Abstract
BackroundThis study was designed to analyse the value of preoperative Cone Beam CTs (CBCT) prior to the surgical removal of complex lower third molars. Furthermore, the aim was to assess injuries to the inferior alveolar nerve (IAN) bundle and postoperative neurological disorders depending on the position of the lower third molar and the inferior alveolar nerve bundle.MethodsIn this retrospective examination preoperative Cone Beam CTs and Orthopantomographs (OPT) of 324 patients were analysed concerning the location of the lower third molars in relation to the mandible and the inferior alveolar nerve bundle. Surgery protocols of all patients who underwent the surgical removal of at least one complex lower third molar were analysed concerning patient data, length of surgery, intraoperative haemorrhage, intraoperative exposure of the inferior alveolar nerve bundle, postoperative swelling and postoperative neurological disorders. The data was then compared to data from international studies.ResultsIn all 324 patients a permanent neurological damage was not found. Temporary neurological damage was recorded in 13 cases (2.6%). A caudal nerve position with no measurable distance to the root of the lower third molar was associated with the highest risk of a temporal neurological damage. A vestibular touching nerve route also correlated with postoperative sensitivity impairment. If a mesioangulation (Winter) or a Pell and Gregory Type IIIC appears in the OPT, risk of neurological damage is at its highest.ConclusionsThree-dimensional radiographic imaging, in our patient group, does not significantly affect the risk for complications during the surgical removal of complex lower third molars. Therefore, it should only be utilized for risk assessment, especially in cases of symptom-free lower third molars.A preoperative orthopantomogram still can be accepted as standard for radiographic imaging.An intraoperative exposure of the IAN bundle does not necessarily predict simultaneous neurological damage. Exposure of the IAN bundle is no indication for a discontinuation of the surgery.
Highlights
The surgical removal of lower third molars is one of the most common procedures in dentomaxillofacial surgery and has been done for over a century [1]
The mostly feared complication during osteotomy is the damage of the inferior alveolar nerve (IAN) bundle with a permanent neurological damage
The aim of this study was to analyse the value of preoperative Cone Beam CTs (CBCT) prior to the surgical removal of complex lower third molars
Summary
The surgical removal of lower third molars is one of the most common procedures in dentomaxillofacial surgery and has been done for over a century [1]. The mostly feared complication during osteotomy is the damage of the inferior alveolar nerve (IAN) bundle with a permanent neurological damage. The route of the IAN to the third molar root is very important for the operation plan. When the IAN have tight contact to the roots of the third molar the Coronectomy can be a possible choice for the operation to provide neurological deficits. It is possible to cut the third molar in different pieces to protect the IAN bundle. The more precise the preoperative informations about the course of the IAN is the better the operation can be planed
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