Does a preoperative cone beam CT reduce complication rates in the surgical removal of complex lower third molars? A retrospective study including 486 cases.
Cone-Beam Computed Tomography
Humans
Mandible
/ diagnostic imaging
Mandibular Nerve
/ diagnostic imaging
Molar, Third
/ diagnostic imaging
Radiography, Panoramic
Retrospective Studies
Tooth Extraction
/ adverse effects
Tooth, Impacted
/ diagnostic imaging
Trigeminal Nerve Injuries
/ prevention & control
Cone-beam computed tomography
Extraction
Inferior alveolar nerve
Radiography
Third molar
Journal
Head & face medicine
ISSN: 1746-160X
Titre abrégé: Head Face Med
Pays: England
ID NLM: 101245792
Informations de publication
Date de publication:
14 Aug 2021
14 Aug 2021
Historique:
received:
30
05
2020
accepted:
24
05
2021
entrez:
14
8
2021
pubmed:
15
8
2021
medline:
18
8
2021
Statut:
epublish
Résumé
This 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. In 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. In 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. Three-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.
Identifiants
pubmed: 34389020
doi: 10.1186/s13005-021-00271-5
pii: 10.1186/s13005-021-00271-5
pmc: PMC8364039
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
33Informations de copyright
© 2021. The Author(s).
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