Abstract
BackgroundPreoperative radiographic examination of impacted mandibular third molars (IMTM) is essential to prevent inferior alveolar nerve injury during extraction. The purpose of this study was to evaluate the correlation between cone-beam computed tomography (CBCT) and digital panoramic radiography (DPR) findings in preoperative examination of IMTM.MethodsThis retrospective study included 298 teeth in 191 individuals. The relationship between the inferior alveolar canal (IAC) and the IMTM (buccal, lingual, interradicular or inferior), the position of the IMTM with respect to the IAC (contact, no contact), the morphologic shape of the mandible in the IMTM region (round, lingual extended, lingual concave), the type of IMTM (vertical, horizontal or angular) and the number of roots of the IMTM were evaluated on CBCT images. DPR images were evaluated for the number of roots of the IMTM and for the most common radiographic findings indicating a relationship between the IAC and the IMTM (darkening of the roots, diversion of the IAC, narrowing of the IAC and interruption of the white line). Data were statistically analyzed with Cramer V coefficient, Kappa statistic, chi-square and Fisher’s exact test.ResultsThere was a significant difference in number of roots detected on DPR versus CBCT images. There was a significant association between the type of IMTM and the morphologic shape of the mandible on CBCT images. Darkening of the roots and interruption of the white line on DPR images were significantly associated with the presence of contact between the IMTM and the IAC on CBCT images.ConclusionsPanoramic radiography is inadequate, whereas CBCT is useful to detect multiple roots of IMTM. When darkening of the roots and interruption of the white line are observed on panoramic images, there is increased likelihood of contact between the IMTM and the IAC. CBCT is required in these cases.
Highlights
Preoperative radiographic examination of impacted mandibular third molars (IMTM) is essential to prevent inferior alveolar nerve injury during extraction
There was a significant association between darkening of the roots and interruption of the white line on digital panoramic radiography (DPR) images and the presence of contact between the IMTM and the inferior alveolar canal (IAC) on cone-beam computed tomography (CBCT) images (p < 0.05)
No significant association was found between other variables on DPR images and the position of the IAC-IMTM on CBCT images (p > 0.05; Table 2)
Summary
Preoperative radiographic examination of impacted mandibular third molars (IMTM) is essential to prevent inferior alveolar nerve injury during extraction. The purpose of this study was to evaluate the correlation between cone-beam computed tomography (CBCT) and digital panoramic radiography (DPR) findings in preoperative examination of IMTM. Extraction of impacted mandibular third molars (IMTM) is a routine procedure in oral surgery, with several possible postoperative complications [1]. Accurate assessment of the relationship between the IMTM and the IAC before surgery is necessary to avoid IAN injury [16]. Panoramic images are sufficient for preoperative assessment of IMTM; this technique cannot provide any information about the buccolingual direction [18]. Assessment of the buccolingual direction is very important for cases in which the IMTM and the IAC are in close proximity [18,19]. Three-dimensional (3D) imaging with conventional computed tomography and cone-beam computed tomography (CBCT) is recommended in these cases to detect the exact relationship [18]
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