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

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.

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Does a preoperative Cone Beam CT reduce complication rates in the surgical removal of complex lower third molars? A retrospective study including 486 cases.

10.21203/rs.3.rs-31630/v2 ◽

2020 ◽

Author(s):

Jan 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.

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

10.21203/rs.3.rs-31630/v1 ◽

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.

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

European Journal of Dentistry ◽

10.1055/s-0040-1721294 ◽

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.

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

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/593 ◽

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

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

European Journal of Dentistry ◽

10.4103/1305-7456.195168 ◽

2016 ◽

Vol 10 (04) ◽

pp. 454-458 ◽

Cited By ~ 3

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.

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

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.03.3425 ◽

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.

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Coronectomy of the wisdom teeth: the dental extraction alternative

Journal of Stomatological Medicine ◽

10.53530/1857-1328.21.59.02 ◽

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.

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Incidence of neurosensory deficits following surgical removal of mandibular third molars: a prospective clinical study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191633 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1546

Author(s):

Thaufiq Ahamed M. I. ◽

Naveen Jayakumar ◽

Neelakandan R. S.

Keyword(s):

Tamil Nadu ◽

Statistical Significance ◽

Maxillofacial Surgery ◽

Inferior Alveolar Nerve ◽

Third Molar ◽

Lingual Nerve ◽

Surgical Removal ◽

Third Molars ◽

Post Surgery ◽

Mandibular Third Molars

Background: The aim of this prospective study was to determine the incidences of inferior alveolar nerve and lingual nerve deficit following surgical removal of impacted mandibular third molars and to evaluate the risk factors responsible for these postoperative neurosensory deficits.Methods: A total of 80 patients who reported to department of oral and maxillofacial surgery, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India requiring surgical removal of impacted mandibular third molar were included in this cross-sectional study. Standard surgical procedure was performed. All patients were reassessed one week post-surgery. Subjectively reported altered sensations were recorded and objective assessments were performed with light touch test, two-point discrimination threshold and pin-pick pain threshold. The collected data was analyzed using the chi square test to find out any clinical relevance.Results: There was no inferior alveolar nerve related neurosensory deficits and 6 (7.5%) resulted in lingual nerve related neurosensory deficits. The incidence of LN deficit for mesioangular, horizontal, distoangular was 1.3%, 3.8% and 2.5% respectively. Type of impaction assumed a mild statistical significance (p = 0.050).Conclusions: This study highlights the importance of careful preoperative clinical and radiographic assessment of patients where third molar surgery is planned. The surgical technique of third molar removal is also likely to have great impact on the outcome.

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Evaluating the presence of IAN injury in patients with juxta-apical radiolucency after third molar surgery: a retrospective cohort study

BMC Oral Health ◽

10.1186/s12903-021-01785-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mahvash Hasani ◽

Nasim Razavi ◽

Abdolaziz Haghnegahdar ◽

Motahhareh Zarifi

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Significant Relationship ◽

Third Molar ◽

Mandibular Canal ◽

Cone Beam ◽

Cortical Plate ◽

Third Molar Surgery ◽

Surgical Removal ◽

Third Molars

Abstract Background Juxta-apical radiolucency (JAR) has been presented as a radiographic sign, suggestive of the IAN injury through third molar surgery. This study aimed to evaluate the relation of JAR with IAN injury in cone-beam computed tomography (CBCT) images and to determine whether the presence of JAR is related to tooth angulation, proximity to the mandibular canal, position to the IAN, and thinning of the cortical plates. Methods Of an initial sample of 545 mandibular third molars, a total of 75 JAR+ and 75 JAR− teeth were evaluated by CBCT. We assessed the relationship between the presence of JAR in cone-beam computed tomography (CBCT) images and the presence of IAN injury after mandibular third molar surgeries. Moreover, we investigated whether the presence of IAN injury is related to tooth angulation, proximity to the mandibular canal, position to the IAN, and thinning of the cortical plates. Descriptive statistics, Chi-square test, and Fisher’s exact test were performed for statistical analysis. Results A significant relationship was found between JAR and temporary IAN injury (P = 0.036). However, there was no case of permanent IAN injury. IAN injury showed no significant relationship with the tooth angulation, position to IAN and proximity to the mandibular canal, lingual cortical plate thinning, sex, and age. Conclusions JAR is generally in contact with the mandibular canal, and some degree of cortical thinning can be found in most cases. In this study, JAR was significantly related to temporary IAN injury. JAR may increase the risk of nerve injury during the surgical removal of third molars.

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Radiographic Assessment of Impacted Mandibular Third Molar- An Ex-vivo study

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i51b33514 ◽

2021 ◽

pp. 67-77

Author(s):

Ujwala B. Kale ◽

Anita D. Munde ◽

Sunil S. Mishra ◽

J. Farooqui Anjum Ara ◽

Pooja B. Nayak ◽

...

Keyword(s):

Ex Vivo ◽

Preoperative Evaluation ◽

Inferior Alveolar Nerve ◽

Third Molar ◽

Radiographic Evaluation ◽

Surgical Removal ◽

Third Molars ◽

Impacted Teeth ◽

Group I ◽

Mandibular Third Molars

Background: Mandibular third molars are the most commonly impacted teeth and frequently associated with various pathologies including infection, traumatic, inflammatory and cystic lesions necessitating their surgical removal. To avoid complications, clinical and radiographic evaluation of impacted teeth is essential to provide information about tooth anatomy, position and condition of the surrounding bone. Aim: To evaluate impacted mandibular third molars (IMTM) with the help of panoramic radiographs for the type of impaction, available third molar space, level of eruption, and relation to the inferior alveolar nerve (IAN). Materials and Methods: Total 600 patients were selected and were divided into three groups; group I (18-27 years), group II (28-37 years), and group III (>38 years). Digital OPG were traced and evaluated for angulations, third molar space, level of eruption, and relation of third molar roots to IAN canal. The observations were subjected to statistical analysis using Chi-square test. Results: Out of 600 samples, 306 (51%) were males and 294 (49%) were females. Out of 1079 third molar sites, mesioangular impaction (40.22%) was the most common. Class II relation (84.24%) for third molar space and level A of eruption (45.69%) were most frequent. In true relation, interruption of the white line of the IAN canal (20.85%) was the most frequent relation of the IMTM roots to the IAN canal and others (false/no relation) was the most common in all relations. Conclusion: Panoramic radiography is a relatively safe, reliable, inexpensive, and readily accessible technique for preoperative evaluation of IMTM and their relation to IAN canal.

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