Using cone beam computed thomography in planning the extraction of impacted third molars

Abstract

The panoramic radiography is the most used diagnostic imaging method in planning impacted lower third molar extractions. However, often panoramic radiography does not provide enough information in treatment planning for performing safely surgical extraction of impacted third molars. CBCT (Cone beam computed tomography) provides more precise information in diagnostic analysis especially for planning surgical procedures where complications can be expected due to close relationship between mandibular canal and lower impacted third molars. The aim of this study is comparative analysis of panoramic radiography and CBCT in evaluating the topographic relationship between mandibular canal and impacted third molars. The study included 50 patients with close relationship between mandibular canal and impacted third molars detected using panoramic radiography. After panoramic radiography analysis CBCT was performed in order to diagnose, plan and prevent complications during the surgical tooth extraction. CBCT examination considered comparative analysis with panoramic radiography, marking, volume rendering and assessment of mandibular canal in buccolingual direction. Out of total patients where suprimposition of mandibular canal and impacted third molar on panoramic radiography was detected, in 32 patients mandibular chanal was localised on lingual side. Mandibular canal was positioned at bucal side in 18 of 50 patients. Results of this research indicate that panoramic radiography can be useful in everyday practice for diagnosis, planning and preparing lower third molar extractions, but in cases where close relationship between mandibular canal and lower third molars is detected CBCT is recommended as more precise radiographic imaging method in order to prevent complications.