Correlation of Panoramic Radiological and Intra-Operative Findings of Impacted Mandibular 3rd Molar in Relation to Inferior Alveolar Canal: A Prospective Study.

Abstract

The objective of this study was to correlate the preoperative radiological findings and intraoperative surgical findings during removal of impacted mandibular 3rd molar with respect to the inferior alveolar canal. The prospective study design included 100 patients between the age group of 20years and 50years who visited the Department of Oral and Maxillofacial Surgery at Vydehi Institute of Dental Sciences and Research Centre, Whitefield, Bengaluru. A preoperative panoramic radiograph was taken and the parameters were assessed and a normal surgical protocol was followed to extract the impacted mandibular 3rd molar with intra-operative assessment as well. Out of the 100 patients with definitive radiological signs showing close relation of the third molar to the mandibular canal who underwent surgical removal, only 12 patients presented with definitive clinical findings of the association. A true close relationship between the third molars and mandibular canal increases the risk of inferior alveolar nerve injury, and accurate evaluation of the relationship is essential to avoid the risk of surgery. The accuracy of the plain radiographs to diagnose an intimate relationship between the neurovascular bundle and the third molar root has its limitations, since only 12 of the 100 patients with positive radiological signs showed clinical evidence of involvement. Surgeons should be aware of the limitations of the radiographic markers of panoramic radiography and should consider more detailed imaging in more specific cases in which one or more radiographic marker is present.