World Journal of Dentistry

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VOLUME 9 , ISSUE 6 ( November-December, 2018 ) > List of Articles

ORIGINAL RESEARCH

Reliability of the Panoramic Imaging Compared to Cone-beam Computed Tomography in Determining the Relationship of the Third Molar to the Mandibular Canal

Farah AM Azahar, Aung L Oo, Phrabhakaran Nambiar, Sathick Manzoor, Nisreen M AL-Namnam

Keywords : Cone-beam computed tomography, Dental panoramic tomography, Inferior alveolar canal mandibular, Third molar tooth

Citation Information : Azahar FA, Oo AL, Nambiar P, Manzoor S, AL-Namnam NM. Reliability of the Panoramic Imaging Compared to Cone-beam Computed Tomography in Determining the Relationship of the Third Molar to the Mandibular Canal. World J Dent 2018; 9 (6):481-488.

DOI: 10.5005/jp-journals-10015-1584

License: CC BY-NC 4.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: The incidence of injury to the inferior alveolar nerve during mandibular molar extraction increased the demand for pre-surgical planning to avoid any complications. Aim: To investigate the diagnostic accuracy of the dental panoramic image compared to cone-beam computed tomography (CBCT) in predicting the inferior alveolar nerve (IAN) exposure during impacted third molar extraction. Materials and methods: This is a prospective study of consecutive patients, consulted for third molar extraction under local anesthesia. Thirty-two patients showed sign of proximity of the roots of the third molars to the mandibular canal from the dental panoramic image, were selected for CBCT. Results: With respect to the interobserver reliability, no significant difference (p < 0.05) was observed for the prediction on nerve exposure and injury from the dental panoramic image, however, showed a significant difference (p = 0.001) for the cone-beam computed tomography. The prevalence of contact between the third molar to the inferior alveolar canal (IAC) was 96.8% with a significant finding p = 0.002. There was a significant difference in the loss of cortex in predicting nerve exposure with p = 0.04. Clinically, three patients had nerve exposure and two patients had neurosensory disturbances. Conclusion: Dental panoramic image is still valuable for predicting the proximity of the third molar to the inferior alveolar canal. Nevertheless, CBCT has the best precision in localizing the close contact between the third molar and the inferior alveolar canal. Clinical significance: There was no significant finding from the CBCT for the incidence of the inferior alveolar nerve exposure and injury. However, it was seen to be accurate in predicting the IAN exposure. All these findings prove that cone-beam computed tomography contributes in the surgical plan, reduced operative time and patient morbidity.


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  1. Robert RC, Bacchetti P, Pogrel MA. Frequency of trigeminal nerve injuries following third molar removal. J Oral Maxillofac Surg 2005;63:732-735.
  2. Ohman A, Kivijarvi K, Blomback U, Flygare L. Pre-operative radiographic evaluation of lower third molars with computed tomography. Dentomaxillofac Radiol 2006;35:30-35.
  3. Rood JP, Shehab BA. The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg 1990;28:20-25.
  4. Hill CM, Mostafa P, Thomas DW, Newcombe RG, Walker RV. Nerve morbidity following wisdom tooth removal under local and general anaesthesia. Br J Oral Maxillofac Surg 2001; 39:419-422.
  5. Zuniga JR, Meyer RA, Gregg JM, Miloro M, Davis LF. The accuracy of clinical neurosensory testing for nerve injury diagnosis. J Oral Maxillofac Surg 1998;56:2-8.
  6. Dessouky R, Xi Y. Role of MR Neurography for the Diagnosis of Peripheral Trigeminal Nerve Injuries in Patients with Prior Molar Tooth Extraction. AJNR Am J Neuroradiol 2018;39:162-169.
  7. Friedland B, Donoff B, Dodson TB. The use of 3-dimensional reconstructions to evaluate the anatomic relationship of the mandibular canal and impacted mandibular third molars. J Oral Maxillofac Surg 2008;66:1678-1685.
  8. Bell GW. Use of dental panoramic tomographs to predict the relation between mandibular third molar teeth and the inferior alveolar nerve. Radiological and surgical findings, and clinical outcome. Br J Oral Maxillofac Surg 2004;42:21-27.
  9. Kipp DP, Goldstein BH, Weiss WWJR. Dysesthesia after mandibular third molar surgery: a retrospective study and analysis of 1,377 surgical procedures. J Am Dent Assoc 1980; 100:185-192.
  10. Szalma J, Lempel E, Jeges S, Szabo G, Olasz L. The prognostic value of panoramic radiography of inferior alveolar nerve damage after mandibular third molar removal: retrospective study of 400 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:294-302.
  11. Blaeser BF, August MA, Donoff RB, Kaban LB, Dodson TB. Panoramic radiographic risk factors for inferior alveolar nerve injury after third molar extraction. J Oral Maxillofac Surg 2003;61:417-421.
  12. Sedaghatfar M, August MA, Dodson TB. Panoramic radiographic findings as predictors of inferior alveolar nerve exposure following third molar extraction. J Oral Maxillofac Surg 2005;63:3-7.
  13. Bundy MJ, CF Cavola, Dodson TB. Panoramic radiographic findings as predictors of mandibular nerve exposure following third molar extraction: digital versus conventional radiographic techniques. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e36-40.
  14. Tantanapornkul W, Okochi K, Bhakdinaronk A, Ohbayashi N, Kurabayashi T. Correlation of darkening of impacted mandibular third molar root on digital panoramic images with cone beam computed tomography findings. Dento- Maxillo-Facial Radiology 2009;38:11-16.
  15. Pandey R, Ravindran C, Pandiyan D, Gupta A, Aggarwal A, Aryasri S. Assessment of Roods and Shehab criteria if one or more radiological signs are present in orthopantomogram and position of the mandibular canal in relation to the third molar apices using cone beam computed tomography: a radiographic study. Tanta Dental Journal 2018;15:33-38.
  16. Ali AS, Benton JA, Yates JM. Risk of inferior alveolar nerve injury with coronectomy vs surgical extraction of mandibular third molars-A comparison of two techniques and review of the literature. J Oral Rehabil 2018;45:250-257.
  17. Monaco G, Montevecchi M, Bonetti GA, Gatto MR, Checchi L. Reliability of panoramic radiography in evaluating the topographic relationship between the mandibular canal and impacted third molars. J Am Dent Assoc 2004;135:312-318.
  18. Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Berge SJ. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg 2009;38:964-971.
  19. Wenzel A. It is not clear whether commonly used radiographic markers in panoramic images possess predictive ability for determining the relationship between the inferior alveolar nerve and the mandibular third molar. J Evid Based Dent Pract 2010;10:232-234.
  20. Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C. Inferior alveolar nerve damage after lower third molar surgical extraction: a prospective study of 1117 surgical extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92: 377-383.
  21. Tantanapornkul W, Okouchi K, Fujiwara Y, Yamashiro M, Maruoka Y, Ohbayashi N et al. A comparative study of conebeam computed tomography and conventional panoramic radiography in assessing the topographic relationship between the mandibular canal and impacted third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:253-259.
  22. Feras Yabroudi SSP. Cone Beam Tomography (CBCT) as a Diagnostic Tool to Assess the Relationship between the Inferior Alveolar Nerve and Roots of Mandibular Wisdom Teeth. Smile Dental Journal 2012;7:12-17.
  23. Nakagawa Y, Ishii H, Nomura Y, Watanabe NY, Hoshiba D, Kobayashi et al. Third molar position: reliability of panoramic radiography. J Oral Maxillofac Surg 2007;65:1303-1308.
  24. Quereshy FA, Savell TA, Palomo JM. Applications of cone beam computed tomography in the practice of oral and maxillofacial surgery. J Oral Maxillofac Surg 2008;66: 791-796.
  25. Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Berge SJ. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg 2009;38:964-971.
  26. Maegawa H, Sano K, Kitagawa Y, Ogasawara T, Miyauchi K, Sekine J et al. Preoperative assessment of the relationship between the mandibular third molar and the mandibular canal by axial computed tomography with coronal and sagittal reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:639-646.
  27. Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Vlijmen OJ et al. The use of cone beam CT for the removal of wisdom teeth changes the surgical approach compared with panoramic radiography: a pilot study. Int J Oral Maxillofac Surg 2011;40:834-839.
  28. Ziccardi VB, Zuniga JR. Nerve injuries after third molar removal. Oral Maxillofac Surg Clin North Am 2007;19:105-115.
  29. Sharma R, Srivastava A, Chandramala R. Nerve injuries related to mandibular third molar extractions. E-Journal of Dentistry 2012;2:146.
  30. Bello SA, Adeyemo WL, Bamgbose BO, Obi EV, Adeyinka AA. Effect of age, impaction types and operative time on inflammatory tissue reactions following lower third molar surgery. Head Face Med 2011;7-8.
  31. Benediktsdottir IS, Wenzel A, Petersen JK, Hintze H. Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:438-446.
  32. Smith AC, Barry SE, Chiong AY, Hadzakis D, Kha SL, Mok SC et al. Inferior alveolar nerve damage following removal of mandibular third molar teeth. A prospective study using panoramic radiography. Aust Dent J 1997;42:149-152.
  33. Shepherd JP, Brickley M. Activity analysis: measurement of the effectiveness of surgical training and operative technique. Ann R Coll Surg Engl 1992;74:417.
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