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Ruiz-Roca J, Rodríguez-Molinero J, Javaloyes-Vicente P, Pereira-Lopes O, Gay-Escoda C. Use of CBCT and panoramic radiography in the prediction of alterations in sensivity of the inferior alveolar nerve in third molars: A retrospective cross-sectional study. Saudi Dent J 2024; 36:1105-1110. [PMID: 39176156 PMCID: PMC11337963 DOI: 10.1016/j.sdentj.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 05/31/2024] [Accepted: 06/02/2024] [Indexed: 08/24/2024] Open
Abstract
Objectives We investigated which type of orthopantomography (OPG) was best able to predict neurological alterations of the inferior alveolar nerve (IAN) during extraction of a lower third molar (3 M). Methods We analysed cone beam computed tomographies (CBCTs) that were performed at a private dental clinic in Cartagena, Spain over five consecutive years. The CBCTs, together with their corresponding OPGs, had been prescribed for the surgical extraction of a lower 3 M. Results We analysed a total of 342 CBCTs and their corresponding OPGs. After explaining the risk of changes in the IAN sensitivity, 37 patients refused to undergo surgical extraction. The incidence of sensitivity alterations in the 332 dental extractions was 62 (19%): 44 were paraesthesias of the IAN, and 18 were associated with darkening of the root and interruption of the cortical line. Conclusion When an OPG revealed darkening of the root and interruption of the cortical line, the risk of contact between the lower 3 M and the IAN-that is, the probability of changes in IAN sensitivity-increased by over three-fold.
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Affiliation(s)
- J.A. Ruiz-Roca
- Faculty of Dentistry, Department of Dermatology, Stomatology and Radiology, University of Murcia, Spain
| | - J.A. Rodríguez-Molinero
- Faculty of Health Sciences, Department of Nursery and Stomatology, IDIBO Research Group, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - P. Javaloyes-Vicente
- Faculty of Dentistry, Department of Dermatology, Stomatology and Radiology, University of Murcia, Spain
| | - O. Pereira-Lopes
- Faculty of Health Sciences, Department of Oral Medicine and Oral Surgery, University Fernando Pessoa, Oporto, Portugal
| | - C. Gay-Escoda
- Chairman and Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Barcelona, Spain
- Coordinator/Researcher at the IDIBELL (Bellvitge Biomedical Research Institute), Barcelona, Spain
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Huang H, Yan Y, Jiang D, Zhao X, Cao D, She D. Is 3T MR nerve-bone fusion imaging a viable alternative to MRI-CBCT to identify the relationship between the inferior alveolar nerve and mandibular third molar. Clin Oral Investig 2024; 28:256. [PMID: 38630324 DOI: 10.1007/s00784-024-05649-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES To investigate the feasibility of MRI nerve-bone fusion imaging in assessing the relationship between inferior alveolar nerve (IAN) / mandibular canal (MC) and mandibular third molar (MTM) compared with MRI-CBCT fusion. MATERIALS AND METHODS The MRI nerve-bone fusion and MRI-CBCT fusion imaging were performed in 20 subjects with 37 MTMs. The Hausdorff distance (HD) value and dice similarity coefficient (DSC) was calculated. The relationship between IAN/MC and MTM roots, inflammatory, and fusion patterns were compared between these two fused images. The reliability was assessed using a weighted κ statistic. RESULTS The mean HD and DSC ranged from 0.62 ~ 1.35 and 0.83 ~ 0.88 for MRI nerve-bone fusion, 0.98 ~ 1.50 and 0.76 ~ 0.83 for MRI-CBCT fusion. MR nerve-bone fusion had considerable reproducibility compared to MRI-CBCT fusion in relation classification (MR nerve-bone fusion κ = 0.694, MRI-CBCT fusion κ = 0.644), direct contact (MR nerve-bone fusion κ = 0.729, MRI-CBCT fusion κ = 0.720), and moderate to good agreement for inflammation detection (MR nerve-bone fusion κ = 0.603, MRI-CBCT fusion κ = 0.532, average). The MR nerve-bone fusion imaging showed a lower ratio of larger pattern compared to MR-CBCT fusion (16.2% VS 27.3% in the molar region, and 2.7% VS 5.4% in the retromolar region). And the average time spent on MR nerve-bone fusion and MRI-CBCT fusion was 1 min and 3 min, respectively. CONCLUSIONS Both MR nerve-bone fusion and MRI-CBCT fusion exhibited good consistency in evaluating the spatial relationship between IAN/MC and MTM, fusion effect, and inflammation detection. CLINICAL RELEVANCE MR nerve-bone fusion imaging can be a preoperative one-stop radiation-free examination for patients at high risk for MTM surgery.
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Affiliation(s)
- Hao Huang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China
| | - Yalan Yan
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China
| | - Dongmei Jiang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China
| | - Xiance Zhao
- Philips Healthcare, Shanghai, 200000, People's Republic of China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China.
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China.
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People's Republic of China.
- Department of Radiology, Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People's Republic of China.
| | - Dejun She
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China.
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China.
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People's Republic of China.
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Matzen LH, Petersen LB, Schropp L, Hermann L, Wenzel A. Risk factors observed in 2-dimensional radiographs for permanent injury of the inferior alveolar nerve after removal of mandibular third molars: a case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:490-499. [PMID: 37357068 DOI: 10.1016/j.oooo.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To assess whether differences exist in signs observed in 2D radiographs of mandibular third molars between a case group of patients with and a control group without permanent sensory disturbance of the inferior alveolar nerve (IAN) after removal. STUDY DESIGN Three observers blinded to patient status assessed radiographs from the case group (n=162) and the control group (n=172). Two new signs, craniocaudal relation of the roots and the mandibular canal and position of the canal over the roots; and 4 "classic" signs, interruption of the white borders of the canal, darkening of the roots, narrowing of the canal lumen, and diversion of the canal over the roots were registered. Chi-square tests assessed differences in distribution of radiographic signs between the groups. Odds ratios expressed the association between radiographic signs and permanent sensory disturbance. Inter- and intraobserver reliability values were calculated. RESULTS We found significantly more teeth with roots positioned inferiorly to the canal borders (P<0.001; OR 4.1-5.3) and with the canal superimposed over the upper or middle third of the roots (P<0.001; OR 2.6-3.9) in the case group than in the control group. Inter- and intraobserver reproducibility was excellent for roots inferior to the canal borders and fair to good for canal superimposition. CONCLUSIONS Two radiographic signs are valid predictors of permanent sensory disturbance of the IAN in 2D radiographs.
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Affiliation(s)
- Louise Hauge Matzen
- Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Denmark.
| | | | - Lars Schropp
- Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Denmark
| | - Louise Hermann
- Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Denmark
| | - Ann Wenzel
- Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Denmark
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Gurusamy K, Duhan J, Tewari S, Sangwan P, Gupta A, Mittal S, Kumar V, Arora M. Patient-centric outcome assessment of endodontic microsurgery using periapical radiography versus cone beam computed tomography: A randomized clinical trial. Int Endod J 2023; 56:3-16. [PMID: 36135595 DOI: 10.1111/iej.13837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 12/13/2022]
Abstract
AIM This study aimed to evaluate whether utilizing additional cone beam computed tomography (CBCT) imaging has any effect on quality of life and healing outcome following periapical surgery compared with periapical radiographs (PR). METHODOLOGY The study was registered in ClinicalTrials.gov (NCT04333940). In this parallel group randomized controlled trial, 52 patients (88 teeth) with persistent apical periodontitis and periapical radiographic evidence of periapical lesion were randomly assigned to either PR or CBCT group. The primary predictor was the type of the imaging method (PR only or with additional CBCT). The primary outcome was patient's quality of life during the first week after periapical surgery and the secondary outcomes were duration of surgery and healing outcome at 12-month follow-up. Participants of both groups received periapical surgery based on the pre-surgical plan provided by the radiographic imaging methods. Quality of life (QoL) was assessed using Modified Shugars questionnaire. Radiographic analysis for healing was conducted using Molven's criteria and modified PENN 3D criteria. The categorical data between groups were analysed using the Chi-square test, whilst intragroup comparisons were analysed using the McNemar test. The average scores for each component of QoL (oral functions, general functions, pain, swelling and other symptoms), combined QoL scores (overall average of values of 13 variables) and analgesic usage on each day were calculated and analysed. RESULTS At 12 months of follow-up, fifty patients were evaluated. Participants in PR group reported significantly more swelling on first three days compared with CBCT group. The analgesic use was higher in the PR group on 2nd and 3rd day (Mann-Whitney U test with Bonferroni correction; p < .007). A significant difference in the limitation of general functions was observed at the second day (p < .07) with the higher values in the PR group. The combined QoL score between the two groups was found to be non-significant. However, none of the patients experienced intraoperative complications or neurovascular exposure. The mean surgical time was lesser in the CBCT group (p < .05). Radiographic healing revealed a success rate of 96.2% for the PR group and 95.8% for the CBCT group with no significant difference between the groups. CONCLUSION Participants in the CBCT group experienced substantially less early postoperative swelling and limitation in general functions, in comparison with the PR group. However, preoperative CBCT had no effect on other QoL parameters and intraoperative complications in medium-risk patients. Furthermore, CBCT did not exhibit any added advantage over periapical radiography in terms of assessing healing outcome following endodontic microsurgery. CBCT offered surgically relevant anatomic information for pre-surgical planning and ensured the treatment rendition with a significantly reduced operative time.
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Affiliation(s)
- Keerthana Gurusamy
- Department of Conservative Dentistry & Endodontics, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - Jigyasa Duhan
- Department of Conservative Dentistry & Endodontics, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - Sanjay Tewari
- Department of Conservative Dentistry & Endodontics, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - Pankaj Sangwan
- Department of Conservative Dentistry & Endodontics, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - Ambika Gupta
- Department of Oral Medicine & Radiology, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - Shweta Mittal
- Department of Conservative Dentistry & Endodontics, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - Vinay Kumar
- Department of Conservative Dentistry & Endodontics, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
| | - Mayank Arora
- Department of Conservative Dentistry & Endodontics, Postgraduate Institute of Dental Sciences (PGIDS), Rohtak, India
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Robbins J, Smalley KR, Ray P, Ali K. Does the addition of cone-beam CT to panoral imaging reduce inferior dental nerve injuries resulting from third molar surgery? A systematic review. BMC Oral Health 2022; 22:466. [PMCID: PMC9635162 DOI: 10.1186/s12903-022-02490-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Objective This systematic review aims to examine whether cone-beam CT (CBCT) assessment influences the incidence of nerve injury following high-risk mandibular third molar (MTM) surgery. Study Design Randomised controlled trials comparing two and three-dimensional imaging for assessing high-risk MTMs were included. MEDLINE, EMBASE, CENTRAL and the Dentistry and Oral Science Source (DOSS) were systematically searched along with extensive grey literature searches, hand searching of web sites, and detailed citation searching up to 3 September 2022. Risk of bias was assessed against the Cochrane Risk of Bias Tool (RoB 2.0). Certainty of the evidence was assessed using GRADE. Results Two authors independently screened 402 abstracts prior to full text screening of 27 articles, which culminated in seven RCTs for inclusion. Two studies were assessed as high risk of bias overall. The other five raised some concerns largely due to unblinded patients and lack of prior trial registration. Just one study reported significantly less nerve injuries following CBCT. The remaining six articles found no significant difference. Conclusion The seven RCTs included in this systematic review offered moderate quality evidence that CBCT does not routinely translate to reduced incidence of nerve injury in MTM removal. A single study provided low quality evidence for a consequent change in the surgical approach. Low quality evidence from 3 studies suggested CBCT does not influence the duration of third molar surgery.
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Affiliation(s)
- James Robbins
- grid.416116.50000 0004 0391 2873Specialty Doctor Oral and Maxillofacial Surgery, Royal Cornwall Hospital Treliske, TR1 3LJ Truro, UK
| | - Katelyn Rene Smalley
- grid.11201.330000 0001 2219 0747Plymouth University, Drake Circus, PL4 8AA Plymouth, UK
| | - Pamela Ray
- grid.11201.330000 0001 2219 0747Plymouth University, Drake Circus, PL4 8AA Plymouth, UK
| | - Kamran Ali
- grid.412603.20000 0004 0634 1084QU Health, College of Dental Medicine, Qatar University, 141 F H-12 Annex Building, 2713 Doha, Qatar
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A Fused Deep Learning Architecture for the Detection of the Relationship between the Mandibular Third Molar and the Mandibular Canal. Diagnostics (Basel) 2022; 12:diagnostics12082018. [PMID: 36010368 PMCID: PMC9407570 DOI: 10.3390/diagnostics12082018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 12/01/2022] Open
Abstract
The study aimed to generate a fused deep learning algorithm that detects and classifies the relationship between the mandibular third molar and mandibular canal on orthopantomographs. Radiographs (n = 1880) were randomly selected from the hospital archive. Two dentomaxillofacial radiologists annotated the data via MATLAB and classified them into four groups according to the overlap of the root of the mandibular third molar and mandibular canal. Each radiograph was segmented using a U-Net-like architecture. The segmented images were classified by AlexNet. Accuracy, the weighted intersection over union score, the dice coefficient, specificity, sensitivity, and area under curve metrics were used to quantify the performance of the models. Also, three dental practitioners were asked to classify the same test data, their success rate was assessed using the Intraclass Correlation Coefficient. The segmentation network achieved a global accuracy of 0.99 and a weighted intersection over union score of 0.98, average dice score overall images was 0.91. The classification network achieved an accuracy of 0.80, per class sensitivity of 0.74, 0.83, 0.86, 0.67, per class specificity of 0.92, 0.95, 0.88, 0.96 and AUC score of 0.85. The most successful dental practitioner achieved a success rate of 0.79. The fused segmentation and classification networks produced encouraging results. The final model achieved almost the same classification performance as dental practitioners. Better diagnostic accuracy of the combined artificial intelligence tools may help to improve the prediction of the risk factors, especially for recognizing such anatomical variations.
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Wanzeler AMV, Silveira HLDD, Buligon RP, Corsetti A, Vieira HT, Arús NA, Vizzotto MB. Can CBCT change the level of confidence of oral maxillofacial surgeons in mandibular third molar management? Braz Oral Res 2022; 36:e078. [PMID: 35703704 DOI: 10.1590/1807-3107bor-2022.vol36.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/03/2021] [Indexed: 11/21/2022] Open
Abstract
This study analyzed the impact of CBCT on the level of confidence in diagnostic and treatment thinking in mandibular lower molar (M3M) clinical management. Thirty cases for which panoramic radiographs and CBTC images were available were selected and classified according to radiologic signs indicating the proximity of the M3M to the mandibular canal (interruption of the radiopaque borders of the canal of the mandibular canal wall, darkening of the roots, and diversion or narrowing of the canal, n = 10 for each classification). Twelve oral and maxillofacial surgeons (OMS) contributed to this study by answering two questionnaires. The first questionnaire contained a clinical description of the case and a panoramic radiograph. After 30 days, a second questionnaire with the same clinical illustrations and tomographic multiplanar reconstruction images was administered. Both questionnaires asked specialists to rate diagnostic confidence, the surgical complexity, chosen treatment, and surgical confidence. In approximately 40% of answers, CBCT images had a positive impact on ratings of diagnostic confidence and treatment thinking confidence, and in 24.4%, they increased the surgical complexity score. There was no change in the treatment plan following the use of CBCT, but the CBCT examination was a determining factor for diagnosis and treatment planning in 72.8% of the answers CBCT improved the confidence level in diagnostic and treatment thinking of the M3M management while also increasing the perceived level of surgical complexity. The findings of this study support the need to consider using CBCT in diagnosis and treatment planning for M3Ms with radiographic signs such as darkening of the roots, interruption of the radiopaque borders of the mandibular canal, or deviation of the mandibular canal and narrowing of the roots.
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Affiliation(s)
| | | | - Rodrigo Pagliarini Buligon
- Universidade Federal do Rio Grande do Sul - UFRS, Surgery and Orthopedics Department , Porto Alegre , RS , Brazil
| | - Adriana Corsetti
- Universidade Federal do Rio Grande do Sul - UFRS, Surgery and Orthopedics Department , Porto Alegre , RS , Brazil
| | | | - Nádia Assein Arús
- Universidade Federal do Rio Grande do Sul - UFRS, Surgery and Orthopedics Department , Porto Alegre , RS , Brazil
| | - Mariana Boessio Vizzotto
- Universidade Federal do Rio Grande do Sul - UFRS, Surgery and Orthopedics Department , Porto Alegre , RS , Brazil
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Radiographic imaging in relation to the mandibular third molar: a survey among oral surgeons in Sweden. Clin Oral Investig 2021; 26:2073-2083. [PMID: 34596771 PMCID: PMC8816342 DOI: 10.1007/s00784-021-04189-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/17/2021] [Indexed: 11/14/2022]
Abstract
Objectives To query the experience of oral surgeons concerning referral routines and preferences for radiographic imaging modality before surgical removal of mandibular third molars and investigate factors that influence imaging modality preferences. Materials and methods Members of the Swedish Association of Oral and Maxillofacial Surgeons (n = 280) were invited to participate in a web-based digital survey concerning their experiences and use of three imaging modalities in pre-surgical assessment of mandibular third molar removal. The survey comprised multiple-choice questions and four cases depicted in images; respondents reported whether they would supplement the cases with other images and, if so, from which modality. Results The response rate was 64%. Panoramic radiographs were most commonly used in pre-surgical planning (response options: always or often), significant difference between professions (p = 0.039), and considered to facilitate treatment planning (87%), as was CBCT (82%); for 51%, CBCT reduced post-operative complications. Preferred modality for localizing the mandibular canal was fairly evenly distributed and for non-complex case, significant difference between subgroups of OMFS surgeons was found (p = 0.003) as to preference for intraoral radiographs. Conclusions A majority of respondents received a report within 2 weeks of their referral for CBCT and would read the report and view the images before surgery. Image modality preference differed depending on case complexity, with a greater perceived need for CBCT. Profession and practical experience affected choice. Clinical relevance Choice of imaging modality in mandibular third molar assessment is also important from dose delivery and social economy standpoints. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04189-9.
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Tofangchiha M, Koushaei S, Mortazavi M, Souri Z, Alizadeh A, Patini R. Positive Predictive Value of Panoramic Radiography for Assessment of the Relationship of Impacted Mandibular Third Molars with the Mandibular Canal Based on Cone-Beam Computed Tomography: A Cross-Sectional Study. Diagnostics (Basel) 2021; 11:diagnostics11091578. [PMID: 34573920 PMCID: PMC8465178 DOI: 10.3390/diagnostics11091578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 11/21/2022] Open
Abstract
The aim of the present study was to assess the positive predictive value (PPV) of panoramic radiographic signs in the assessment of the relationship between impacted mandibular third molars (IMTMs) and the mandibular canal (MC). This cross-sectional study was conducted by reviewing 102 cone-beam computed tomography (CBCT) and panoramic radiographs of patients with IMTMs and radiographic signs of the contact of the IMTMs with the MC on panoramic radiographs (i.e., root apex darkening and interference with the white line). A positive relationship of the IMTM roots with the MC based on CBCT findings was recorded as the gold standard. The PPV of panoramic radiographic signs was calculated for the detection of the relationship of the IMTM root with the MC. The IMTMs were in contact with the MC on CBCT scans in 90.1% of the cases. The PPV of root apex darkening and the interference with the white line was found to be 89.09% (95% CI: (77.75, 95.88)) and 91.48% (95% CI: (79.62, 97.63)), respectively. The MC had a buccal position in 63.7%, and a lingual position in 35.2%, of the cases. The contact of IMTMs with the MC was more commonly seen in patients with a lingual position (100% of the samples). The IMTM root apex darkening and interference with the white line of the MC on panoramic radiographs had a high PPV for determination of the contact of IMTMs with the MC. Thus, presence of the above-mentioned risk factors indicates the need for subsequent 3D radiographic assessments.
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Affiliation(s)
- Maryam Tofangchiha
- Department of Oral and Maxillofacial Radiology, Dental Caries Prevention Research Center, Qazvin University of Medical Sciences, Qazvin 34199-15315, Iran;
| | - Soheil Koushaei
- Department of Oral and Maxillofacial Surgery, Dental Faculty, Qazvin University of Medical Sciences, Qazvin 34199-15315, Iran;
| | - Maryam Mortazavi
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin 34199-15315, Iran; (M.M.); (Z.S.)
| | - Zahra Souri
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin 34199-15315, Iran; (M.M.); (Z.S.)
| | - Ahad Alizadeh
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin 34199-15315, Iran
- Correspondence:
| | - Romeo Patini
- Department of Head, Neck and Sense Organs, School of Dentistry, Catholic University of Sacred Heart, 00135 Rome, Italy;
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Klatt JC, Sorowka T, Kluwe L, Smeets R, Gosau M, Hanken H. Does a preoperative cone beam CT reduce complication rates in the surgical removal of complex lower third molars? A retrospective study including 486 cases. Head Face Med 2021; 17:33. [PMID: 34389020 PMCID: PMC8364039 DOI: 10.1186/s13005-021-00271-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 05/24/2021] [Indexed: 12/17/2022] Open
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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Affiliation(s)
- Jan C Klatt
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Tony Sorowka
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Lan Kluwe
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Henning Hanken
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Abstract
Impacted third molars occur in a significant number of patients and often require treatment because of presence of symptoms and/or disease. Management of these teeth typically involves referral to oral and maxillofacial surgeons for diagnosis, treatment planning, and ultimate removal if indicated. Proper diagnosis and treatment planning helps optimize surgical results at each stage of the procedure, and ultimately patient outcomes. Adherence to proper surgical techniques helps minimize risks and complications associated with the procedure. Multiple alternative surgical techniques also exist for uncommon, but potentially complicated, situations that arise with some impacted third molars.
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Affiliation(s)
- William Synan
- Department of Oral and Maxillofacial Surgery, The University of Iowa, College of Dentistry, 451 Dental Science S, 801 Newton Road, Iowa City, IA 52242-1001, USA.
| | - Kyle Stein
- Department of Oral and Maxillofacial Surgery, The University of Iowa, College of Dentistry, 451 Dental Science S, 801 Newton Road, Iowa City, IA 52242-1001, USA
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Rohlin M, Horner K, Lindh C, Wenzel A. Through the quality kaleidoscope: reflections on research in dentomaxillofacial imaging. Dentomaxillofac Radiol 2020; 49:20190484. [PMID: 31971827 PMCID: PMC7461737 DOI: 10.1259/dmfr.20190484] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/10/2020] [Accepted: 01/17/2020] [Indexed: 12/13/2022] Open
Abstract
The REduce research Waste And Reward Diligence statement has highlighted how weaknesses in health research can produce misleading results and waste valuable resources. Research on diagnostic efficacy in the field of dentomaxillofacial radiology (DMFR) is no exception to these criticisms and could be strengthened by more robust study designs, consistent use of a core set of outcome measures and completeness in reporting. Furthermore, we advocate that everyone participating in collaborative research on clinical interventions subscribes to the importance of methodological quality in how imaging methods are used. The aim of this paper, therefore, is to present a guide to conducting high-quality research on diagnostic efficacy in DMFR.We initially propose a framework inspired by the hierarchical model of efficacy of Fryback and Thornbury, highlighting study designs, measures of analysis, completeness of reporting and established guidelines to assist in these aspects of research. Bias in research, and measures to prevent or limit it, are then described.It is desirable to climb the Fryback and Thornbury "ladder" from technical efficacy, via accuracy and clinical efficacy, to societal efficacy of imaging methods. Efficacy studies on the higher steps of the ladder may be difficult to perform, but we must strive to answer questions of how useful our methods are in patient management and assess benefits, risks, costs, ethical and social issues. With the framework of six efficacy levels as the structure and based on our experience, we present information that may facilitate quality enhancement of diagnostic efficacy research in DMFR.
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Affiliation(s)
| | - Keith Horner
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, UK
| | | | - Ann Wenzel
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Schulze RKW, Drage NA. Cone-beam computed tomography and its applications in dental and maxillofacial radiology. Clin Radiol 2020; 75:647-657. [PMID: 32451060 DOI: 10.1016/j.crad.2020.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
Cone-beam computed tomography (CBCT) was first used in dental and maxillofacial radiology (DMFR) at the end of the 1990s. Since then, it has been successfully established as the standard three-dimensional radiographic imaging technique in DMFR, with a wide variety of applications in this field. This manuscript briefly reviews the background information on the technology and summarises available data on effective dose and dose optimisation. In addition, typical clinical applications and indications of the technique in DMFR are presented.
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Affiliation(s)
- R K W Schulze
- Department of Oral and Maxillofacial Surgery, Section of Oral Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - N A Drage
- Department of Dental and Maxillofacial Radiology, University Dental Hospital, Cardiff, UK
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Szalma J, Vajta L, Lovász BV, Kiss C, Soós B, Lempel E. Identification of Specific Panoramic High-Risk Signs in Impacted Third Molar Cases in Which Cone Beam Computed Tomography Changes the Treatment Decision. J Oral Maxillofac Surg 2020; 78:1061-1070. [PMID: 32304662 DOI: 10.1016/j.joms.2020.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of this study was to investigate the treatment decisions of oral-maxillofacial surgeons in the management of impacted lower third molars (M3s) according to panoramic radiography (PR) and cone beam computed tomography (CBCT) risk analysis. PATIENTS AND METHODS Ten surgeons analyzed 40 deliberately selected M3 cases showing 1 or more panoramic high-risk signs: 1) darkening of the root, 2) interruption of the white line, 3) diversion of the inferior alveolar canal (IAC), 4) narrowing of the IAC, and 5) 2 or more signs occurring simultaneously (including darkening and/or interruption of the IAC). After evaluating the PR images, the observers analyzed the patients' CBCT images. The treatment decision (extraction vs coronectomy) and surgical technique (number of planned tooth sections) were recorded. RESULTS On the CBCT coronal slices, direct contact between the M3 and IAC, together with narrowing and/or fenestration of the IAC, was observed most frequently when 2 or more panoramic signs were seen simultaneously on the PR images (odds ratio [OR], 7.2; P = .021). CBCT findings led to a significant decrease in the number of coronectomy decisions (23% vs 14.5%, P = .002), which was most prominent in the groups showing panoramic signs of darkening (approximately 50%, P = .007) and narrowing (approximately 66%, P = .044). A significant number of extraction decisions were modified to coronectomy when 2 or more panoramic signs occurred together (OR, 7.9; P < .001). However, there were no significant differences regarding the number of planned hypothetical tooth sections. CONCLUSIONS The results showed that the surgeons' confidence in the treatment decision increased after CBCT imaging, resulting in fewer coronectomy decisions. CBCT information that changed a previous coronectomy decision to extraction was most frequently observed in cases showing darkening and narrowing PR signs. The chance of changing an extraction decision to a coronectomy decision after evaluating the patient's CBCT images was the highest when 2 or more PR signs were observed simultaneously.
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Affiliation(s)
- József Szalma
- Associate Professor and Head of the Department, Department of Oral and Maxillofacial Surgery, University of Pécs, Pécs, Hungary.
| | - László Vajta
- Assistant Lecturer, Department of Oral and Maxillofacial Surgery, University of Pécs, Pécs, Hungary
| | - Bálint Viktor Lovász
- Resident and PhD Student, Department of Oral and Maxillofacial Surgery, University of Pécs, Pécs, Hungary
| | - Csanád Kiss
- Resident, Department of Oral and Maxillofacial Surgery, University of Pécs, Pécs, Hungary
| | - Balázs Soós
- PhD Student and Assistant Lecturer, Department of Oral and Maxillofacial Surgery, University of Pécs, Pécs, Hungary
| | - Edina Lempel
- Associate Professor, Department of Conservative Dentistry and Periodontology, University of Pécs, Pécs, Hungary
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Nikoyan L, Patel R. Intraoral Scanner, Three-Dimensional Imaging, and Three-Dimensional Printing in the Dental Office. Dent Clin North Am 2020; 64:365-378. [PMID: 32111275 DOI: 10.1016/j.cden.2019.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The use of 3-dimensional (3D) cone-beam computed tomography (CBCT) imaging in the dental office has become a common imaging modality. The authors present an overview of multiple treatments that would benefit from the use of this technology. From preoperative, intraoperative, to postoperative patient management, 3D technology plays a vital role in the dental practice. With the incorporation of 3D CBCT, intraoral scanners, and 3D printing, a dental provider can accurately plan and execute the treatment with greater confidence. The contemporary dentist, however, has many options for incorporating the digital workflow based on the specific practice needs.
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Affiliation(s)
- Levon Nikoyan
- Department of Dentistry and Oral and Maxillofacial Surgery, Woodhull Hospital, 760 Broadway, Brooklyn, NY 11206, USA; Private Practice, Forward Oral Surgery, 248-62 Jericho Tpke, Floral Park, NY 11001, USA.
| | - Rinil Patel
- Department of Dentistry and Oral and Maxillofacial Surgery, Woodhull Hospital, 760 Broadway, Brooklyn, NY 11206, USA
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de Toledo Telles-Araújo G, Peralta-Mamani M, Caminha RDG, de Fatima Moraes-da-Silva A, Rubira CMF, Honório HM, Rubira-Bullen IRF. CBCT does not reduce neurosensory disturbances after third molar removal compared to panoramic radiography: a systematic review and meta-analysis. Clin Oral Investig 2020; 24:1137-1149. [PMID: 32052178 DOI: 10.1007/s00784-020-03231-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/29/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The current dentistry scenario is showing an increase in the availability of cone-beam computed tomography (CBCT) in dental offices. Oral surgeons are using three-dimensional information as an additional tool to assess preoperative data for lower third molar (LTM) removal in moderate and high-risk cases of inferior alveolar nerve (IAN) injury diagnosed through the panoramic radiography (PR). The aim of this study is to identify whether CBCT examination reduces neurosensoric disturbances (ND) following the removal of the LTM when compared to PR. MATERIALS AND METHODS PubMed, Embase, Web of Science, Science Direct, and Scopus electronic databases were searched for studies published up to February 2019. The gray literature was also searched including papers that eventually met the eligibility criteria. Meta-analysis was performed using the comprehensive meta-analysis software, p < 0.05 considered significant. RESULTS Among the search, 6 studies met all eligibility criteria. There was no statistically significant difference between the two groups (PR and CBCT) in all six studies regarding reducing ND (95%. Confidence interval, 0,788-1734; heterogeneity: Q = 10,361; I2 = 22.788%). CONCLUSIONS CBCT was not superior to PR in avoiding ND. However, further studies are necessary with standardized parameters for a better comparability between variables in the studies. CLINICAL RELEVANCE To better understand the CBCT clinical applicability in LTM removal to avoid unnecessary extra radiation when compared to PR to the patient and to improve patient's prognosis.
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Affiliation(s)
- Gabriel de Toledo Telles-Araújo
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Mariela Peralta-Mamani
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Raquel D'Aquino Garcia Caminha
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | - Cássia Maria Fischer Rubira
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Heitor Marques Honório
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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Matzen LH, Villefrance JS, Nørholt SE, Bak J, Wenzel A. Cone beam CT and treatment decision of mandibular third molars: removal vs. coronectomy-a 3-year audit. Dentomaxillofac Radiol 2019; 49:20190250. [PMID: 31778318 DOI: 10.1259/dmfr.20190250] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess: (1) the workflow in the treatment decision process of mandibular third molars based on a panoramic image and CBCT and (2) the impact of radiographic markers in CBCT on the decision to perform coronectomy. METHODS 1437 teeth in 917 patients (mean age 27.8 years, range 18-72) underwent clinical and panoramic examination. If there was an indication for removal of the tooth, and signs of a close relation to the inferior alveolar nerve were present in the panoramic image, a CBCT was performed. Treatment decision based on panoramic image and CBCT was calculated. Statistical analyses were performed to assess whether signs in CBCT had an impact on the treatment decision "coronectomy". Moreover, the actually operated teeth and post-operative sensory disturbances were assessed and discussed in relation to the radiographic method. RESULTS Based on the panoramic image, in 462 cases it was decided not to treat, 553 were scheduled for surgery, and 422 referred for a CBCT examination. "No bony separation between the tooth and mandibular canal" seen in CBCT was the main factor influencing the decision to perform a coronectomy (odds ratio = 56.8, p < 0.001). 840 mandibular third molars had undergone surgical intervention, 152 had a coronectomy and 688 were fully removed. Six patients perceived a sensory disturbance of the inferior alveolar nerve: one permanent and five temporary. CONCLUSION 29% of the examined cases were referred for a CBCT and of these, the majority were scheduled for coronectomy based on the sign "no bony separation between the tooth and mandibular canal" seen in CBCT.
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Affiliation(s)
- Louise Hauge Matzen
- Section of Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Denmark, Europe
| | - Julie Suhr Villefrance
- Section of Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Denmark, Europe
| | - Sven Erik Nørholt
- Section of Oral Surgery and Oral Pathology, Department of Dentistry and Oral Health, Aarhus University, Denmark, Europe.,Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark, Europe
| | - Jesper Bak
- Section of Oral Surgery and Oral Pathology, Department of Dentistry and Oral Health, Aarhus University, Denmark, Europe
| | - Ann Wenzel
- Section of Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Denmark, Europe
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Del Lhano NC, Ribeiro RA, Martins CC, Assis NMSP, Devito KL. Panoramic versus CBCT used to reduce inferior alveolar nerve paresthesia after third molar extractions: a systematic review and meta-analysis. Dentomaxillofac Radiol 2019; 49:20190265. [PMID: 31724883 DOI: 10.1259/dmfr.20190265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The aim of this systematic review was to verify whether CBCT in comparison with panoramic radiography reduced the cases of temporary paresthesias of the inferior alveolar nerve (IAN) associated with third molar extractions. METHODS The literature search included five databases (PubMed, Scopus, Web of Science, Cochrane, SciELO), in addition to gray literature and hand search of reference list of included studies. Two reviewers independently screened titles/abstracts, and full texts according to eligibility criteria, extracted data and evaluated risk of bias through Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB 2.0). Data were meta-analyzed by comparing CBCT versus panoramic radiographs for number of events (temporary paresthesia after third molar surgery). Fixed effect model was used for non-significant heterogeneity; relative risk (RR) and 95% CI were calculated. The certainty of evidence was evaluated by Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS Four randomized controlled trials (RCTs) were included in meta-analysis, and for the majority of domains they presented low risk of bias. RR was 1.23 (95% IC: 0.75-2.02; I2: 0%; p = 0.43) favouring panoramic radiography, but without significant effect, and with moderate certainty of evidence. CONCLUSIONS We concluded that both interventions had a similar ability to reduce temporary paresthesia of the IAN after third molar surgery with moderate certainty of evidence.
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Affiliation(s)
| | - Rosangela Almeida Ribeiro
- Department of Social and Pediatric Dentistry, School of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Carolina Castro Martins
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Karina Lopes Devito
- Department of Dental Clinic, School of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
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Araujo GDTT, Peralta-Mamani M, Silva ADFMD, Rubira CF, Honório HM, Rubira-Bullen IF. Influence of cone beam computed tomography versus panoramic radiography on the surgical technique of third molar removal: a systematic review. Int J Oral Maxillofac Surg 2019; 48:1340-1347. [DOI: 10.1016/j.ijom.2019.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 04/08/2019] [Indexed: 12/16/2022]
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20
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Mandibular canal-related parameters interpreted in panoramic images and CBCT of mandibular third molars as risk factors to predict sensory disturbances of the inferior alveolar nerve. Int J Oral Maxillofac Surg 2019; 48:1094-1101. [DOI: 10.1016/j.ijom.2019.03.898] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/11/2019] [Accepted: 03/15/2019] [Indexed: 11/16/2022]
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Matzen LH, Berkhout E. Cone beam CT imaging of the mandibular third molar: a position paper prepared by the European Academy of DentoMaxilloFacial Radiology (EADMFR). Dentomaxillofac Radiol 2019; 48:20190039. [PMID: 30810357 DOI: 10.1259/dmfr.20190039] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Lack of evidence on the use of CBCT for management of mandibular third molars in Radiation Protection guideline no. 172 of the European Commission made the European Academy of DentoMaxilloFacial Radiology (EADMFR) decide to update the recommendations of the guideline. METHODS AND MATERIALS A literature search was performed addressing the following questions: (1) does CBCT change the treatment of the patient?; (2) does CBCT reduce the number of post-operative sensory disturbances of the inferior alveolar nerve?; and (3) can CBCT predict the risk for a post-operative sensory disturbance of the inferior alveolar nerve? RESULTS: Since the European Commission published the guideline in 2012 several high-evidence studies on the use of CBCT before removal of mandibular third molars have been conducted including five randomized controlled clinical trials and one meta-analysis. Present literature allows to propose recommendations with highest level of evidence. CONCLUSION New and up-to-date evidence-based recommendations advocate that CBCT imaging of the mandibular third molar should not be applied as a routine method before removal of mandibular third molars and therefore, CBCT imaging should only be applied when the surgeon has a very specific clinical question in an individual patient case that cannot be answered by conventional (panoramic and/or intraoral) imaging.
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Affiliation(s)
- Louise Hauge Matzen
- 1 Department of Dentistry and Oral Health, Section of Oral Radiology, Aarhus University , Aarhus , Denmark
| | - Erwin Berkhout
- 2 Department of Oral Radiology and Radiation Protection, Academic Center for Dentistry, VU University & University of Amsterdam , The Netherlands
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Hoshi R, Tetsumura A, Yamaguchi S. Preoperative imaging findings as predictors of postoperative inferior alveolar nerve injury following mandibular cyst surgery. J Oral Sci 2019; 60:618-625. [PMID: 30606945 DOI: 10.2334/josnusd.17-0458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The purpose of the present study was to predict inferior alveolar nerve (IAN) exposure and associated neurosensory deficits after mandibular cyst surgery based on imaging findings. The study includes 193 sites in 184 consecutive patients who underwent enucleation of cystic lesions around a mandibular third molar (MM3) and extraction of the associated MM3. Absence/presence of white lines on panoramic radiographs (PR) and absence/presence of cortication surrounding the mandibular canal on computed tomography (CT) are evaluated as predictor variables. Outcome variables are operative IAN exposure and postoperative lower lip and/or chin dysesthesia. There is a significant correlation between interruption of white lines and loss of cortication. The predictor variables are statistically associated with IAN exposure and dysesthesia. Positive predictive values of CT findings (loss of cortication) for each outcome variable are slightly higher than those of PR findings (interruption of white lines). When considering the variables, type IV, with interruption of white lines and loss of cortication, shows a statistically significant difference compared to the other groups. White lines on PR images and cortication status of the mandibular canal on CT images predict operative IAN exposure and postoperative dysesthesia in mandibular cyst surgery.
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Affiliation(s)
- Reiko Hoshi
- Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Akemi Tetsumura
- Oral and Maxillofacial Radiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Satoshi Yamaguchi
- Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
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Pedersen M, Bak J, Matzen L, Hartlev J, Bindslev J, Schou S, Nørholt S. Coronectomy of mandibular third molars: a clinical and radiological study of 231 cases with a mean follow-up period of 5.7 years. Int J Oral Maxillofac Surg 2018; 47:1596-1603. [DOI: 10.1016/j.ijom.2018.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/02/2018] [Accepted: 06/14/2018] [Indexed: 12/13/2022]
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Panmekiate S, Rungwittayathon P, Suptaweeponboon W, Tangtraitham N, Pauwels R. Optimization of exposure parameters in dental cone beam computed tomography using a 3-step approach. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:545-552. [PMID: 30237039 DOI: 10.1016/j.oooo.2018.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 03/17/2018] [Accepted: 08/13/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to find the optimal balance among tube voltage (kV), tube current (mA), and exposure time (s) in cone beam computed tomography (CBCT). STUDY DESIGN Three human hemimandibles were scanned by using the 3D Accuitomo 170 scanner (J. Morita, Kyoto, Japan). First, 3 combinations of kilovolt (kV) and milliampere (mA) were used at a constant radiation dose. Seven observers evaluated the images; the kV of the highest-scoring scan was considered optimal. Second, the lowest acceptable mA for visualizing different anatomic structures was determined. Finally, the samples were scanned by using 3 combinations of tube current and exposure time; the observers determined the combination with the highest image quality. RESULTS At a constant radiation dose, the highest available voltage (i.e., 90 kV) resulted in the highest image quality in terms of general impression, sharpness, noise, and artefacts. Depending on the anatomic structure, mA reductions of 20% to 40% compared with the default setting were possible. Fast-scan protocols showed equal or slightly better image quality compared with the standard-scan mode. CONCLUSIONS For the CBCT model used in this study, optimization implies the use of the highest kV along with the shortest exposure time and a task-specific mA. The proposed stepwise optimization approach could be applied to any CBCT unit, preferably during commissioning.
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Affiliation(s)
- Soontra Panmekiate
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Peera Rungwittayathon
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Wijuck Suptaweeponboon
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Nattarus Tangtraitham
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Ruben Pauwels
- Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand; OMFS-IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Mechanical Engineering Department, Catholic University of Leuven, Leuven, Belgium.
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Abstract
Cone beam computed tomography (CBCT) can be a useful adjunct to conventional plain film radiography, but its use must be carefully justified as the radiation dose is generally higher. Factors affecting the dose include the field of view (FOV) size, the exposure factors, the angle of rotation and voxel size. Once justified, the exposure should be fully optimised to ensure the dose to the patient is kept as low as possible while ensuring there is no reduction in the diagnostic yield. The European Commission (EC) and the Faculty of General Dental Practice (FGDP)(UK) have published selection criteria on the use of CBCT in dentistry. This article provides an overview of CBCT and summarises the latest guidance on selection criteria relevant to the general dental practitioner.
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Winstanley KL, Otway LM, Thompson L, Brook ZH, King N, Koong B, O'Halloran M. Inferior alveolar nerve injury: Correlation between indicators of risk on panoramic radiographs and the incidence of tooth and mandibular canal contact on cone‐beam computed tomography scans in a Western Australian population. ACTA ACUST UNITED AC 2018; 9:e12323. [DOI: 10.1111/jicd.12323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 11/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Kate L. Winstanley
- Oral Health Centre of Western Australia Perth Western Australia Australia
| | - Lisa M. Otway
- Oral Health Centre of Western Australia Perth Western Australia Australia
| | - Lionel Thompson
- Oral Health Centre of Western Australia Perth Western Australia Australia
| | - Zoe H. Brook
- Oral Health Centre of Western Australia Perth Western Australia Australia
| | - Nigel King
- Oral Health Centre of Western Australia Perth Western Australia Australia
| | - Bernard Koong
- Oral Health Centre of Western Australia Perth Western Australia Australia
| | - Michael O'Halloran
- Oral Health Centre of Western Australia Perth Western Australia Australia
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Affiliation(s)
- Ralf K W Schulze
- 1 Department of Oral Surgery and (Oral Radiology) University Medical Center of the Johannes Gutenberg-University , Mainz , Germany
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Chen Y, Liu J, Pei J, Liu Y, Pan J. The Risk Factors that Can Increase Possibility of Mandibular Canal Wall Damage in Adult: A Cone-Beam Computed Tomography (CBCT) Study in a Chinese Population. Med Sci Monit 2018; 24:26-36. [PMID: 29293490 PMCID: PMC5761695 DOI: 10.12659/msm.905475] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background The objective of this study was to analyze the factors that can increase the possibility of mandibular canal (MC) defect in Chinese people, to evaluate the risk of nerve impairment, and to choose the proper operative method to reduce the risk of mandibular alveolar nerve injury during the extraction of mandibular third molar (MTM). Material/Methods A total of 954 patients (1,304 MTMs) who underwent orthopantomography (OPG) and cone-beam computed tomography (CBCT) between July 2014 and December 2014 were included in this study. The age and gender of patients, impacted type (high impaction, moderate impaction, and low impaction), Winter classification of MTM, position of MTM relative to MC, vertical classification of MTM and MC, and the feature images of OPG were collected and compared to the imperfection of the MC wall in CBCT images. Results The wall situation of MC was significantly correlated with the age of the patient, the depth of the molar, the position of the roots, and six imaging appearances on OPG. There was no significant difference based on gender. Conclusions Most incomplete walls of MCs could be inferred by OPG. However, images based on CBCT could clarify the defect of the MC and also could clearly display the spatial relationship between the root and inferior alveolar canal.
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Affiliation(s)
- Yafei Chen
- State Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Jiyuan Liu
- State Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Jun Pei
- State Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yuanyuan Liu
- State Key Laboratory of Oral Diseases, Department of Oral Radiology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Jian Pan
- State Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China (mainland)
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Abstract
Data sourcesMedline, Embase, relevant dental journals, reference lists of included studies and the World Health Organisation International Clinical Trials Registry.Study selectionStudies evaluating the predictive accuracy of panoramic radiography for postoperative inferior alveolar nerve (IAN) injury reporting on at least one of the seven signs of IAN injury and providing data to calculate false-positive (FP), true-positive (TP), false-negative (FN) and true-negative (TN) proportions were included.Data extraction and synthesisData were abstracted independently by two reviewers. Positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were extracted or calculated. Overall pooled estimates of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR) (LR-) and diagnostic odds ratio (DOR), with 95% confidence intervals (CIs) were calculated using a random effects model. Summary receiver operating characteristic (SROC) curves were also generated. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool (http://www.bristol.ac.uk/social-community-medicine/projects/quadas/quadas-2/).ResultsEight studies were included. Only one study was considered to be at low risk of bias, one at low risk and the remainder at unclear risk. A summary of the pooled sensitivity, specificity and diagnostic odds ratios are shown in the table.ConclusionsFor all seven signs, the added value of panoramic radiography is too low to consider it appropriate for ruling out postoperative IAN in the decision-making before MM3 surgery. The added value of panoramic radiography for determining the presence of diversion of the canal, interruption of the white line of the canal and darkening of the root can be considered sufficient for ruling in the risk of postoperative IAN injury in the decision-making before MM3 surgery.
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Clé-Ovejero A, Sánchez-Torres A, Camps-Font O, Gay-Escoda C, Figueiredo R, Valmaseda-Castellón E. Does 3-dimensional imaging of the third molar reduce the risk of experiencing inferior alveolar nerve injury owing to extraction? J Am Dent Assoc 2017; 148:575-583. [DOI: 10.1016/j.adaj.2017.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 03/29/2017] [Accepted: 04/04/2017] [Indexed: 01/25/2023]
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Manor Y, Abir R, Manor A, Kaffe I. Are different imaging methods affecting the treatment decision of extractions of mandibular third molars? Dentomaxillofac Radiol 2016; 46:20160233. [PMID: 27990846 DOI: 10.1259/dmfr.20160233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To find the differences between treatment decisions of lower impacted third molars among experts of oral and maxillofacial surgery according to panoramic radiographic and CBCT findings. METHODS A retrospective analysis of 62 panoramic radiographs and CBCT of lower third molars evaluated for treatment decisions by 9 independent experts of oral and maxillofacial surgery. RESULTS Differences in interpretation of the panoramic radiography were found between surgeons. The absence of radiological signs suspected for risk to the inferior alveolar nerve lead to the decision of extraction according to panoramic radiography without CBCT (p < 0.01). The presence of those signs lead to referral to CBCT by surgeons before treatment but did not change their decision. CONCLUSIONS Treatment decision for surgical treatment of the lower third molar can be accepted without CBCT findings. The use of CBCT is popular before extraction of lower third molars. We found that it has a little effect on the treatment decision of the surgical intervention in comparison to panoramic radiography.
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Affiliation(s)
- Yifat Manor
- Department of Oral and Maxillofacial Surgery, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Dental Division, Assaf Harofe Medical Center, Beer Yaacov, Israel
| | - Refael Abir
- Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alex Manor
- Economical Unit, Edith Wolfson Medical Center, Holon, Israel
| | - Israel Kaffe
- Department of Oral Medicine and Diagnosis, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Matzen LH, Schropp L, Spin-Neto R, Wenzel A. Radiographic signs of pathology determining removal of an impacted mandibular third molar assessed in a panoramic image or CBCT. Dentomaxillofac Radiol 2016; 46:20160330. [PMID: 27681861 DOI: 10.1259/dmfr.20160330] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To (1) compare pathological findings related to the mandibular third molar in panoramic images (PAN) and CBCT; (2) estimate the frequency of removals if pathological findings were indicative; and (3) assess factors in PAN associated with resorption and marginal bone loss at the second molar as observed in CBCT. METHODS 379 mandibular third molars were examined with PAN and CBCT. Four observers registered resorption and marginal bone loss at the second molar and increased periodontal space at the third molar in both imaging modalities. Agreement between PAN and CBCT, frequency of removals based on pathological findings in either of the two modalities and interobserver reproducibility was calculated. Logistic regression analyses assessed factors in PAN, which could predict marginal bone loss and resorption observed in CBCT. RESULTS Agreement between PAN and CBCT: resorption 54-74%; marginal bone loss 66-85%; and increased periodontal space 92-97%. Removals based on CBCT and PAN: 58-71% and 36-65%. Interobserver percentage accordance and kappa values ranged from 57 to 98% and 0.10-0.91 for PAN and 61-97% and 0.22-0.78 for CBCT, respectively. Mesioangulated/horizontally positioned third molars were associated with marginal bone loss [odds ratio (OR) = 7.0-31.3; p < 0.001] and resorption (OR = 2.9-35.6; p < 0.001) in CBCT. Overprojection between the third and the second molars in PAN predicted resorption observed in CBCT (OR = 5.6-21.2; p < 0.001). CONCLUSIONS Pathology associated with the third molar is more often observed in CBCT than in PAN. More third molars would be removed if pathological findings are based on CBCT. Mesioangulated/horizontally positioned third molars overprojecting the cervical/root part of the second molar in PAN are strongly associated with pathology observed in CBCT.
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Affiliation(s)
- Louise H Matzen
- Section of Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
| | - Lars Schropp
- Section of Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
| | - Rubens Spin-Neto
- Section of Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
| | - Ann Wenzel
- Section of Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
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Matzen LH, Petersen LB, Wenzel A. Radiographic methods used before removal of mandibular third molars among randomly selected general dental clinics. Dentomaxillofac Radiol 2016; 45:20150226. [PMID: 26943178 DOI: 10.1259/dmfr.20150226] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess radiographic methods and diagnostically sufficient images used before removal of mandibular third molars among randomly selected general dental clinics. Furthermore, to assess factors predisposing for an additional radiographic examination. METHODS 2 observers visited 18 randomly selected clinics in Denmark and studied patient files, including radiographs of patients who had their mandibular third molar(s) removed. The radiographic unit and type of receptor were registered. A diagnostically sufficient image was defined as the whole tooth and mandibular canal were displayed in the radiograph (yes/no). Overprojection between the tooth and mandibular canal (yes/no) and patient-reported inferior alveolar nerve sensory disturbances (yes/no) were recorded. Regression analyses tested if overprojection between the third molar and the mandibular canal and an insufficient intraoral image predisposed for additional radiographic examination(s). RESULTS 1500 mandibular third molars had been removed; 1090 had intraoral, 468 had panoramic and 67 had CBCT examination. 1000 teeth were removed after an intraoral examination alone, 433 after panoramic examination and 67 after CBCT examination. 90 teeth had an additional examination after intraoral. Overprojection between the tooth and mandibular canal was a significant factor (p < 0.001, odds ratio = 3.56) for an additional examination. 63.7% of the intraoral images were sufficient and 36.3% were insufficient, with no significant difference between images performed with phosphor plates and solid-state sensors (p = 0.6). An insufficient image predisposed for an additional examination (p = 0.008, odds ratio = 1.8) but was only performed in 11% of the cases. CONCLUSIONS Most mandibular third molars were removed based on an intraoral examination although 36.3% were insufficient.
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Affiliation(s)
- Louise H Matzen
- Section of Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
| | - Lars B Petersen
- Section of Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
| | - Ann Wenzel
- Section of Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
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