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Zhang MJ, Huo L, Chai Y, Wang YW, Han ZX, Liu YM, Wang HS, Wei WB, Chen MJ. Soft tissue inflammation around upper third molar cause limited mouth opening: common but overlooked. Clin Oral Investig 2024; 28:427. [PMID: 38992326 DOI: 10.1007/s00784-024-05820-1] [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: 02/18/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES The aim of this study was to explore inflammation of soft tissue around the upper third molar as a prevalent cause of limited mouth opening, identify the clinical and radiographic features, and summarize the therapeutic effectiveness of tooth extraction. MATERIALS AND METHODS A retrospective analysis of data from 264 patients with limited mouth opening over the last five years was performed. RESULTS Among the 264 patients, 24 (9.1%) had inflammation of the soft tissue around the upper third molar, which was the second most common cause of limited mouth opening. Twenty-one of the twenty-four affected patients, with an average mouth opening of 19.1 ± 7.6 mm, underwent upper third molar extraction. Gingival tenderness around the upper third molar or maxillary tuberosity mucosa was a characteristic clinical manifestation (p < 0.05). The characteristic features on maxillofacial CT included soft tissue swelling around the upper third molar and gap narrowing between the maxillary nodules and the mandibular ascending branch. Post extraction, the average mouth opening increased to 31.4 ± 4.9 mm (p < 0.05), and follow-up CT demonstrated regression of the inflammatory soft tissue around the upper third molar. CONCLUSIONS Inflammation of soft tissue around the upper third molar is a common cause of limited mouth opening. Symptoms of pain associated with the upper third molar and distinctive findings on enhanced maxillofacial CT scans are crucial for diagnosis. Upper third molar extraction yields favorable therapeutic outcomes. CLINICAL RELEVANCE Inflammation of the soft tissue around the maxillary third molar commonly causes limited mouth opening, but this phenomenon has long been overlooked. Clarifying this etiology can reduce the number of misdiagnosed patients with restricted mouth opening and enable more efficient treatment for patients.
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Affiliation(s)
- Meng-Jie Zhang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai, China
- National Center for Stomatology, and National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Zhizaoju Road 639, Shanghai, China
| | - Liang Huo
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai, China
- National Center for Stomatology, and National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Zhizaoju Road 639, Shanghai, China
| | - Ying Chai
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai, China
- National Center for Stomatology, and National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Zhizaoju Road 639, Shanghai, China
| | - Yi-Wen Wang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai, China
- National Center for Stomatology, and National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Zhizaoju Road 639, Shanghai, China
| | - Zi-Xiang Han
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai, China
- National Center for Stomatology, and National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Zhizaoju Road 639, Shanghai, China
| | - Yue-Min Liu
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai, China
- National Center for Stomatology, and National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Zhizaoju Road 639, Shanghai, China
| | - Han-Shao Wang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai, China
- National Center for Stomatology, and National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Zhizaoju Road 639, Shanghai, China
| | - Wen-Bin Wei
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai, China.
- National Center for Stomatology, and National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Zhizaoju Road 639, Shanghai, China.
| | - Min-Jie Chen
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai, China.
- National Center for Stomatology, and National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Zhizaoju Road 639, Shanghai, China.
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Vasegh Z, Bakhshaei P, Jahanbani M, Mahmoudi Anzabi R. Evaluation of anatomical relationships in the mandibular third molar region based on its angulation and depth of impaction: a CBCT-based study. Oral Maxillofac Surg 2024; 28:613-622. [PMID: 37620734 DOI: 10.1007/s10006-023-01178-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE The aim of this study is to evaluate the relationship between the inclination/impaction depth and root proximity to the inferior alveolar canal/lingual plate on a millimeter scale using CBCT scans. METHODS 340 CBCT scans of the mandibular third molar (M3) of 219 patients were evaluated for this cross-sectional study. After adjustment of the 3D orientation of the individual's jaws, the study variables including the angulation between M3 and second molar (M2)/occlusal plane (OP), and the distance of mesial (M)/distal (D) roots of M3 from the inferior alveolar canal (IAC) and lingual plate (LP) were measured. Winter's classification was used for the specification of teeth angulation. The vertical position of each M3 was then evaluated using the 3D view window (based on Pell & Gregory classification). The Spearman correlation coefficient was used for reporting the correlation between quantitative variables. The One-way ANOVA test and the Welch analysis were used for inter-group comparisons. Finally, a multivariant analysis of variances was performed. RESULTS Most third molars had a mesioangular inclination (52.1%), and vertical inclination (25.9%) was in second place. There was no significant correlation between angulation and age or the D/LP. A strong positive correlation between M3:M2 and M3:OP was observed (0.983). Furthermore, there was a weak negative correlation between M/IAC or M/LP and angulation (- 0.16 and - 0.13, respectively). Concerning Winter's classification, the relationship between D/IAC and angulation was statistically significant (P = 0.003). Furthermore, teeth in position A had lesser inclination compared to those with B or C positions. Multivariate analysis revealed that there was no statistically significant relationship between particular combinations of inclination-impaction depth and proximity of the M3 roots to the IAC or LP (P = 0.211). CONCLUSIONS The findings of the current study revealed that there is a strong correlation between M3:M2 and M3:OP. The D/IAC was the only variable that had a significant relationship with the angulation of these teeth. Moreover, the roots of horizontally inclined teeth with position A were the closest to the LP and the farthermost to the IAC.
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Affiliation(s)
- Zahra Vasegh
- Oral and Maxillofacial Radiology Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pedram Bakhshaei
- Oral and Maxillofacial Surgery Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Jahanbani
- Orthodontics Department, School of Dentistry, Babol University of Medical Sciences, Babol, Iran.
| | - Reza Mahmoudi Anzabi
- Orthodontics Department, School of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
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Al-Haj Husain A, Stadlinger B, Winklhofer S, Bosshard FA, Schmidt V, Valdec S. Imaging in Third Molar Surgery: A Clinical Update. J Clin Med 2023; 12:7688. [PMID: 38137758 PMCID: PMC10744030 DOI: 10.3390/jcm12247688] [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: 11/27/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Third molar surgery is one of the most common surgical procedures performed in oral and maxillofacial surgery. Considering the patient's young age and the often-elective nature of the procedure, a comprehensive preoperative evaluation of the surgical site, relying heavily on preoperative imaging, is key to providing accurate diagnostic work-up, evidence-based clinical decision making, and, when appropriate, indication-specific surgical planning. Given the rapid developments of dental imaging in the field, the aim of this article is to provide a comprehensive, up-to-date clinical overview of various imaging techniques related to perioperative imaging in third molar surgery, ranging from panoramic radiography to emerging technologies, such as photon-counting computed tomography and magnetic resonance imaging. Each modality's advantages, limitations, and recent improvements are evaluated, highlighting their role in treatment planning, complication prevention, and postoperative follow-ups. The integration of recent technological advances, including artificial intelligence and machine learning in biomedical imaging, coupled with a thorough preoperative clinical evaluation, marks another step towards personalized dentistry in high-risk third molar surgery. This approach enables minimally invasive surgical approaches while reducing inefficiencies and risks by incorporating additional imaging modality- and patient-specific parameters, potentially facilitating and improving patient management.
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Affiliation(s)
- Adib Al-Haj Husain
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (A.A.-H.H.); (B.S.); (F.A.B.); (V.S.)
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (A.A.-H.H.); (B.S.); (F.A.B.); (V.S.)
| | | | - Fabienne A. Bosshard
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (A.A.-H.H.); (B.S.); (F.A.B.); (V.S.)
| | - Valérie Schmidt
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (A.A.-H.H.); (B.S.); (F.A.B.); (V.S.)
| | - Silvio Valdec
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (A.A.-H.H.); (B.S.); (F.A.B.); (V.S.)
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Machado AH, Freitas DQ, Fontenele RC, Farias-Gomes A, Francesquini Júnior L, Ambrosano GMB. Radiographic evaluation of mandibular third molars: an ex vivo comparative study between multilayer and conventional panoramic radiography. Clin Oral Investig 2023; 27:6451-6460. [PMID: 37728617 DOI: 10.1007/s00784-023-05249-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES To compare the multilayer panoramic radiography (MPAN) and conventional panoramic radiography (CPAN) in the evaluation of mandibular third molars using cone-beam computed tomography (CBCT) as a reference. METHODS CPAN, MPAN, and CBCT scans from 33 dry human mandibles were acquired using the OP300 Maxio unit, totalizing 56 mandibular third molars to be evaluated. Three examiners evaluated each third molar according to their position, depth of impaction in the mandibular ramus, proximity between the dental root apexes and the mandibular canal, and the presence of radiographic signs of proximity to the mandibular canal. In addition, when there was a distance between the root apexes and the mandibular canal, it was measured. As a reference, these same parameters were assessed in the CBCT scans by a fourth examiner. For the statistical analysis, the weighted Kappa, Bland Altman, and Wilcoxon tests were performed (α = 0.05). RESULTS The agreement between the assessments performed in the panoramic modalities with the CBCT ranged from 66.1% to 100.0% for the categorical variables. Overall, the agreement values of CPAN and MPAN with CBCT were similar. The distances between the dental root apex and the mandibular canal for both CPAN and MPAN were significantly underestimated compared to CBCT (p < 0.05). The intra- and interexaminer agreements of the examiners ranged from poor to almost perfect; in general, the agreements were higher in the evaluation performed in the MPAN than in the CPAN. CONCLUSIONS The MPAN performs similarly to CPAN for evaluating mandibular third molars and their proximity relationship to the mandibular canal. CLINICAL RELEVANCE Preoperative evaluation of lower mandibular third molars is usually performed using CPAN. Recently, a new tool, MPAN, was developed, which has not yet been tested for the evaluation of mandibular third molars and showed similar performance to CPAN in the present study. Future studies using MPAN are encouraged to evaluate other diagnostic tasks.
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Affiliation(s)
- Alessiana Helena Machado
- Department of Oral Diagnosis - Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis - Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Rocharles Cavalcante Fontenele
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Amanda Farias-Gomes
- Department of Oral Diagnosis - Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Luiz Francesquini Júnior
- Department of Forensic Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Gláucia Maria Bovi Ambrosano
- Department of Health Sciences and Pediatric Dentistry - Biostatistics Area, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
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Ahmed J, Nath M, Sujir N, Ongole R, Shenoy N. Correlation of Pericoronal Radiolucency Around Impacted Mandibular Third Molars Using CBCT with Histopathological Diagnosis: A Prospective Study. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2111121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
This study aimed to correlate the pericoronal width surrounding impacted mandibular third molars with their histopathological findings.
Materials and Methods:
The present study included patients who were advised for extraction of impacted mandibular third molars with the pericoronal radiolucency radiographically. The CBCT scans were compared with histopathologic findings of the follicles.
Results:
Out of 70 patients evaluated histopathologically, 24 patients showed mild inflammatory changes, whereas 34 patients revealed cystic changes suggestive of a dentigerous cyst, followed by 12 patients showing evidence of calcifications in the pericoronal follicles. The dentigerous cyst was more likely to occur if the bucco-lingual width of the pericoronal radiolucency was 14.00-16.00mm, and calcifications were found to be most likely present if the buccolingual width was 12.00-14.00mm, both of which were statistically significant.
Conclusion:
CBCT can be a reliable tool in the evaluation of pericoronal follicular space, and the values in different dimensions can be an accurate predictor radiologically for the diagnosis of pathologies when compared to 2D imaging.
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Asar NV, Çimen T, Duruel O, Goyushov S, Karabulut E, Tözüm TF. Inferior alveolar nerve topography and its bifurcation features: a cone beam computed tomography evaluation. Minerva Dent Oral Sci 2022; 71:149-154. [PMID: 35758828 DOI: 10.23736/s2724-6329.21.04644-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Mandibular canal (MC) is the most important vital structure in mandible to prevent from complications such as bleeding and paresthesia. The aims of the present study were to inform the features (diameter, distances to the mandibular borders, and distance to tooth apex) of the MC for each posterior tooth region, and to present the bifurcation features of the MC. METHODS Four-hundreds-eighteen MC images of 209 patients were evaluated. The parameters were recorded from right and left hemi-mandibles for each posterior teeth region: 1) MC diameter; 2) MC and mandibular basis distance; 3) MC and crest distance; 4) MC and tooth apex distance; 5) MC and buccal plate distance; 6) MC and lingual plate distance; and 7) possible implant length (the distance between 2 mm coronal of the MC and 1 mm apical of the crest). Additionally, MC bifurcation type and bifid mandibular canal length were noted for right and left sides. RESULTS While higher MC diameter values were recorded at molars, MC diameter in first premolars bilaterally were the lowest. In premolars, MC and mandibular basis distance showed higher values than molars. There was a trend of decrease in MC and crest distance from molars to premolars. The highest MC and tooth apex distance was measured in second molar; however, the lowest was in the first premolar. Additionally, MC and buccal plate distances were higher in molars, while MC and lingual plate distances were higher in premolars. Possible implant length in first premolar was the lowest, when it was the highest in second molars. CONCLUSIONS For simulating overall MC topography, it extended bucco-coronally from molars to premolars. Due to this topography, possible implant length increased from premolars to molars.
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Affiliation(s)
- Neset V Asar
- College of Dentistry, Department of Periodontics, University of Illinois at Chicago, Chicago, IL, USA
- Department of Prosthetic Dentistry, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Tansu Çimen
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Onurcem Duruel
- Private Practitioner Limited in Periodontology and Implantology, Ankara, Turkey
| | - Samir Goyushov
- Department of Periodontology, Faculty of Dentistry, Istanbul Aydin University, Istanbul, Turkey
| | - Erdem Karabulut
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tolga F Tözüm
- College of Dentistry, Department of Periodontics, University of Illinois at Chicago, Chicago, IL, USA -
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Wen C, Jiang R, Zhang ZQ, Lei B, Yan YZ, Zhong YQ, Tang L. Vertical direction impaction of kissing molars: A case report. World J Clin Cases 2022; 10:3959-3965. [PMID: 35647150 PMCID: PMC9100717 DOI: 10.12998/wjcc.v10.i12.3959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/29/2022] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Kissing molars (KMs) are a scarcely reported form of molar impaction in which the occlusal surfaces contact each other within a single dental follicle and the roots point in opposite directions. The direction of KMs impaction is generally tilted. KMs with vertical direction impaction have not been reported in the literature.
CASE SUMMARY A 25-year-old female visited a dentist for right maxillary wisdom teeth extraction and was diagnosed with two vertically impacted KMs in the left mandible on panoramic radiography. After cone-beam computed tomography examination confirmed no secondary complication, the patient chose to undergo observation and regular follow-up. A literature review of KMs revealed that vertical impacted KMs are rare; high-quality evidence regarding their prevalence is still lacking. At present, the causality of KMs is controversial. In this study, we have tried to provide a detailed definition of KMs to allow an accurate evaluation of their prevalence and classification based on their impaction direction which may be related to their pathogenesis. The treatment plan of KMs depends on the condition and location of the affected teeth and associated complications; they may be either directly extracted or treated using a multidisciplinary approach including maxillofacial surgeons and orthodontists.
CONCLUSION KMs are a rare clinical condition of impacted teeth with unclear pathogenesis. Vertically impacted KMs were seldom reported. Reasonable definition and classification of KMs can help in the understanding of their causes and prevalence.
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Affiliation(s)
- Cai Wen
- Department of Oral Implantology, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
- Department of VIP Dental Service, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
- Luzhou Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Rong Jiang
- Department of Dentistry, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Ma'erkang 624000, Sichuan Province, China
| | - Zhi-Qiang Zhang
- Department of Dentistry, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Ma'erkang 624000, Sichuan Province, China
| | - Bo Lei
- Department of Dentistry, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Ma'erkang 624000, Sichuan Province, China
| | - Yuan-Zheng Yan
- Luzhou Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ying-Quan Zhong
- Department of Dentistry, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Ma'erkang 624000, Sichuan Province, China
| | - Long Tang
- Department of Radiology, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Ma'erkang 624000, Sichuan Province, China
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Impact of thyroid gland shielding on radiation doses in dental cone beam computed tomography with small and medium fields of view. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:245-253. [PMID: 35534405 DOI: 10.1016/j.oooo.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/11/2022] [Accepted: 03/04/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the impact of thyroid gland shielding on radiation doses in dental cone beam computed tomography (CBCT) with small and medium fields of view (FOVs). STUDY DESIGN Six CBCT protocols were investigated by exposing an adult anthropomorphic male phantom head without and with thyroid shielding, using 4 small (4 × 5 cm) and 2 medium (10 × 6 cm) FOVs. Twenty metal oxide semiconductor field-effect transistor dosimeters were placed in the phantom head to measure absorbed doses and calculate equivalent doses at 11 sites. Effective doses were calculated based on the tissue weighting factors in International Commission on Radiological Protection Publication 103. The data were analyzed using the independent samples t test. RESULTS Thyroid gland shielding led to significant equivalent dose reductions in many tissues for all protocols. Equivalent dose reductions to the thyroid were significant in all 6 protocols (P ≤ .037). Significant reduction depended on the FOV and ranged between 24.5% and 42.6% for the thyroid gland and 4.9% and 34.5% for other tissues and organs. Effective doses were significantly lower in all protocols (P ≤ .016). CONCLUSIONS Thyroid gland shielding protects the thyroid gland and other organs and should be utilized with all CBCT examinations where feasible.
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Ilo AM, Ekholm M, Pakbaznejad Esmaeili E, Waltimo-Sirén J. Minimum size and positioning of imaging field for CBCT-scans of impacted lower third molars: a retrospective study. BMC Oral Health 2021; 21:670. [PMID: 34965859 PMCID: PMC8717649 DOI: 10.1186/s12903-021-02029-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background Cone-beam Computed Tomography (CBCT) is widely used for preoperative 3D imaging of lower third molars. Hence, for this imaging indication, the present study aimed to define the minimum field-of-view (FOV) size and its optimum placement, to decrease radiation exposure, and highlight the need of computer-assisted FOV centering technique for dental CBCT devices. To facilitate proper placement of image field, lower second molar was chosen as reference. Methods The retrospective study included 50 CBCT-scans of 46 patients with mean age of 34 years. Based on the lower second molar, a three-dimensional coordinate was formed and the location of mandibular canal (MC) and the dimensions and locations of the lower third molars, and possible associated pathological findings were assessed. Accordingly, the FOV size and position for third-molar imaging were optimized, while ensuring encompassment of all relevant structures. Results The minimum cylindrical volume, covering lower third molars and MC, was 32.1 (diameter) × 31.6 (height) mm, placed in relation to the second molar crown, top 2.2 mm above cusp tips, anterior edge 6.7 mm in the front of the most distal point of the crown, and lingual edge 7.9 mm on the medial side of the lingual wall. Conclusions The optimized FOV for lower third molars was smaller than common standard small FOVs. We recommend using FOV volume 3.5∅ × 3.5 cm for third molars without associated pathology. Accurate FOV protocols are essential for development of new CBCT-devices with computer-assisted and indication-specific FOV placement.
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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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Awad S, ElKhateeb SM. Prediction of neurosensory disorders after impacted third molar extraction based on cone beam CT Maglione's classification: A pilot study. Saudi Dent J 2021; 33:601-607. [PMID: 34803307 PMCID: PMC8589609 DOI: 10.1016/j.sdentj.2020.08.001] [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: 03/11/2020] [Revised: 06/08/2020] [Accepted: 08/04/2020] [Indexed: 10/26/2022] Open
Abstract
Background Surgical difficulty assessment in the extraction of impacted mandibular third molars is a constant challenge for oral surgeons. Aim The first aim was to apply Maglione's new classification on patients that needed surgical extraction of impacted mandibular third molars, and the second aim was to study the correlation of the classification classes with the occurrence of postoperative neurosensory disorders. Materials & methods The present prospective clinical trial pilot study was conducted on patients attending oral and maxillofacial surgery clinics from February 2017 until January 2018 for the surgical extraction of impacted lower third molars. Results Fifty-one out of sixty-nine patients made the surgical removal of one impacted mandibular third molar. The most common subclass was 1B (24.6%), followed by subclass 3B (23.2%). Subclass 3A and 4B showed an equal distribution of (11.6%) each, and then subclass 2B (10%). The most significant subclass was 4B with (5.9%) neurosensory disturbance. None of the patients had a permanent disturbance. Conclusion Maglione's classification offers unique detailed description of the buccolingual relationship of MTM with IAC that could be used as a future reliable radiographic guide to reduce the risk of post-operative neurosensory disturbances after MTM surgical removal.
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Affiliation(s)
- Sally Awad
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Egypt.,Department of Oral & Maxillofacial Surgery, Taibah University, Almadinah Almunawarah, Saudi Arabia
| | - Sara M ElKhateeb
- Department of Basic Dental Sciences, College of Dentistry, Princess Nourah Bint Abdurahman University, Riyadh, Saudi Arabia.,Department of Oral Medicine, Periodontology, Diagnosis and Oral Radiology, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Barry E, Ball R, Patel J, Obisesan O, Shah A, Manoharan A. Retrospective evaluation of sensory neuropathies after extraction of mandibular third molars with confirmed "high-risk" features on cone beam computed topography scans. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 134:e1-e7. [PMID: 34758933 DOI: 10.1016/j.oooo.2021.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The objective of this study was to identify the incidence of inferior alveolar nerve (IAN) injury after extraction of mandibular third molars with confirmed "high-risk" features on cone beam computed topography scans and establish any risk factors that significantly increase the chances of sustaining an IAN injury. STUDY DESIGN This study is a retrospective analysis of outcomes after surgical extraction of 500 mandibular third molars over a 5-year period. All teeth showed signs of contact with or compression of the IAN on cone beam computed topography scans. RESULTS The overall incidence of IAN injury was 6.6%, with permanent neuropathies accounting for 1.8% within this high-risk cohort. Statistically significant factors shown to increase the risk of nerve injury included increasing age (P = .002), compression of the nerve evident on cone beam computed topography scan (P = .005), and buccal or interradicular position of the nerve (P = .042). CONCLUSIONS Results indicate a low incidence of IAN injury, particularly given the high-risk nature of all teeth that were extracted. It highlights the benefits of cone beam computed topography scans in surgical planning. These data are an important contribution to the existing literature and valuable in the consent procedure for patients undergoing surgical removal of mandibular third molars in contact with the IAN.
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Affiliation(s)
- Elizabeth Barry
- Oral Surgery, King's College Hospital, London, United Kingdom.
| | - Rebecca Ball
- Oral Surgery, King's College Hospital, London, United Kingdom
| | - Jashme Patel
- Oral Surgery, King's College Hospital, London, United Kingdom
| | | | - Aneesha Shah
- Oral Surgery, King's College Hospital, London, United Kingdom
| | - Andiappan Manoharan
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
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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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Reia VCB, de Toledo Telles-Araujo G, Peralta-Mamani M, Biancardi MR, Rubira CMF, Rubira-Bullen IRF. Diagnostic accuracy of CBCT compared to panoramic radiography in predicting IAN exposure: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:4721-4733. [PMID: 34275000 DOI: 10.1007/s00784-021-03942-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study is to verify whether the diagnostic accuracy of cone beam computed tomography (CBCT) is superior to panoramic radiography (PR) in predicting inferior alveolar nerve (IAN) exposure during the lower third molar extraction. MATERIALS AND METHODS Eight electronic databases were searched up to September 2020. Studies that evaluated the accuracy (sensitivity, specificity, positive-predictive value, and negative predictive value) of both imaging methods were included. The gold standard was the visualization of the IAN exposure during the extraction of lower third molars. The gray literature was also used to include any other paper that might meet the eligibility criteria. The meta-analysis was performed with OpenMeta-Analyst and ReviewManager v.5.3 software. The methodology of the studies was evaluated using QUADAS-2. RESULTS Among the search, three studies met all the eligibility criteria and were included in the qualitative and quantitative synthesis. The meta-analysis was conducted with all included studies. Accuracy values for CBCT were 95.1% for sensitivity (p=0.666) and 64.4% for specificity (p<0.001). For PR sensitivity and specificity, we observed 73.9% (p=0.101) and 24.8% (p<0.001), respectively. CONCLUSIONS Both exams were reliable for detecting positive cases of exposure of the IAN. However, CBCT had a better performance compared to PT in predicting IAN exposure during surgery. CLINICAL RELEVANCE To better understand the CBCT accuracy in predicting the IAN exposure during surgery, since this event can increase the likelihood of IAN injury and, consequently, cause neurosensory disturbances.
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Affiliation(s)
- Veronica Caroline Brito Reia
- Department of Surgery, Stomatology, Pathology, and Radiology, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisola, 9-75, Bauru, São Paulo, 17012-901, Brazil
| | | | - Mariela Peralta-Mamani
- Department of Surgery, Stomatology, Pathology, and Radiology, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisola, 9-75, Bauru, São Paulo, 17012-901, Brazil
| | - Mariel Ruivo Biancardi
- Department of Surgery, Stomatology, Pathology, and Radiology, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisola, 9-75, Bauru, São Paulo, 17012-901, Brazil
| | - Cássia Maria Fischer Rubira
- Department of Surgery, Stomatology, Pathology, and Radiology, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisola, 9-75, Bauru, São Paulo, 17012-901, Brazil
| | - Izabel Regina Fischer Rubira-Bullen
- Department of Surgery, Stomatology, Pathology, and Radiology, Bauru School of Dentistry, University of São Paulo, Alameda Octávio Pinheiro Brisola, 9-75, Bauru, São Paulo, 17012-901, Brazil.
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Yesiltepe S, Kılcı G. Evaluation the relationship between the position and impaction level of the impacted maxillary third molar teeth and marginal bone loss, caries and resorption findings of the second molar teeth with CBCT scans. Oral Radiol 2021; 38:269-277. [PMID: 34255286 DOI: 10.1007/s11282-021-00554-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the relationship between the position and impaction level of the impacted maxillary third molar teeth and marginal bone loss, caries and resorption findings on the distal surface of the second molar teeth with cone beam computerized tomography (CBCT) scans. METHODS All CBCT images of 189 impacted maxillary teeth belonging to 121 patients were examined by an observer. After determining the position and impaction level of the impacted maxillary third molar teeth, presence of caries, resorption and marginal bone loss in the distal of the second molar tooth were evaluated. IBM SPSS Statistics 22.0 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.) was used for statistical analyses and calculations. Data were analysed using the Chi-square test and Fisher's exact test. RESULTS A statistically significant difference was found in terms of the impaction level of the impacted maxillary third molar tooth and the presence of caries in the distal surface of the second molar tooth, in terms of the impaction level of the impacted third molar tooth and the presence of marginal bone loss in the distal surface of the second molar tooth. A similar difference was found in terms of the impaction level of the impacted third molar tooth and the presence of root resorption in the distal surface of the second molar tooth. CONCLUSION These data on the natural history of impacted maxillary third molars may contribute to both more accurate estimates of the risk of complications associated with these teeth and determination of the prophylactic approach to asymptomatic impacted third molars.
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Affiliation(s)
- Selin Yesiltepe
- Department of Oral and Dentomaxillofacial Radiology, Faculty of Dentistry, Aydın Adnan Menderes University, 09100, Aydın, Turkey.
| | - Gulcin Kılcı
- Department of Oral and Dentomaxillofacial Radiology, Faculty of Dentistry, Aydın Adnan Menderes University, 09100, Aydın, Turkey
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Three-Dimensional Classification of Lower Third Molars and Their Relationship to the Mandibular Canal. J Oral Maxillofac Surg 2021; 79:1611-1620. [PMID: 33775651 DOI: 10.1016/j.joms.2021.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To develop a novel classification making full use of radiographic three-dimensional (3D) information to describe the position, geometric configuration of a mandibular third molar (M3M) and its spatial relation to neighboring structures such as the mandibular canal (MC). The classification presented in this study helps to establish a common language and serves as a framework for further studies, for example, on 3D parameters influencing prognosis of the M3M and level of difficulty associated with its removal. MATERIAL AND METHODS A total of 8 parameters were included in the classification including position, the cranio-caudal height, the number of roots of the M3M as well as its spatial relationship to the MC, its course, its deformation, and distance to the M3M. The classification was retrospectively applied to a sample of 483 patients and these data were statistically evaluated. RESULTS The most commonly observed categories were the (+) vertical position (39.8%); the cranio-caudal height A (38.7%); 2 roots (83.2%); and the spatial relationship no contact caudal (37.5%). Contact between the M3M and inferior alveolar nerve was observed in 58% of all cases. A deformation of the MC was found in 81% of cases. CONCLUSIONS Our novel classification aims to provide a more holistic description of parameters defining 3D M3M position, as well as its spatial relation to relevant neighboring structures. It creates a uniform terminology that can be applied in practice by surgeons and radiologists, and also serves as a foundation for further research projects, such that results from similarly designed studies could be compared.
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Bigagnoli S, Greco C, Costantinides F, Porrelli D, Bevilacqua L, Maglione M. CBCT Radiological Features as Predictors of Nerve Injuries in Third Molar Extractions: Multicenter Prospective Study on a Northeastern Italian Population. Dent J (Basel) 2021; 9:dj9020023. [PMID: 33669928 PMCID: PMC7924829 DOI: 10.3390/dj9020023] [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: 01/18/2021] [Revised: 02/04/2021] [Accepted: 02/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Neurological alterations are one of the main complications occurring after the third molar extractions. The aim of this prospective multicenter cohort study was to find out Cone Beam Computed Tomography (CBCT) features and distribution of neurological complications in patients undergoing lower third molar surgery and to determine the radiological and patient-related factors that could be correlated to the occurrence of inferior alveolar and lingual nerves injury. Material and Methods: 378 patients who underwent lower third molar extraction from March 2018 to March 2019 were included. Clinical and radiological data were collected. CBCT features were recorded following Maglione et al. classification. Symptoms and characteristics of patients who experienced neurological alterations were evaluated. Results: 193 patients needed a second-level radiological exam (CBCT). In these patients, the most common feature was Maglione class 3: a higher frequency of apical or buccal mandibular canals in direct contact with the tooth was observed. 3.17% of the patients developed a neurological complication. Maglione class 4, increased age, and operative time were all positively correlated with neurological alterations. Conclusions: while the buccal or apical position of the mandibular canal was the more common findings, the lingual position was found to have a higher correlation with a negative outcome. Age and operative time were also found to be risk factors for developing nerve injury in the considered population.
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Affiliation(s)
- Stefano Bigagnoli
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
| | - Christian Greco
- Unit of Dentistry, Merano Hospital, via Giacomo Rossini 5, 39012 Merano, Italy;
| | - Fulvia Costantinides
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
| | - Davide Porrelli
- Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy;
| | - Lorenzo Bevilacqua
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
- Correspondence:
| | - Michele Maglione
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
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Iwanaga J, Kunisada Y, Masui M, Obata K, Takeshita Y, Sato K, Kikuta S, Abe Y, Matsushita Y, Kusukawa J, Tubbs RS, Ibaragi S. Comprehensive review of lower third molar management: A guide for improved informed consent. Clin Anat 2020; 34:224-243. [DOI: 10.1002/ca.23693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Department of Neurology, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Dental and Oral Medical Center, Kurume University School of Medicine Fukuoka Japan
- Division of Gross and Clinical Anatomy, Department of Anatomy Kurume University School of Medicine Fukuoka Japan
| | - Yuki Kunisada
- Department of Oral and Maxillofacial Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Masanori Masui
- Department of Oral and Maxillofacial Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Kyoichi Obata
- Department of Oral and Maxillofacial Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Yohei Takeshita
- Department of Oral and Maxillofacial Radiology Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Kotaro Sato
- Department of Oral and Maxillofacial Surgery Nagoya University Graduate School of Medicine Nagoya Japan
| | - Shogo Kikuta
- Dental and Oral Medical Center, Kurume University School of Medicine Fukuoka Japan
| | - Yushi Abe
- Dental and Oral Medical Center, Kurume University School of Medicine Fukuoka Japan
| | - Yuki Matsushita
- University of Michigan School of Dentistry Ann Arbor Michigan USA
- Department of Clinical Oral Oncology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Jingo Kusukawa
- Dental and Oral Medical Center, Kurume University School of Medicine Fukuoka Japan
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Department of Neurology, Tulane Center for Clinical Neurosciences Tulane University School of Medicine New Orleans Louisiana USA
- Department of Structural & Cellular Biology Tulane University School of Medicine New Orleans Louisiana USA
- Department of Neurosurgery and Ochsner Neuroscience Institute Ochsner Health System New Orleans Louisiana USA
- Department of Anatomical Sciences St. George's University St. George's Grenada
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
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Hassani A, Rakhshan V, Hassani M, Aghdam HM. Preoperative imaging of the inferior alveolar nerve canal by cone-beam computed tomography and 1-year neurosensory recovery following mandibular setback through bilateral sagittal split ramus osteotomy: a randomized clinical trial. J Korean Assoc Oral Maxillofac Surg 2020; 46:41-48. [PMID: 32158680 PMCID: PMC7049768 DOI: 10.5125/jkaoms.2020.46.1.41] [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: 06/06/2019] [Revised: 07/25/2019] [Accepted: 08/17/2019] [Indexed: 11/09/2022] Open
Abstract
Objectives One of the most common complications of bilateral sagittal split ramus osteotomy (BSSRO) is neurosensory impairment of the inferior alveolar nerve (IAN). Accurate preoperative determination of the position of the IAN canal within the mandible using cone-beam computed tomography (CBCT) is recommended to prevent IAN dysfunction during BSSRO and facilitate neurosensory improvement after BSSRO. Materials and Methods This randomized clinical trial consisted of 86 surgical sites in 43 patients (30 females and 13 males), including 21 cases (42 sides) and 22 controls (44 sides). Panoramic and lateral cephalographs were obtained from all patients. In the experimental group, CBCT was also performed from both sides of the ramus and mandibular body. Neurosensory function of the IAN was subjectively assessed using a 5-point scale preoperatively and 7 days, 1 month, 3 months, 6 months, and 12 months post-surgery. Data were analyzed using Fisher's test, Spearman's test, t-test, linear mixed-model regression, and repeated-measures ANCOVA (α=0.05, 0.01). Results Mean sensory scores in the control group were 1.57, 2.61, 3.34, 3.73, and 4.20 over one year and were 1.69, 3.00, 3.60, 4.19, and 4.48 in the CBCT group. Significant effects were detected for CBCT intervention (P=0.002) and jaw side (P=0.003) but not for age (P=0.617) or displacement extent (P=0.122). Conclusion Preoperative use of CBCT may help surgeons to practice more conservative surgery. Neurosensory deficits might heal faster on the right side.
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Affiliation(s)
- Ali Hassani
- Department of Oral and Maxillofacial Surgery and Implant Research Center, Islamic Azad University, Tehran Dental Branch, Tehran, Iran
| | - Vahid Rakhshan
- Department of Dental Anatomy, Dental School, Islamic Azad University, Tehran, Iran
| | - Mohammad Hassani
- Craniomaxillofacial Research Center, Islamic Azad University, Tehran Dental Branch, Tehran, Iran
| | - Hamidreza Mahaseni Aghdam
- Department of Oral and Maxillofacial Surgery and Implant Research Center, Islamic Azad University, Tehran Dental Branch, Tehran, Iran
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Brasil DM, Nascimento EH, Gaêta-Araujo H, Oliveira-Santos C, Maria de Almeida S. Is Panoramic Imaging Equivalent to Cone-Beam Computed Tomography for Classifying Impacted Lower Third Molars? J Oral Maxillofac Surg 2019; 77:1968-1974. [DOI: 10.1016/j.joms.2019.03.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 11/30/2022]
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Risk stratification against inferior alveolar nerve injury after lower third molar extraction by scoring on cone-beam computed tomography image. Odontology 2019; 108:124-132. [DOI: 10.1007/s10266-019-00438-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/04/2019] [Indexed: 12/18/2022]
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Quirino de Almeida Barros R, Bezerra de Melo N, de Macedo Bernardino Í, Arêa Leão Lopes Araújo Arruda MJ, Meira Bento P. Association between impacted third molars and position of the mandibular canal: a morphological analysis using cone-beam computed tomography. Br J Oral Maxillofac Surg 2018; 56:952-955. [PMID: 30448357 DOI: 10.1016/j.bjoms.2018.10.280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/12/2018] [Indexed: 11/19/2022]
Abstract
Our aim was to assess the association between the angle of impaction of the third molar and the position of the mandibular canal on cone-beam computed tomography (CT). We designed a retrospective study of 100 cone-beam CT images of 173 mandibular third molars that were obtained between January 2012 and December 2015, and recorded the angle of impaction of the third molar, the position of the mandibular canal in relation to the impacted tooth, and the potential contact between the roots of the tooth and the mandibular canal. Most third molars tilted mesially (n=33), while the mandibular canal was positioned below the roots of the third molar in most cases (n=73). Contact between the two was most likely when the mandibular canal was between (RR=1.49; 95% CI 1.27 to 1.75, p<0.001), or to the lingual side (RR=1.49; 95% CI 1.27 to 1.75, p<0.001) of the roots of the tooth. These outcomes indicate a greater likelihood of contact between the canal and the roots when the canal is between, and to the lingual side, of the roots. We found no association between the angle of impaction and the position of the canal. These findings illustrate the importance of surgical planning using complementary imaging tests such as cone-beam CT.
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Affiliation(s)
| | - N Bezerra de Melo
- Department of Dentistry, State University of Paraíba, Campina Grande, Brazil.
| | | | | | - P Meira Bento
- Department of Dentistry, State University of Paraíba, Campina Grande, Brazil.
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de Andrade PF, Silva JNN, Sotto-Maior BS, Ribeiro CG, Devito KL, Assis NMSP. Three-dimensional analysis of impacted maxillary third molars: A cone-beam computed tomographic study of the position and depth of impaction. Imaging Sci Dent 2017; 47:149-155. [PMID: 28989897 PMCID: PMC5620459 DOI: 10.5624/isd.2017.47.3.149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/21/2017] [Accepted: 06/28/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose The classification of impacted maxillary third molars (IMTMs) facilitates interdisciplinary communication and helps estimate the degree of surgical difficulty. Thus, this study aimed to develop a 3-dimensional classification of the position and depth of impaction of IMTMs and to estimate their prevalence with respect to gender and age. Materials and Methods This cross-sectional retrospective study analyzed images in sagittal and coronal cone-beam computed tomography (CBCT) sections of 300 maxillary third molars. The proposed classification was based on 3 criteria: buccolingual position (buccal, lingual, or central), mesial-distal position (mesioangular, vertical, or distoangular), and depth of impaction (low, medium, or high). CBCT images of IMTMs were classified, and the associations of the classifications with gender and age were examined using analysis of variance with the Scheffé post-hoc test. To determine the associations among the 3 classifications, the chi-square test was used (P<.05). Results No significant association of the classifications with gender was observed. Age showed a significant relationship with depth of impaction (P=.0001) and mesial-distal position (P=.005). The most common positions were buccal (n=222), vertical (n=184), and low (n=124). Significant associations among the 3 tested classifications were observed. Conclusion CBCT enabled the evaluation of IMTMs in a 3-dimensional format, and we developed a proposal for a new classification of the position and depth of impaction of IMTMs.
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Affiliation(s)
- Priscila Ferreira de Andrade
- Master's Program in Dental Clinic, Faculty of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Jesca Neftali Nogueira Silva
- Master's Program in Dental Clinic, Faculty of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Bruno Salles Sotto-Maior
- Department of Restorative Dentistry, Faculty of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Cleide Gisele Ribeiro
- Faculty of Medical and Health Sciences - SUPREMA, Juiz de Fora, Minas Gerais, Brazil
| | - Karina Lopes Devito
- Department of Dental Clinic, Faculty of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
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Tachinami H, Tomihara K, Fujiwara K, Nakamori K, Noguchi M. Combined preoperative measurement of three inferior alveolar canal factors using computed tomography predicts the risk of inferior alveolar nerve injury during lower third molar extraction. Int J Oral Maxillofac Surg 2017; 46:1479-1483. [PMID: 28602570 DOI: 10.1016/j.ijom.2017.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 03/30/2017] [Accepted: 05/10/2017] [Indexed: 12/13/2022]
Abstract
A retrospective cohort study was performed to assess the clinical usefulness of combination assessment using computed tomography (CT) images in patients undergoing third molar extraction. This study included 85 patients (124 extraction sites). The relationship between cortication status, buccolingual position, and shape of the inferior alveolar canal (IAC) on CT images and the incidence of inferior alveolar nerve (IAN) injury after third molar extraction was evaluated. IAN injury was observed at eight of the 124 sites (6.5%), and in five of 19 sites (26.3%) in which cortication was absent+the IAC had a lingual position+the IAC had a dumbbell shape. Significant relationships were found between IAN injury and the three IAC factors (cortication status, IAC position, and IAC shape; P=0.0001). In patients with the three IAC factors, logistic regression analysis indicated a strong association between these factors and IAN injury (P=0.007). An absence of cortication, a lingually positioned IAC, and a dumbbell-shaped IAC are considered to indicate a high risk of IAN injury according to the logistic regression analysis (P=0.007). These results suggest that a combined assessment of these three IAC factors could be useful for the improved prediction of IAN injury.
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Affiliation(s)
- H Tachinami
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama City, Toyama, Japan
| | - K Tomihara
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama City, Toyama, Japan.
| | - K Fujiwara
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama City, Toyama, Japan
| | - K Nakamori
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama City, Toyama, Japan; Department of Oral and Maxillofacial Surgery, Regional Independent Administrative Corporation Naha City Hospital, Naha City, Okinawa, Japan
| | - M Noguchi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama City, Toyama, Japan
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Hasani A, Ahmadi Moshtaghin F, Roohi P, Rakhshan V. Diagnostic value of cone beam computed tomography and panoramic radiography in predicting mandibular nerve exposure during third molar surgery. Int J Oral Maxillofac Surg 2016; 46:230-235. [PMID: 27810140 DOI: 10.1016/j.ijom.2016.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/19/2016] [Accepted: 10/07/2016] [Indexed: 01/18/2023]
Abstract
The aim of this study was to evaluate the diagnostic accuracies of cone beam computed tomography (CBCT) and panoramic techniques in predicting inferior alveolar nerve (IAN) exposure. The sample size was determined based on a pilot study. This prospective clinical series study included 59 third molar extraction sites with any of seven previously suggested panoramic signs of IAN exposure. The diagnosis of nerve exposure was done on panoramic and CBCT images. Molars were extracted and nerve exposure was evaluated clinically. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CBCT method, and sensitivity and PPV of panoramic method were estimated). The panoramic and CBCT methods correctly classified 67.7% and 93.3%, respectively, of 60 cases. This difference was statistically significant (χ2=13.333, P=0.000). The sensitivity, specificity, PPV, and NPV for CBCT were 97.4%, 85.7%, 92.7%, and 94.7%, respectively. The sensitivity and PPV of panoramic radiography were 67.8% and 97.6%, respectively. The signs with the highest sensitivity were interruption of the mandibular canal border and abrupt canal narrowing. None of the Pell and Gregory criteria, molar angulations, or three-dimensional canal-apex relationships was significantly associated with clinically confirmed IAN exposure. Panoramic radiography may miss about one-third of exposure cases, but a positive panoramic diagnosis is most likely to be a real exposure and should be taken seriously.
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Affiliation(s)
- A Hasani
- Department of Maxillofacial Surgery, Dental Branch, Islamic Azad University, Tehran, Iran
| | | | - P Roohi
- Private Practice, Tehran, Iran
| | - V Rakhshan
- Department of Dental Anatomy and Morphology, Dental Branch, Islamic Azad University, Tehran, Iran
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Pippi R, Santoro M, D’Ambrosio F. Accuracy of cone-beam computed tomography in defining spatial relationships between third molar roots and inferior alveolar nerve. Eur J Dent 2016; 10:454-458. [PMID: 28042257 PMCID: PMC5166298 DOI: 10.4103/1305-7456.195168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Cone-beam computed tomography (CBCT) has been proposed in surgical planning of lower third molar extraction. The aim of the present study was to assess the reliability of CBCT in defining third molar root morphology and its spatial relationships with the inferior alveolar nerve (IAN). MATERIALS AND METHODS Intraoperative and radiographic variables of 74 lower third molars were retrospectively analyzed. Intraoperative variables included IAN exposure, number of roots, root morphology of extracted third molars, and presence/absence of IAN impression on the root surface. Radiographic variables included presence/absence of the cortex separating IAN from the third molar roots on CBCT examination, number of roots and root morphology on both orthopantomography (OPG) and CBCT. The statistical association between variables was evaluated using the Fisher's exact test. RESULTS In all cases of intraoperative IAN exposure, the cortex appeared discontinuous on CBCT images. All cases, in which the cortical bone was continuous on CBCT images, showed no association with nerve exposure. In all cases in which nerve impression was identified on the root surface, the IAN cortex showed interruptions on CBCT images. No nerve impression was identified in any of the cases, in which the cortex appeared continuous on CBCT images. CBCT also highlighted accessory roots and apical anomalies/curvatures, not visible on the OPG. CONCLUSIONS CBCT seems to provide reliable and accurate information about the third molar root morphology and its relationship with the IAN.
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Affiliation(s)
- Roberto Pippi
- Department of Odontostomatological and Maxillo Facial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Marcello Santoro
- Department of Odontostomatological and Maxillo Facial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Ferdinando D’Ambrosio
- Department of Sensory Organs, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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Jung YH, Cho BH. Assessment of maxillary third molars with panoramic radiography and cone-beam computed tomography. Imaging Sci Dent 2015; 45:233-40. [PMID: 26730371 PMCID: PMC4697008 DOI: 10.5624/isd.2015.45.4.233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 08/21/2015] [Accepted: 09/03/2015] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study investigated maxillary third molars and their relation to the maxillary sinus using panoramic radiography and cone-beam computed tomography (CBCT). MATERIALS AND METHODS A total of 395 maxillary third molars in 234 patients were examined using panoramic radiographs and CBCT images. We examined the eruption level of the maxillary third molars, the available retromolar space, the angulation, the relationship to the second molars, the number of roots, and the relationship between the roots and the sinus. RESULTS Females had a higher frequency of maxillary third molars with occlusal planes apical to the cervical line of the second molar (Level C) than males. All third molars with insufficient retromolar space were Level C. The most common angulation was vertical, followed by buccoangular. Almost all of the Level C molars were in contact with the roots of the second molar. Erupted teeth most commonly had three roots, and completely impacted teeth most commonly had one root. The superimposition of one third of the root and the sinus floor was most commonly associated with the sinus floor being located on the buccal side of the root. CONCLUSION Eruption levels were differently distributed according to gender. A statistically significant association was found between the eruption level and the available retromolar space. When panoramic radiographs showed a superimposition of the roots and the sinus floor, expansion of the sinus to the buccal side of the root was generally observed in CBCT images.
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Affiliation(s)
- Yun-Hoa Jung
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Bong-Hae Cho
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan, Korea
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Petersen LB, Vaeth M, Wenzel A. Neurosensoric disturbances after surgical removal of the mandibular third molar based on either panoramic imaging or cone beam CT scanning: A randomized controlled trial (RCT). Dentomaxillofac Radiol 2015; 45:20150224. [PMID: 26648386 DOI: 10.1259/dmfr.20150224] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE Pre-surgical CBCT has been suggested before removal of the mandibular third molar. Currently, the standard-of-care is two-dimensional (2D) panoramic imaging. The aim of this randomized controlled trial was to analyse possible differences in neurosensoric disturbances of the inferior alveolar nerve between patients undergoing either panoramic imaging or CBCT before surgical removal of the mandibular third molar. Furthermore, the aim was to perform a sensitivity analysis to assess the statistical significance of different assumptions related to sample size calculations. METHODS 230 patients were randomized to a scan group and a non-scan group. All patients were referred from practicing dentists in the Copenhagen area. Inclusion criteria were overlap of the root complex and the mandibular canal on a 2D radiographic image. Central allocation of the randomization code and double blind settings were established. The surgical removal was performed in a specialized surgical practice geographically and personally separated from the study practice. Registration of neurosensoric anomalies was performed with a Semmes-Weinstein test and a visual analogue scale questionnaire pre- and post-surgically. RESULTS In the scan group (n = 114), 21 episodes of neurosensoric disturbances were registered and in the non-scan group (n = 116), 13 episodes of neurosensoric disturbances were registered. There was no statistically significant difference between the two groups (p = 0.14). Performing a sensitivity analysis confirmed that CBCT was not superior to panoramic imaging in avoiding neurosensoric disturbances. CONCLUSIONS The use of CBCT before removal of the mandibular third molar does not seem to reduce the number of neurosensoric disturbances.
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Affiliation(s)
- Lars B Petersen
- 1 Section for Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
| | - Michael Vaeth
- 2 Department of Public Health, Department of Biostatistics, Aarhus University, Aarhus, Denmark
| | - Ann Wenzel
- 1 Section for Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
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