic radiographs were used for training (n = 588) and validation (n = 250) of the network. A fully convolutional neural network with ResNet-101 backbone jointly predicted the molar segmentation maps and an estimate of the orientation lines, which was then iteratively refined by regression on the mesial and distal sides of the segmentation contours. Accuracy was quantified as the fraction of correct angulations (with predefined error intervals) compared to human reference measurements. Performance differences between the network and reference measurements were visually assessed using Bland−Altman plots. The quantitative analysis for automatic molar segmentation resulted in mean IoUs approximating 90%. Mean Hausdorff distances were lowest for first and second molars. The network angulation measurements reached accuracies of 79.7% [−2.5°; 2.5°] and 98.1% [−5°; 5°], combined with a clinically significant reduction in user-time of >53%. In conclusion, this study validated a new and unique AI-driven tool for fast, accurate, and consistent automated measurement of molar angulations on panoramic radiographs. Complementing the dental practitioner with accurate AI-tools will facilitate and optimize dental care and synergistically lead to ever-increasing diagnostic accuracies.

scholarly journals O USO DA TERAPIA LASER DE BAIXA INTENSIDADE APÓS EXODONTIA DE TERCEIROS MOLARES: REVISÃO DE LITERATURA

2013 ◽  
Vol 4 (1) ◽  
Author(s):  
Amanda Affonsêca Pedreira ◽  
Maíra Sá ◽  
Alena Peixoto Medrado
Keyword(s):  
Laser Therapy ◽  
Soft Tissues ◽  
Third Molar ◽  
Bone Destruction ◽  
Low Level Laser Therapy ◽  
Surgical Removal ◽  
Postoperative Phase ◽  
Third Molars ◽  
Accelerate Wound Healing ◽  
The Third

Dental extraction is a procedure involving bones and soft tissues trauma. The intervention severity, dental units location, tissue consistency and  the degree of bone destruction are variables that influences the presence or absence of postoperative deleterious effects, particularly regarding the third molar extraction.  The low-level-laser therapy (LLLT) has been used clinically to accelerate wound healing and pain control. However, while laser therapy is now indicated after extraction of third molars, its use has been rarely prescribed. This article aims to perform a literature review on the use of laser therapy during the third molars surgical removal postoperative phase.

scholarly journals Inferior alveolar nerve injury assessment after surgical removal of mandibular third molar.

2020 ◽  
Vol 27 (03) ◽  
pp. 530-534
Author(s):  
Abdul Wahid Bhangwar ◽  
Muhammad Irfan Khan ◽  
Hira Fatima ◽  
Salman Shams
Keyword(s):  
Nerve Injury ◽  
Local Anesthesia ◽  
Maxillofacial Surgery ◽  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Surgical Removal ◽  
Third Molars ◽  
Mandibular Third Molar ◽  
Mandibular Third Molars ◽  
Inferior Alveolar Nerve Injury

To assess the nerve injury (inferior alveolar nerve) after surgical removal of mandibular third molars under local anesthesia. Study Design: Observational study. Setting: Oral & Maxillofacial Surgery Department LUMHS Jamshoro/Hyderabad. Period: From 11th November 2015 to 10th May 2016. Material & Methods: This study consisted of one hundred patients. Inclusion criteria’s were patients with impacted mandibular third molar, patient’s age from 18 to 45years and irrespective of gender. Exclusion criteria were patients younger than 18yrs of age of above 45 years, patients having neurological disorders, medically compromised patients, patients receiving radiotherapy or chemotherapy, patients with known allergy to local anesthesia, patients having pathology due to mandibular third molars, patients radiographicaly root is very near to inferior dental canal. Results: Out of 100 patients incorporated in this research 66 were male (66%) and 34 female (34%). The mean age was 29+3.20 years. Common indication of extraction were recurrent pericoronitis  52(52%) cases followed by deep caries/ pulpitis in 28(28%)  cases, orthodontic reason in 11(11%) cases and caries to adjacent tooth in 9(9%) cases. Third molar impaction according to winter’s classification were Mesioangular in 54(54%) cases followed by Horizontal in 26(26%) cases and Vertical in 11(11%). Radiographic showed Narrowing of root in 21% cases and narrowing of inferior dental (ID) canal 20% cases, followed by diversion of ID canal in 16 % cases, deflection of root 14 % cases and darkening of root in 11% cases. After surgical removal of mandibular third molar, the inferior alveolar nerve injury was observed in 6(6%) cases. Conclusion: We conclude that inferior alveolar nerve paresthesia occurs in 6% after surgical removal of mandibular third molars.

scholarly journals Prevalence of third molar impaction in patient with mandibular anterior teeth crowding

2016 ◽  
Vol 28 (3) ◽  
Author(s):  
Tan Chun Wei ◽  
Eky Setiawan Soeria Soemantri ◽  
Iwa Rahmat Sunaryo
Keyword(s):  
Third Molar ◽  
Horizontal Position ◽  
Third Molars ◽  
Probability Sampling ◽  
Panoramic Radiographs ◽  
Descriptive Research ◽  
The Third ◽  
Anterior Teeth ◽  
Controversial Topic ◽  
Sample Range

Introduction: Third molar impaction has been a controversial topic among clinician when it comes to mandibular anterior teeth crowding. The aim is to know the prevalence of third molar impaction in patient with mandibular anterior teeth crowding in Orthodontic Department, RSGM UNPAD, Indonesia. Methods: This was a descriptive research, with non-probability sampling obtained from a population with full arch 32 teeth. Totaling 54 samples from year 2011 to 2014 were obtained. The age of sample range from 15 to 25 years old. Also all panoramic radiographs taken from the year 2011 to 2014 were examined using a computer. The position of third molars were determined by Winter’s classification using angle formed between the intersected longitudinal axes of the second and third molars and anterior teeth status by using Little’s irregularities index. Results: This study obtained data that as much as 68.52% mesioangular third molar, 19.44% distoangular, 4.63% horizontal, 1.85% buccolingual and 0% others. In mesioangular impaction condition there was crowding 83.78%, in distoangular condition there was 100% crowding, in horizontal position crowding found 100%, while at buccolingual crowding found 100%.Conclusion: In all positions the third molar impaction was accompanied by crowding of the mandible anterior teeth, with the largest percentage of impaction was the mesioangular position

scholarly journals Coronectomy of the wisdom teeth: the dental extraction alternative

2021 ◽  
Vol 3 (59) ◽  
pp. 12-17
Author(s):  
Sergiu Beliniuc ◽  
◽  
Gabriela Motelica ◽  
Keyword(s):  
Inferior Alveolar Nerve ◽  
Third Molar ◽  
Mandibular Canal ◽  
Surgical Removal ◽  
Third Molars ◽  
Close Proximity ◽  
Wisdom Teeth ◽  
Low Incidence ◽  
Upper Third ◽  
Surgical Separation

Background. Coronectomy of the wisdom teeth is an alternative surgical procedure to tooth extraction, which aims to preserve the roots of the wisdom teeth in the dental socket after surgical separation of the crown, in order to avoid the injury of the inferior alveolar vascular-nervous bundle. Purpose. Minimizing the damage to the inferior alveolar nerve when extracting lower third molars caused by the intimate relationship between the nerve and the roots of the teeth, by using the technique of coronectomy, or intentional root retention. Material and Methods. Patients who reported to University Dental clinic during the period 2020–2021 for surgical removal of impacted L3M were screened for nerve–root relationship with OPG or CBCT. 15 patients underwent coronectomy as a procedure to remove the crown and upper third of the roots of a lower third molar to reduce the risk of damage to the inferior alveolar nerve. Results. 15 patients were enrolled in this study, with a total of 17 lower third molars. Sixteen sites healed primarily, but in 1 case the sockets on both sides opened and failed to close secondarily. In this case, the root fragments were later removed and found to be mobile. Conclusion. Coronectomies are safer to perform than complete extractions in situations in which the third molar is in close proximity to the mandibular canal. The technique appears to be associated with a low incidence of complications and the removal of remaining roots is required in around 6-7% of cases due to the mesial migration of the fragment and not any symptoms or reinfection.

Age estimation from developing third molars

2021 ◽  
pp. 002581722110529
Author(s):  
Yvonne Padmini Wilson ◽  
Phrabhakaran Nambiar ◽  
Hashim Yaacob ◽  
Muhammad Khan Asif
Keyword(s):  
Root Development ◽  
Age Estimation ◽  
Third Molar ◽  
Growth Patterns ◽  
Third Molars ◽  
Panoramic Radiographs ◽  
The Third ◽  
The Subject ◽  
Congenitally Missing ◽  
Demirjian’S Method

We investigated the development of third molars among Malaysians (including variations between jaws and genders) using Demirjian’s method. Dental panoramic radiographs of 1224 subjects aged 8 to 24 years were examined, and the molars were assigned Demirjian et al.’s development grades (A–H). Results indicated that 18.8% had congenitally missing or extracted third molars. Development of molars begins earlier in females (also in the mandible), but by age 9, male children's molar development speeds up with more advanced grades in their middle teens than females. Grade C indicates the subject is a juvenile, while initiation of root development (Grade E), was observed from 13 years on. Grade H can occur in a child aged 18 years who technically is still a juvenile. We compared the development and growth patterns of the third molar from both the maxilla and the mandible.

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