Imaginological Findings that Indicate Proximity of the Roots of Lower Molar Third Parties with the Mandibular Channel: Literature Review
DOI:
https://doi.org/10.21270/archi.v11i1.5456Keywords:
Radiography, Panoramic, Cone-Beam Computed Tomography, Molar Third, Mandibular NerveAbstract
Panoramic radiography (RP) is the most widely used imaging test to evaluate the relationship between the roots of the lower third molar (LTM) and the mandibular canal (MC), however the cone beam computed tomography (CBCT) can also be indicated for the same purpose, due to its advantage of allowing a three-dimensional analysis of the region. The aim of this study was to carry out a bibliographic survey on radiographic signs that indicate a close relationship between the dental root of the LTM with the MC on PR and CBCT. Searches were made on PubMed, Medline and Lilacs using the following descriptors: Panoramic radiography, Mandibular Nerve, Third molar, Cone-Beam Computed Tomography. A complete reading of the texts compatible with the objectives was performed, excluding those in which the MC did not have intimate contact with the roots of the LTM in the image exams alongside clinical case reports and articles that used periapical radiographs to observe such a relationship. The most relevant radiographic signs to assess the root and mandibular canal relationship were: interruption of the white line of the canal, root darkening, deviation / narrowing of the canal, as well as signs observed over tomography which include absence of corticalization, lingual nerve position and anatomical shape of the canal (tear-drop and dumbbell), as predictors of higher risk for nerve damage. It is concluded that the exam of choice to evaluate the proximity of the LTM with the MC remains the PR, considering that it presents reliable signs, lower radiation dose and cost when compared to the CBCT.
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Zandi M, Shokri A, Malekzadeh H, Amini P, Shafiey P. Evaluation of third molar development and its relation to chronological age: a panoramic radiographic study. Oral Maxillofac Surg. 2015;19:183-89.
Chou YH, Ho PS, Ho KY, Wang WC, Hu KF. Association between the eruption of the third molar and caries and periodontitis distal to the second molars in elderly patients. Kaohsiung J Med Sci. 2017;33(5):246-51.
L i ZB, Qu HL, Zhou LN, Tian BM, Chen FM. Influence of Non-Impacted Third Molars on Pathologies of Adjacent Second Molars: A Retrospective Study. J Periodontol. 2017;88(5):450-56.
Steed MB. The indications for third-molar extractions. J Am Dent Assoc. 2014;145(6): 570-73.
Mortazavi H, Baharvand M. Jaw lesions associated with impacted tooth: A radiographic diagnostic guide. Imaging Sci Dent. 2016;46(3):147-57.
Hatami A, Dreyer C. The extraction of first, second or third permanent molar teeth and its effect on the dentofacial complex. Aust Dent J. 2019;64(4):302-11.
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(1):1-7.
Matzen LH, Schropp L, Spin-Neto R, Wenzel A. Radiographic signs of pathology determining removal of an impacted mandibular third molar assessed in a panoramic image or CBCT. Dentomaxillofac Radiol. 2017;46(1): 20160330.
Huang C-K, Lui M-T, Cheng D-H. Use of panoramic radiography to predict postsurgical sensory impairment following extraction of impacted mandibular third molars. J Chinese Med Assoc. 2015;78(10):617-22.
Zandi M, Shokri A, Heidari A, Peykar EM. Objectivity and reliability of panoramic radiographic signs of intimate relationship between impacted mandibular third molar and inferior alveolar nerve. Oral Maxillofac Surg. 2015;19:43-8.
Su N, Wijk A, Berkhout E, Sanderink G, Lange J De, 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.
Umar G, Obisesan O, Bryant C, Rood JP. Elimination of permanent injuries to the inferior alveolar nerve following surgical intervention of the “high risk” third molar. Br J Oral Maxillofac Surg. 2013;51(4):353-57.
Suomalainen A, Ventä I, Mattila M, Turtola L, Vehmas T, Peltola JS. Reliability of CBCT and other radiographic methods in preoperative evaluation of lower third molars. Oral Surgery, Oral Med Oral Pathol Oral Radiol Endodontology. 2010;109(2):276-84.
Susarla SM, Sidhu HK, Avery LL, Dodson TB. Does Computed Tomographic Assessment of Inferior Alveolar Canal Cortical Integrity Predict Nerve Exposure During Third Molar Surgery? J Oral Maxillofac Surg. 2010;68(6):1296–303.
Grunheid T, Schieck JRK, Pliska BT, Ahmad M, Larson BE. Dosimetry of a cone-beam computed tomography machine compared with a digital x-ray machine in orthodontic imaging. Am J Orthod Dentofac Orthop. 2012;141(4):436-43.
Szalma J, Lempel E, Jeges S, Szabó 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 Surgery, Oral Med Oral Pathol Oral Radiol Endodontology. 2010;109(2):294-302.
Jaju PP, Jaju SP. Cone-beam computed tomography: Time to move from ALARA to ALADA. Imaging Sci Dent. 2015;45(4):263-65.
Rafetto LK. Managing Impacted Third Molars. Oral Maxillofac Surg Clin North Am. 2015; 27(3):363-71.
Synan W, Stein K. Management of Impacted Third Molars. Oral Maxillofac Surg Clin North Am. 2020;32(4):519-59.
Matzen LH, Wenzel A. Efficacy of CBCT for assessment of impacted mandibular third molars: a review - based on a hierarchical model of evidence. Dentomaxillofac Radiol. 2015;44(1):20140180.
Atieh MA. Diagnostic Accuracy of Panoramic Radiography in Determining Relationship Between Inferior Alveolar Nerve and Mandibular Third Molar. J Oral Maxillofac Surg. 2010;68(1):74-82.
Lobbers HT, Matthews F, Damerau G, Kruse AL, Obwegeser JA, Gratz KWA, et al. Anatomy of impacted lower third molars evaluated by computerized tomography is there an indication for 3-dimensional imaging? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111(5):547-50.
Rood JP. Degrees of injury to the inferior alveolar nerve sustained during the removal of impacted mandibular third molars by the lingual split technique. Br J Oral Surg. 1983;21:103-16.
Xu G, Yang C, Fan X-D, Yu C-Q, Cai X-Y, 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):215-19.
Candotto V, Oberti L, Gabrione F, Scarano A, Rossi D, Romano M. Complication in third molar extractions. J Biol Regul Homeost Agents. 2019;33(3):169-72.
Rood JP, Shehab BAAN. The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg. 1990;28(1):20-5.
Winstanley KL, Otway LM, Thompson L, Brook ZH, King N, Koong B, et al. Inferior alveolar nerve injury: Correlation between indicators of risk on panoramic radiographs and the incidence of tooth and mandibular canal contact on cone-beam computed tomography scans in a Western Australian population. J Investig Clin Dent. 2018;9(3):12323.
Sanmartí-Garcia G, Valmaseda-Castellón E, Gay-Escoda C. Does computed tomography prevent inferior alveolar nerve injuries caused by lower third molar removal? J Oral Maxillofac Surg. 2012;70(1):5-11.
Dalili Z, Mahjoub P, Sigaroudi AK. Comparison between cone beam computed tomography and panoramic radiography in the assessment of the relationship between the mandibular canal and impacted class C mandibular third molars. Dent Res J. 2011;8(4):203-10.
Hasani A, Moshtaghin FA, Roohi P, Rakhshan V. Diagnostic value of cone beam computed tomography and panoramic radiography in predicting mandibular nerve exposure during third molar surgery. Int J Oral Maxillofac Surg. 2017;46(2):230-35.
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.
Jung Y-H, Nah K-S, Cho B-H. Correlation of panoramic radiographs and cone beam computed tomography in the assessment of a superimposed relationship between the mandibular canal and impacted third molars. Imaging Sci Dent. 2012;42:121-27.
Neves FS, Souza TC, Almeida SM, Haiter-Neto F, Freitas DQ, Bóscolo FN. Correlation of panoramic radiography and cone beam CT findings in the assessment of the relationship between impacted mandibular third molars and the mandibular canal. Dentomaxillofacial Radiol. 2012;41(7):553-57.
Ueda M, Nakamori K, Shiratori K, Igarashi T, Sasaki T, Anbo N, et al. Clinical Significance of Computed Tomographic Assessment and Anatomic Features of the Inferior Alveolar Canal as Risk Factors for Injury of the Inferior Alveolar Nerve at Third Molar Surgery. J Oral Maxillofac Surg. 2012;70(3):514-20.
Kubota S, Imai T, Nakazawa M, Uzawa N. Risk stratification against inferior alveolar nerve injury after lower third molar extraction by scoring on cone-beam computed tomography image. Odontology. 2020;108(1):124-32.
Umar G, Bryant C, Obisesan O, Rood JP. Correlation of the radiological predictive factors of inferior alveolar nerve injury with cone beam computed tomography findings. Oral Surg. 2010;3(3):72-82.
Eyrich G, Seifert B, Matthews F, Matthiessen U, Heusser CK, Kruse AL, et al. 3-Dimensional Imaging for Lower Third Molars: Is There an Implication for Surgical Removal? J Oral Maxillofac Surg. 2011;69(7):1867-72.
Pippi R, Santoro M, D’Ambrosio F. Accuracy of cone-beam computed tomography in defining spatial relationships between third molar roots and inferior alveolar nerve. Eur J Dent. 2016;10(4):454-58.
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(3):532-40.
Hasegawa T, Ri S, Shigeta T, Akashi M, Imai Y, Kakei Y, et al. Risk factors associated with inferior alveolar nerve injury after extraction of the mandibular third molar—a comparative study of preoperative images by panoramic radiography and computed tomography. Int J Oral Maxillofac Surg. 2013;42(7):843-51.
Selvi F, Dodson TB, Nattestad A, Robertson K, Tolstunov L. Factors that are associated with injury to the inferior alveolar nerve in high-risk patients after removal of third molars. Br J Oral Maxillofac Surg. 2013;51(8):868-73.
Shiratori K, Nakamori K, Ueda M, Sonoda T, Dehari H. Assessment of the Shape of the Inferior Alveolar Canal as a Marker for Increased Risk of Injury to the Inferior Alveolar Nerve at Third Molar Surgery: A Prospective Study. J Oral Maxillofac Surg. 2013;71(12): 2012-19.
Nakamori K, Tomihara K, Noguchi M. Clinical significance of computed tomography assessment for third molar surgery. World J Radiol. 2014;6(7):417-23.
Tachinami H, Tomihara K, Fujiwara K, Nakamori K, Noguchi M. Combined preoperative measurement of three inferior alveolar canal factors using computed tomography predicts the risk of inferior alveolar nerve injury during lower third molar extraction. Int J Oral Maxillofac Surg.2017;46(11):1479-83.
Szalma J, Vajta L, Lovász BV, Kiss C, Soós B, Lempel E. Identification of Specific Panoramic High-Risk Signs in Impacted Third Molar Cases in Which Cone Beam Computed Tomography Changes the Treatment Decision. J Oral Maxillofac Surg. 2020;78(7):1061-70.
Ali S Al, Jaber M. Correlation of panoramic high-risk markers with the cone beam CT findings in the preoperative assessment of the mandibular third molars. J Dent Sci. 2020;15(1):75-83.
Patel PS, Shah JS, Dudhia BB, Butala PB, Jani Y V, Macwan RS. Comparison of panoramic radiograph and cone beam computed tomography findings for impacted mandibular third molar root and inferior alveolar nerve canal relation. Indian J Dent Res. 2020;31(1):91-102.
Telles-Araújo G de T, Peralta-Mamani M, Caminha RDG, Moraes-da-Silva A de F, Rubira CMF, Honório HM, et al. CBCT does not reduce neurosensory disturbances after third molar removal compared to panoramic radiography: a systematic review and meta-analysis. Clin Oral Investig. 2020;24(3):1137-49.
Clé-Ovejero A, Sánchez-Torres A, Camps-Font O, Gay-Escoda C, Figueiredo R, Valmaseda-Castellón E. Does 3-dimensional imaging of the third molar reduce the risk of experiencing inferior alveolar nerve injury owing to extraction?: A meta-analysis. J Am Dent Assoc. 2017;148(8):575-83.
Petersen LB, Vaeth M, Wenzel A. Neurosensoric disturbances after surgical removal of the mandibular third molar based on either panoramic imaging or cone beam CT scanning: A randomized controlled trial (RCT). Dentomaxillofac Radiol. 2016;45(2):20150224.
Ghaeminia H, Gerlach NL, Hoppenreijs TJ, Kicken M, Dings JP, Borstlap WA, et al. Clinical relevance of cone beam computed tomography in mandibular third molar removal: a multicentre, randomised, controlled trial. J Craniomaxillofac Surg. 2015;43(10):2158-67.
Matzen LH, Berkhout E. Cone beam CT imaging of the mandibular third molar: a position paper prepared by the European Academy of DentoMaxilloFacial Radiology (EADMFR). Dentomaxillofac Radiol. 2019;48(5):20190039.
