Assessment of Panoramic Radiographic Variables as Predictors of Inferior Alveolar Nerve Injury During Third Molar Extraction
Keywords:
Surgery, Oral;, Molar, Third, Radiography, DentalAbstract
Objective: To assess the role of radiological predictive markers on orthopantomogram for inferior alveolar nerve (IAN) injury related to the removal of mandibular third molar surgery and the occurrence of post-operative IAN paresthesia. Material and Methods: This prospective observational study was conducted on 60 patients (aged 17-35 years) indicated for extraction and showed one or more of the seven previously known panoramic radiographic risk signs of IAN injury. Variables such as age, sex, tooth angulation, and relationship with the inferior alveolar canal (IAC) were assessed to see their outcome on IAN injury. Data analysis is presented through tables and descriptive methods. Results: Among patients, 26 were male and 34 were female, with a mean age of 26.17 years. Out of seven radiological predictive markers, only six were found in this study, whereas one marker, viz. interruption of white line of the canal was not found. After surgical removal of the lower third molar, only two patients with radiographic signs showing the deflection of roots and darkening of roots continued with sensory deficit 5 weeks post-operatively. Conclusion: The risk of inferior alveolar nerve injury during lower third molar surgery is very low, even in patients with radiological predictive markers.
References
Liu W, Yin W, Zhang R, Li J, Zheng Y. Diagnostic value of panoramic radiography in predicting inferior alveolar nerve injury after mandibular third molar extraction: a meta-analysis. Aust Dent J 2015; 60(2):233-9. https://doi.org/10.1111/adj.12326
Tassoker M. Diversion of the mandibular canal: is it the best predictor of inferior alveolar nerve damage during mandibular third molar surgery on panoramic radiographs? Imaging Sci Dent 2019; 49(3):213-8. https://doi.org/10.5624/isd.2019.49.3.213
Pathak S, Mishra N, Rastogi MK, Sharma S. Significance of radiological variables studied on orthopantomogram to predict post-operative inferior alveolar nerve paresthesia after third molar extraction. J Clin Diagn Res 2014; 8(5):ZC62-4. https://doi.org/10.7860/JCDR/2014/8392.4399
Elkhateeb SM, Awad SS. Accuracy of panoramic radiographic predictor signs in the assessment of proximity of impacted third molars with the mandibular canal. J Taibah Univ Med Sci 2018; 13(3):254-61. https://doi.org/10.1016/j.jtumed.2018.02.006
Su N, van Wijk A, Berkhout E, Sanderink G, De Lange J, Wang H, et al. Predictive value of panoramic radiography for injury of inferior alveolar nerve after mandibular third molar surgery. J Oral Maxillofac Surg 2017; 75(4):663-79. https://doi.org/10.1016/j.joms.2016.12.013
Deshpande P, V Guledgud M, Patil K. Proximity of impacted mandibular third molars to the inferior alveolar canal and its radiographic predictors: a panoramic radiographic study. J Maxillofac Oral Surg 2013; 12(2):145-51. https://doi.org/10.1007/s12663-012-0409-z
Rood JP, Shehab BA. The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg 1990; 28(1):20-5. https://doi.org/10.1016/0266-4356(90)90005-6
Monaco G, Montevecchi M, Bonetti GA, Gatto MR, Checchi L. Reliability of panoramic radiography in evaluating the topographic relationship between the mandibular canal and impacted third molars. J Am Dent Assoc 2004; 135(3):312-8. https://doi.org/10.14219/jada.archive.2004.0179
Nakagawa Y, Ishii H, Nomura Y, Watanabe NY, Hoshiba D, Kobayashi K, Ishibashi K. Third molar position: reliability of panoramic radiography. J Oral Maxillofac Surg 2007; 65(7):1303-8. https://doi.org/10.1016/j.joms.2006.10.028
Sedaghatfar M, August MA, Dodson TB. Panoramic radiographic findings as predictors of inferior alveolar nerve exposure following third molar extraction. J Oral Maxillofac Surg 2005; 63(1):3-7. https://doi.org/10.1016/j.joms.2004.05.217
Bell GW. Use of dental panoramic tomographs to predict the relation between mandibular third molar teeth and the inferior alveolar nerve. Radiological and surgical findings, and clinical outcome. Br J Oral Maxillofac Surg 2004; 42(1):21-7. https://doi.org/10.1016/s0266-4356(03)00186-4
Palma-Carrio C, Garcia-Mira B, Larrazabal-Moron C, Penarrocha-Diago M. Radiographic signs associated with inferior alveolar nerve damage following lower third molar extraction. Med Oral Patol Oral Cir Bucal 2010; 15(6):e886-90. https://doi.org/10.4317/medoral.15.e886
Winter GB. Principles of exodontia as applied to the impacted third molar. St Louis: American Medical Books; 1926.
Queral-Godoy E, Valmaseda-Castellón E, Berini-Aytes L, Gay-Escoda C. Incidence and evolution of inferior alveolar nerve lesions following lower third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 99(3):259-64. https://doi.org/10.1016/j.tripleo.2004.06.001
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(4):377-83. https://doi.org/10.1067/moe.2001.118284
Renton T, Hankins M, Sproate C, McGurk M. A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars. Br J Oral Maxillofac Surg 2005; 43(1):7-12. https://doi.org/10.1016/j.bjoms.2004.09.002
Xu GZ, Yang C, Fan XD, Yu CQ, Cai XY, Wang Y, et al. Anatomic relationship between impacted third mandibular molar and the mandibular canal as the risk factor of inferior alveolar nerve injury. Br J Oral Maxillofac Surg 2013; 51(8):e215-9. https://doi.org/10.1016/j.bjoms.2013.01.011
Kim HJ, Jo YJ, Choi JS, Kim HJ, Kim J, Moon SY. Anatomical risk factors of inferior alveolar nerve injury association with surgical extraction of mandibular third molar in Korean population. Applied Sciences 2021; 11(2):816. https://doi.org/10.3390/app11020816
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(2):242-247. https://doi.org/10.1007/s12663-017-1026-7
Tantanapornkul W, Okouchi K, Fujiwara Y, Yamashiro M, Maruoka Y, Ohbayashi N, et al. A comparative study of cone-beam computed tomography and conventional panoramic radiography in assessing the topographic relationship between the mandibular canal and impacted third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103(2):253-9. https://doi.org/10.1016/j.tripleo.2006.06.060
Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Vlijmen OJ, et al. The use of cone beam CT for the removal of wisdom teeth changes the surgical approach compared with panoramic radiography: a pilot study. Int J Oral Maxillofac Surg 2011; 40(8):834-9. https://doi.org/10.1016/j.ijom.2011.02.032
Jun SH, Kim CH, Ahn JS, Padwa BL, Kwon JJ. Anatomical differences in lower third molars visualized by 2D and 3D X-ray imaging: clinical outcomes after extraction. Int J Oral Maxillofac Surg 2013; 42(4):489-96. https://doi.org/10.1016/j.ijom.2012.12.005
Peixoto LR, Gonzaga AK, Melo SL, Pontual ML, Pontual Ados A, de Melo DP. The effect of two enhancement tools on the assessment of the relationship between third molars and the inferior alveolar canal. J Craniomaxillofac Surg 2015; 43(5):637-42. https://doi.org/10.1016/j.jcms.2015.03.008
Szalma J, Lempel E, Jeges S, Szabo G, Olasz L. The prognostic value of panoramic radiography of inferior alveolar nerve damage after mandibular third molar removal: retrospective study of 400 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109(2):294-302. https://doi.org/10.1016/j.tripleo.2009.09.023
Susarla SM, Dodson TB. Preoperative computed tomography imaging in the management of impacted mandibular third molars. J Oral Maxillofac Surg 2007; 65(1):83-8. https://doi.org/10.1016/j.joms.2005.10.052
Janovics K, Soós B, Tóth Á, Szalma J. Is it possible to filter third molar cases with panoramic radiography in which roots surround the inferior alveolar canal? A comparison using cone-beam computed tomography. J Craniomaxillofac Surg 2021; 49(10):971-979. https://doi.org/10.1016/j.jcms.2021.05.003
Pippi R. A case of inferior alveolar nerve entrapment in the roots of a partially erupted mandibular third molar. J Oral Maxillofac Surg 2010; 68(5):1170-3. https://doi.org/10.1016/j.joms.2009.10.007
Chopra R, Patel D, Sproat C, Patel V. Identifying the Polo® mint mandibular third molar: a case series. Oral Surg 2019; 12:89-95. https://doi.org/10.1111/ors.12387
Rud J. Third molar surgery: relationship of root to mandibular canal and injuries to the inferior dental nerve. Tandlaegebladet 1983; 87(18):619-31.
Owotade FJ, Fatusi OA, Ibitoye B, Otuyemi OD. Dental radiographic features of impacted third molars and some management implications. Odontostomatol Trop 2003; 26(103):9-14.
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 Maxillofac Surg 2012; 70(11):2508-14. https://doi.org/10.1016/j.joms.2012.06.004
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(2):242-7. https://doi.org/10.1007/s12663-017-1026-7
Nakamori K, Fujiwara K, Miyazaki A, Tomihara K, Tsuji M, Nakai M, et al. Clinical assessment of the relationship between the third molar and the inferior alveolar canal using panoramic images and computed tomography. J Oral Maxillofac Surg 2008; 66(11):2308-13. https://doi.org/10.1016/j.joms.2008.06.042
Nagaraj M, Chitre AP. Mandibular third molar and inferior alveolar canal. J Maxillofac Oral Surg 2009; 8(3):233-6. https://doi.org/10.1007/s12663-009-0057-0
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(10):617-22. https://doi.org/10.1016/j.jcma.2015.01.009
Pandey R, Ravindran C, Pandiyan D, Gupta A, Aggarwal A, Aryasri S. Assessment of Roods and Shehab criteria if one or more radiological signs are present in orthopantomogram and position of the mandibular canal in relation to the third molar apices using cone beam computed tomography: a radiographic study. Tanta Dent J 2018; 15(1):33-8. https://doi.org/10.4103/tdj.tdj_53_17
Fauzi AA, Nazimi AJ, Rashdi MF, Fouzi N, Kamarudin NA, Ramli R. Interruption regions in the white line: a novel panoramic finding in the risk assessment of mandibular canal exposure by third molar. J Clin Diagn Res 2019; 13(4):ZC01-7.
Issrani R, Prabhu N, Sghaireen M, Alshubrmi HR, Alanazi AM, Alkhalaf ZA, et al. Comparison of digital OPG and CBCT in assessment of risk factors associated with inferior nerve injury during mandibular third molar surgery. Diagnostics 2021; 11(12):2282. https://doi.org/10.3390/diagnostics11122282
Singh H, Lee K, Ayoub AF. Management of asymptomatic impacted wisdom teeth: a multicentre comparison. Br J Oral Maxillofac Surg 1996; 34(5):389-93. https://doi.org/10.1016/s0266-4356(96)90093-5
Nguyen E, Grubor D, Chandu A. Risk factors for permanent injury of inferior alveolar and lingual nerves during third molar surgery. J Oral Maxillofac Surg 2014; 72(12):2394-401. https://doi.org/10.1016/j.joms.2014.06.451
Jerjes W, El-Maaytah M, Swinson B, Upile T, Thompson G, Gittelmon S, et al. Inferior alveolar nerve injury and surgical difficulty prediction in third molar surgery: the role of dental panoramic tomography. J Clin Dent 2006; 17(5):122-30.
Tay AB, Go WS. Effect of exposed inferior alveolar neurovascular bundle during surgical removal of impacted lower third molars. J Oral Maxillofac Surg 2004; 62(5):592-600. https://doi.org/10.1016/j.joms.2003.08.033
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(2):256-9. https://doi.org/10.1016/j.joms.2007.08.020
Hull DJ, Shugars DA, White RP Jr, Phillips C. Proximity of a lower third molar to the inferior alveolar canal as a predictor of delayed recovery. J Oral Maxillofac Surg 2006; 64(9):1371-6. https://doi.org/10.1016/j.joms.2006.05.022
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Pesquisa Brasileira em Odontopediatria e Clínica Integrada
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.