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.
Highlights
Neurological alterations after third molar extractions are one of the main concerns among oral surgeons
Third molars are positioned closely, and sometimes almost in contact, to at least three branches of the mandibular nerve: lingual nerve (LN), inferior alveolar nerve (IAN), and buccal nerve (BN) are sensitive branches that can be involved in a third molar extraction
The characteristics of patients divided into two groups
Summary
Neurological alterations after third molar extractions are one of the main concerns among oral surgeons. The spatial relation of the third molar crowns and roots represents a major challenge for the surgeon, who must take care of these important structures in all surgical procedures An injury to these branches can result in an array of clinical presentations, from a temporary mild numbness of a small area to a permanent great painful discomfort of a wide anatomical region. This is mainly because these nerves can be injured in many ways, from postoperative swelling compression to cutting bur shearing [1].
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