Browse > Article
http://dx.doi.org/10.5624/isd.20200095

Reliability of panoramic radiography in predicting proximity of third molars to the mandibular canal: A comparison using cone-beam computed tomography  

Nunes, Willy James Porto (Department of Clinical Dentistry, Federal University of Juiz de Fora)
Vieira, Aline Lisboa (Department of Clinical Dentistry, Federal University of Juiz de Fora)
de Abreu Guimaraes, Leticia Drumond (Department of Stomatology, University of Sao Paulo)
de Alcantara, Carlos Eduardo Pinto (Department of Oral and Maxillofacial Surgery, Federal University of Juiz de Fora)
Verner, Francielle Silvestre (Department of Oral and Maxillofacial Radiology, Federal University of Juiz de Fora)
de Carvalho, Matheus Furtado (Department of Oral and Maxillofacial Surgery, Federal University of Juiz de Fora)
Publication Information
Imaging Science in Dentistry / v.51, no.1, 2021 , pp. 9-16 More about this Journal
Abstract
Purpose: The purpose of this study was to analyze the reliability of 7 panoramic radiographic signs for predicting proximity of the root apices of mandibular third molars to the mandibular canal using cone-beam computed tomography and to correlate these findings with the Pell and Gregory and the Winter classification systems. Materials and Methods: An observational, cross-sectional, descriptive study was conducted on 74 patients with bilateral impacted mandibular third molars. Four panoramic radiographic signs were observed in the tooth root (darkening, deflection, and narrowing of the root apices, and bifid apices), and another 3 in the mandibular canal (diversion, narrowing, and interruption of the mandibular canal). Cone-beam computed tomography images were analyzed to identify disruption and diversion of the mandibular canal and root deflection. Results: Binary logistic regression showed that only 4 of the 7 panoramic radiographic signs were able to predict proximity of the root apices of the mandibular third molars to the mandibular canal: darkening of the root, deflection of the root, narrowing of the root, and interruption of the mandibular canal(P<0.05). Conclusion: Darkening, deflection, and narrowing of the root, in tandem with the interruption of the mandibular canal on panoramic radiographs, indicate that cone-beam computed tomography should be performed when planning the extraction of impacted mandibular third molars. Proximity between mandibular third molars and the mandibular canal is correlated with the Winter classification.
Keywords
Cone-beam Computed Tomography; Mandibular Nerve; Radiography, Panoramic; Third Molar;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Gomes AC, Vasconcelos BC, Silva ED, Caldas Ade F Jr, Pita Neto IC. Sensitivity and specificity of pantomography to predict inferior alveolar nerve damage during extraction of impacted lower third molars. J Oral Maxillofac Surg 2008; 66: 256-9.   DOI
2 Peker I, Sarikir C, Alkurt MT, Zor ZF. Panoramic radiography and cone-beam computed tomography findings in preoperative examination of impacted mandibular third molars. BMC Oral Health 2014; 14: 71.   DOI
3 Leung YY, Cheung LK. Correlation of radiographic signs, inferior dental nerve exposure, and deficit in third molar surgery. J Oral Maxillofac Surg 2011; 69: 1873-9.   DOI
4 Blaeser BF, August MA, Donoff RB, Kaban LB, Dodson TB. Panoramic radiographic risk factors for inferior alveolar nerve injury after third molar extraction. J Oral Maxillofac Surg 2003; 61: 417-21.   DOI
5 Kim JW, Cha IH, Kim SJ, Kim MR. Which risk factors are associated with neurosensory deficits of inferior alveolar nerve after mandibular third molar extraction? J Oral Maxiilofac Surg 2012; 70: 2508-14.   DOI
6 Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C. Inferior alveolar nerve damage after lower third molar surgical extraction: a prospective study of 1117 surgical extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 92: 377-83.   DOI
7 Blackburn CW, Bramley PA. Lingual nerve damage associated with the removal of lower third molars. Br Dent J 1989; 167: 103-7.   DOI
8 Carmichael FA, McGowan DA. Incidence of nerve damage following third molar removal: a West of Scotland Oral Surgery Research Group study. Br J Oral Maxillofac Surg 1992; 30: 78-82.   DOI
9 Wang D, Lin T, Wang Y, Sun C, Yang L, Jiang H, et al. Radiographic features of anatomic relationship between impacted third molar and inferior alveolar canal on coronal CBCT images: risk factors for nerve injury after tooth extraction. Arch Med Sci 2018; 14: 532-40.   DOI
10 Carter K, Worthington S. Predictors of third molar impaction: a systematic review and meta-analysis. J Dent Res 2016; 95: 267-76.   DOI
11 Sarikov R, Juodzbalys G. Inferior alveolar nerve injury after mandibular third molar extraction: a literature review. J Oral Maxillofac Res 2014; 5: e1.
12 Rood JP, Shehab BA. The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg 1990; 28: 20-5.   DOI
13 Nakayama K, Nonoyama M, Takaki Y, Kagawa T, Yuasa K, Izumi K, et al. Assessment of the relationship between impacted mandibular third molars and inferior alveolar nerve with dental 3-dimensional computed tomography. J Oral Maxillofac Surg 2009; 67: 2587-91.   DOI
14 Pell GJ, Gregory GT. Impacted third molars: classification and modified technique for removal. Dent Digest 1933; 39: 330-8.
15 Winter GB. Principles of exodontia as applied to the impacted mandibular third molars; a complete treatise on the operative technic with clinical diagnoses and radiographic interpretation. St Louis: American Medical Book Co; 1926.
16 Guerrero ME, Nackaerts O, Beinsberger J, Horner K, Schoenaers J, Jacobs R, et al. Inferior alveolar nerve sensory disturbance after impacted mandibular third molar evaluation using cone beam computed tomography and panoramic radiography: a pilot study. J Oral Maxillofac Surg 2012; 70: 2264-70.   DOI
17 Cheung LK, Leung YY, Chow LK, Wong MC, Chan EK, Fok YH. Incidence of neurosensory deficits and recovery after lower third molar surgery: a prospective clinical study of 4338 cases. Int J Oral Maxillofac Surg 2010; 39: 320-6.   DOI
18 Huang CK, Lui MT, Cheng DH. Use of panoramic radiography to predict postsurgical sensory impairment following extraction of impacted mandibular third molars. J Chin Med Assoc 2015; 78: 617-22.   DOI
19 Patel V, Moore S, Sproat C. Coronectomy - oral surgery's answer to modern day conservative dentistry. Br Dent J 2010; 209: 111-4.   DOI
20 Shahidi S, Zamiri B, Bronoosh P. Comparison of panoramic radiography with cone beam CT in predicting the relationship of the mandibular third molar roots to the alveolar canal. Imaging Sci Dent 2013; 43: 105-9.   DOI
21 Costa FW, Fontenele EH, Bezerra TP, Ribeiro TR, Carneiro BG, Soares EC. Correlation between radiographic signs of third molar proximity with inferior alveolar nerve and postoperative occurrence of neurosensory disorders: a prospective, doubleblind study. Acta Cir Bras 2013; 28: 221-7.   DOI
22 Ahmad M, Jenny J, Downie M. Application of cone beam computed tomography in oral and maxillofacial surgery. Aust Dent J 2012; 57 Suppl 1: 82-94.   DOI
23 Ghai S, Choudhury S. Role of panoramic imaging and cone beam CT for assessment of inferior alveolar nerve exposure and subsequent paresthesia following removal of impacted mandibular third molar. J Maxillofac Oral Surg 2018; 17: 242-7.   DOI