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Barone S, Bennardo F, Salviati M, Cosentino V, Finamore R, Greco V, Madonna A, Procopio A, Antonelli A, Giudice A. Concordance Analysis of Lower Third Molar Surgery Classifications: A Comparative Study. Dent J (Basel) 2024; 12:167. [PMID: 38920868 PMCID: PMC11203060 DOI: 10.3390/dj12060167] [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: 04/19/2024] [Revised: 05/22/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
The high frequency and complexity of mandibular third molar (M3M) surgery have led several authors to the development of classification systems for better evaluation and management in oral surgery. This study compared the classifications of Juodzabalys and Daugela et al. (JD), Sammartino et al., Chang et al., Jhamb et al., Maglione et al., and Nemsi et al. to understand the concordance between the scores of M3M surgery. Two types of analysis were conducted: the relationship between the M3M and the inferior alveolar nerve (IAN), and the overall difficulty score based on the tooth's angulation and its spatial position with the adjacent structure. The analysis of the classifications on the relationship between M3M and IAN resulted in a concordance of 26.1%. In the pairwise comparisons, the classifications of Nemsi et al. and Jhamb et al. showed the highest concordance of 59.5%. Analyzing the total scores difficulty, the JD et al., Chang et al., and Sammartino et al. classifications demonstrated a concordance level of 25.5%. A pairwise assessment revealed a higher concordance degree between the classifications of Sammartino et al. and Chang et al. (57.4%). The results highlight the limits in establishing a comprehensive and objective classification for the surgical difficulty of M3M, possibly attributed to variations in the methodology for computing total scores. An objective, automated, and non-operator-dependent classification method for assessing the surgical difficulty of M3M is still needed.
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Affiliation(s)
- Selene Barone
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (S.B.); (F.B.); (M.S.); (V.C.); (R.F.); (V.G.); (A.M.); (A.G.)
| | - Francesco Bennardo
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (S.B.); (F.B.); (M.S.); (V.C.); (R.F.); (V.G.); (A.M.); (A.G.)
| | - Marianna Salviati
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (S.B.); (F.B.); (M.S.); (V.C.); (R.F.); (V.G.); (A.M.); (A.G.)
| | - Vincenzo Cosentino
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (S.B.); (F.B.); (M.S.); (V.C.); (R.F.); (V.G.); (A.M.); (A.G.)
| | - Riccardo Finamore
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (S.B.); (F.B.); (M.S.); (V.C.); (R.F.); (V.G.); (A.M.); (A.G.)
| | - Vincenzo Greco
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (S.B.); (F.B.); (M.S.); (V.C.); (R.F.); (V.G.); (A.M.); (A.G.)
| | - Antonio Madonna
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (S.B.); (F.B.); (M.S.); (V.C.); (R.F.); (V.G.); (A.M.); (A.G.)
| | - Anna Procopio
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Alessandro Antonelli
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (S.B.); (F.B.); (M.S.); (V.C.); (R.F.); (V.G.); (A.M.); (A.G.)
| | - Amerigo Giudice
- Department of Health Sciences, School of Dentistry, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (S.B.); (F.B.); (M.S.); (V.C.); (R.F.); (V.G.); (A.M.); (A.G.)
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Association of the Inferior Alveolar Nerve Position and Nerve Injury: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10091782. [PMID: 36141394 PMCID: PMC9498832 DOI: 10.3390/healthcare10091782] [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: 07/12/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background: We aimed to compare the relationship between the buccal and lingual positions of the inferior alveolar nerve canal (IAC) relative to the lower third molar (LM3) and the rate of the inferior alveolar nerve (IAN) injury. Methods: A systematic search was performed in the following databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Journals@Ovid. No language or publication status restrictions were set. The publication year was set from 2009 to 2021. The process of meta-analysis was performed by Review Manager software (Cochrane Collaboration). Results: A total of 1063 articles were initially searched and full texts of 53 articles were read, and 11 satisfactory articles were found. There was a statistical difference between the rate of IAN injury and the lingual position and buccal position of the IAC relative to the LM3 roots (OR, 4.96; 95% CI, 2.11 to 11.62; p = 0.0002), with high heterogeneity (p = 0.001, I2 = 65%). Conclusion: A statistical difference was found in the rate of IAN injury between cases where the IAC was positioned buccally and lingually of the LM3 roots. The IAC was at a relatively higher risk of damage in third molar extraction when it was located on the lingual position of the LM3 roots.
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Comparison of Digital OPG and CBCT in Assessment of Risk Factors Associated with Inferior Nerve Injury during Mandibular Third Molar Surgery. Diagnostics (Basel) 2021; 11:diagnostics11122282. [PMID: 34943519 PMCID: PMC8700465 DOI: 10.3390/diagnostics11122282] [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: 11/08/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Pre-operative radiographic assessment of the anatomical relationship between the roots of the mandibular third molar and the inferior alveolar nerve (IAN) is a must to minimize the risk of IAN injury during surgery. Objectives: To compare the radiographic signs of digital orthopantomogram (OPG) and cone-beam computed tomography (CBCT). An additional objective was to assess the cortex status between the mandibular canal and third molar on CBCT images in relation to the demographic characteristics, region (right or left side), and angulation of mandibular molar. Methodology: In this retrospective study, a total of 350 impacted mandibular third molars with a close relationship between the inferior alveolar canal (IAC) and impacted mandibular third molars on digital OPG were further referred for CBCT imaging for assessment of the position of the mandibular canal. The study was conducted between August 2018 and February 2020. Digital OPGs were evaluated for radiographic signs like interruption of the mandibular canal wall, darkening of the roots, diversion of the mandibular canal, and narrowing of the mandibular canal. The age and sex of patients, site of impacted third molar, Winter’s classification of mandibular third molar, position of IAC relative to impacted molar, and the radiographic markers of OPG were assessed for cortical integrity using CBCT. Chi square testing was applied to study the values of difference and binomial logistic regression was done to assess the factors associated with cortication. Statistical significance was set at p ≤ 0.05. Results: Among 350 patients, 207 (59.1%) were male and 143 (40.9%) were female with a mean age of 36.8 years. The most common OPG sign was interruption of white line, seen in 179 (51.1%) cases. In total, 246 cases (70.3%) showed an absence of canal cortication between the mandibular canal and the impacted third molar on CBCT images. Cortication was observed in all cases with a combination of panoramic signs which was statistically significant (p = 0.047). Cortication was observed in 85 (50.6%) cases where IAC was positioned on the buccal side, 11 (16.9%) in cases of inferiorly positioned IAC, and just 8 (7.6%) for cases of lingually positioned IAC which was statistically significant (p = 0.003). Statistically insignificant (p > 0.05) results were noted for cortex status in CBCT images with regards to the age, sex, site, and angulation of impacted third molars. Conclusion: CBCT imaging is highly recommended for those cases where diversion of the mandibular canal is observed on OPG and when the roots are present between canals.
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