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CC BY-NC-ND 4.0 · Eur J Dent 2016; 10(04): 454-458
DOI: 10.4103/1305-7456.195168
Original Article
Dental Investigation Society

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

Roberto Pippi
1   Department of Odontostomatological and Maxillo Facial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy
,
Marcello Santoro
1   Department of Odontostomatological and Maxillo Facial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy
,
Ferdinando D'Ambrosio
2   Department of Sensory Organs, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
› Author Affiliations
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Publication History

Publication Date:
24 September 2019 (online)

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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.

Key words:

Cortical interruption - nerve impression - tooth root
 

  • REFERENCES

  • 1 Leung YY, Cheung LK. Risk factors of neurosensory deficits in lower third molar surgery: An literature review of prospective studies. Int J Oral Maxillofac Surg 2011; 40: 1-10
    CrossrefPubMedSearch in Google Scholar
  • 2 Jhamb A, Dolas RS, Pandilwar PK, Mohanty S. Comparative efficacy of spiral computed tomography and orthopantomography in preoperative detection of relation of inferior alveolar neurovascular bundle to the impacted mandibular third molar. J Oral Maxillofac Surg 2009; 67: 58-66
    PubMedSearch in Google Scholar
  • 3 Szalma J, Lempel E, Jeges S, Szabó G, Olasz L. The prognostic value of panoramic radiography of inferior alveolar nerve damage after mandibular third molar removal: Retrospective study of 400 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 294-302
    CrossrefPubMedSearch in Google Scholar
  • 4 Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. Inferior alveolar nerve damage after lower third molar surgical extraction: A prospective study of 1117 surgical extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 92: 377-83
    CrossrefPubMedSearch in Google Scholar
  • 5 Blaeser BF, August MA, Donoff RB, Kaban LB, Dodson TB. Panoramic radiographic risk factors for inferior alveolar nerve injury after third molar extraction. J Oral Maxillofac Surg 2003; 61: 417-21
    CrossrefPubMedSearch in Google Scholar
  • 6 Sedaghatfar M, August MA, Dodson TB. Panoramic radiographic findings as predictors of inferior alveolar nerve exposure following third molar extraction. J Oral Maxillofac Surg 2005; 63: 3-7
    PubMedSearch in Google Scholar
  • 7 Gomes AC, Vasconcelos BC, Silva ED, Caldas Jr. AdeF, Pita NetoIC. Sensitivity and specificity of pantomography to predict inferior alveolar nerve damage during extraction of impacted lower third molars. J Oral Maxillofac Surg 2008; 66: 256-9
    CrossrefPubMedSearch in Google Scholar
  • 8 Atieh MA. Diagnostic accuracy of panoramic radiography in determining relationship between inferior alveolar nerve and mandibular third molar. J Oral Maxillofac Surg 2010; 68: 74-82
    CrossrefPubMedSearch in Google Scholar
  • 9 Rood JP, Shehab BA. The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg 1990; 28: 20-5
    CrossrefPubMedSearch in Google Scholar
  • 10 Guidelines on CBCT for Dental and Maxillofacial Radiology. SEDENTEXCT Project. Available from: http://www.sedentexct.eu/files/radiation_protection_172.pdf [Last accessed on 2016 May]
  • 11 Matzen LH, Wenzel A. Efficacy of CBCT for assessment of impacted mandibular third molars: A review – Based on a hierarchical model of evidence. Dentomaxillofac Radiol 2015; 44: 20140189
    CrossrefPubMedSearch in Google Scholar
  • 12 Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Vlijmen OJ. et al. The use of cone beam CT for the removal of wisdom teeth changes the surgical approach compared with panoramic radiography: A pilot study. Int J Oral Maxillofac Surg 2011; 40: 834-9
    CrossrefPubMedSearch in Google Scholar
  • 13 Maegawa H, Sano K, Kitagawa Y, Ogasawara T, Miyauchi K, Sekine J. et al. Preoperative assessment of the relationship between the mandibular third molar and the mandibular canal by axial computed tomography with coronal and sagittal reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96: 639-46
    CrossrefPubMedSearch in Google Scholar
  • 14 Ohman A, Kivijärvi K, Blombäck U, Flygare L. Pre-operative radiographic evaluation of lower third molars with computed tomography. Dentomaxillofac Radiol 2006; 35: 30-5
    CrossrefPubMedSearch in Google Scholar
  • 15 Suomalainen A, Ventä I, Mattila M, Turtola L, Vehmas T, Peltola JS. Reliability of CBCT and other radiographic methods in preoperative evaluation of lower third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 276-84
    CrossrefPubMedSearch in Google Scholar
  • 16 Park JB, Kim N, Park S, Ko Y. Evaluation of number of roots and root anatomy of permanent mandibular third molars in a Korean population, using cone-beam computed tomography. Eur J Dent 2013; 7: 296-301
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 1990 Recommendations of the International Commission on Radiological Protection. Ann ICRP 1991; 21: 1-201
    CrossrefPubMedSearch in Google Scholar
  • 18 Susarla SM, Sidhu HK, Avery LL, Dodson TB. Does computed tomographic assessment of inferior alveolar canal cortical integrity predict nerve exposure during third molar surgery?. J Oral Maxillofac Surg 2010; 68: 1296-303
    CrossrefPubMedSearch in Google Scholar
  • 19 Ueda M, Nakamori K, Shiratori K, Igarashi T, Sasaki T, Anbo N. et al. Clinical significance of computed tomographic assessment and anatomic features of the inferior alveolar canal as risk factors for injury of the inferior alveolar nerve at third molar surgery. J Oral Maxillofac Surg 2012; 70: 514-20
    CrossrefPubMedSearch in Google Scholar
  • 20 Nakamori K, Tomihara K, Noguchi M. Clinical significance of computed tomography assessment for third molar surgery. World J Radiol 2014; 6: 417-23
    CrossrefPubMedSearch in Google Scholar
  • 21 Park W, Choi JW, Kim JY, Kim BC, Kim HJ, Lee SH. Cortical integrity of the inferior alveolar canal as a predictor of paresthesia after third-molar extraction. J Am Dent Assoc 2010; 141: 271-8
    CrossrefPubMedSearch in Google Scholar
  • 22 Nakayama K, Nonoyama M, Takaki Y, Kagawa T, Yuasa K, Izumi K. et al. Assessment of the relationship between impacted mandibular third molars and inferior alveolar nerve with dental 3-dimensional computed tomography. J Oral Maxillofac Surg 2009; 67: 2587-91
    CrossrefPubMedSearch in Google Scholar
  • 23 Guerrero ME, Botetano R, Beltran J, Horner K, Jacobs R. Can preoperative imaging help to predict postoperative outcome after wisdom tooth removal?. A randomized controlled trial using panoramic radiography versus cone-beam CT. Clin Oral Investig 2014; 18: 335-42
    CrossrefPubMedSearch in Google Scholar
  • 24 Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Bergé SJ. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg 2009; 38: 964-71
    CrossrefPubMedSearch in Google Scholar