Research Article
Alt gömülü yirmi yaş dişlerinin inferior alveolar sinir ile ilişkisinin panoramik radyografi ve konik ışınlı bilgisayarlı tomografi ile operasyon öncesi muayenesi: Panoramik radyografiler alt gömülü yirmi yaş dişler için hala standart tanı araçları mıdır?
Abstract
Amaç: Bu çalışmanın amacı, konik ışınlı bilgisayarlı tomografi (KIBT) görüntüleri ile panoramik radyografilerde (PR) alt gömülü yirmi yaş dişlerinin (AGY) inferior alveolar sinir (IAN) ile ilişkisinin radyolojik belirteçlerinin uyumluluğunu değerlendirmektir.
Gereç ve Yöntemler: Eylül-Aralık 2021 tarihleri arasında AGY çıkarılması için sevk edilen hastaların PR ve KIBT görüntüleri kullanılmıştır. AGY’ler, PR'de Pederson Zorluk İndeksi'ne göre sınıflandırılmış. Dişler ile IAN arasındaki ilişki tespit edilirse, ilişkiyi doğrulamak için KIBT görüntüleri incelenmiştir.
Bulgular: 52 AGY'li 45 hasta, PR yanında KIBT görüntüleri olduğu için çalışmaya dahil edilmiştir. Pederson İndeksine göre 14 diş çok zor, kalan 38 diş ise orta derecede zor olarak sınıflandırılmıştır. Dişlerin PR görüntüleri incelendiğinde 44 dişte IAN ile ilişki saptanmıştır. IAN ile ilişkili 44 dişin KIBT görüntüleri incelendiğinde bu dişlerden 7'sinde IAN ile ilişki saptanmamıştır. Öte yandan ilişki yok olarak sınıflandırılan 8 dişin KIBT görüntüleri incelendiğinde 4 tanesinin IAN ile ilişkisi olduğu belirlenmiştir. Böylece 52 dişin 41'i IAN ile ilişkili bulunmuştur. 52 dişin 41'inin KIBT görüntüleri IAN'ın yakınlığını doğrulamış, 14'ü çok zor, 27'si orta derecede zor olarak sınıflandırılmıştır.
Sonuç: Bu bulgular, PR'ye göre IAN-AGY ilişkisi şüpheli ise ve Pederson indeksine göre orta derecede zor veya çok zor olarak sınıflandırılan dişler varsa, ameliyattan önce KIBT çekilmesi gerektiğini göstermektedir.
References
- Del Lhano NC, Ribeiro RA, Martins CC, Assis N, Devito KL. Panoramic versus CBCT used to reduce inferior alveolar nerve paresthesia after third molar extractions: a systematic review and meta-analysis. Dentomaxillofac Radiol 2020;49(4):20190265.
- Reia VCB, de Toledo Telles-Araujo G, Peralta-Mamani M, Biancardi MR, Rubira CMF, Rubira-Bullen IRF. Diagnostic accuracy of CBCT compared to panoramic radiography in predicting IAN exposure: a systematic review and meta-analysis. Clin Oral Investig 2021;25(8):4721-33.
- 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.
- Gulicher D, Gerlach KL. Sensory impairment of the lingual and inferior alveolar nerves following removal of impacted mandibular third molars. Int J Oral Maxillofac Surg 2001;30(4):306-12.
- Kipp DP, Goldstein BH, Weiss WW, Jr. Dysesthesia after mandibular third molar surgery: a retrospective study and analysis of 1,377 surgical procedures. J Am DEnt Assoc 1980;100(2):185-92.
- 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.
- Juodzbalys G, Daugela P. Mandibular third molar impaction: review of literature and a proposal of a classification. J Oral Maxillofac Res 2013;4(2):e1.
- Hashimoto K, Kawashima S, Kameoka S, Akiyama Y, Honjoya T, Ejima K, et al. Comparison of image validity between cone beam computed tomography for dental use and multidetector row helical computed tomography. Dentomaxillofac Radiol 2007;36(8):465-71.
- Nagaraj M, Chitre AP. Mandibular third molar and inferior alveolar canal. J Maxillofac Oral Surg 2009;8(3):233-6.
- Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Berge SJ. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg 2009;38(9):964-71.
- Roeder F, Wachtlin D, Schulze R. Necessity of 3D visualization for the removal of lower wisdom teeth: required sample size to prove non-inferiority of panoramic radiography compared to CBCT. Clin Oral Investig 2012;16(3):699-706.
- Akter M, Rahman QB, Uddin MW, Kundu GC, Banik S, Imon AA. Pre-operative assessment of mandibular third molar and inferior alveolar canal using orthopantomography and cone beam computed tomography. Bangabandhu Sheikh Mujib Med Univ J 2016;9:220-2.
- Winter GB. Principles of exodontia applied to the impacted third molar. American Medical Books. St Louis: MO; 1926.
- Pell GJ, Gregory BT. Impacted mandibular third molars: Classification nad modified techniques for removal. Dent Digest 1933;39(330).
- Pederson GW. Surgical removal of tooth. In: Pederson GW, editor, Oral Surgery. Philadelphia: WB Saunders; 1988.
- Cakir M, Karaca IR, Peker E, Ogutlu F. Effects of Inferior Alveolar Nerve Neurosensory Deficits on Quality of Life. Niger J Clin Pract 2018;21(2):206-11.
- 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.
- Howe EL, Poyton HE. Prevention of damage to the inferior dental nerve during the extraction of mandibular third molars. British Dental Journal 1960;109:355-63.
- 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.
- Uzun C, Sumer AP, Sumer M. Assessment of the reliability of radiographic signs on panoramic radiographs to determine the relationship between mandibular third molars and the inferior alveolar canal. Oral Surg Oral Med Oral Pathol Oral Radiol 2020;129(3):260-71.
- Al Ali S, 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.
- 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 (Basel) 2021;11(12).
- Neugebauer J, Shirani R, Mischkowski RA, Ritter L, Scheer M, Keeve E, et al. Comparison of cone-beam volumetric imaging and combined plain radiographs for localization of the mandibular canal before removal of impacted lower third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105(5):633-43.
- 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.
- Suomalainen A, Venta I, Mattila M, Turtola L, Vehmas T, Peltola JS. Reliability of CBCT and other radiographic methods in preoperative evaluation of lower third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109(2):276-84.
- Lubbers HT, Matthews F, Damerau G, Kruse AL, Obwegeser JA, Gratz KW, 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.
- Ülker-Yalçın GM, Ersan N, Çapar GD, Tomruk-Özçakır C, İlgüy D, Şençift MK. Alt yirmi yaş dişlerinin mandibular kanalla olan ilişkisinin panoramik radyografilerde ve konik ışınlı bilgisayarlı tomografi görüntülerinde incelenmesi. Yeditepe J Denr 2016;12(1):41-5.
- Bali A, Bali D, Sharma A. Is Pederson index a true predictive difficulty index for impacted mandibular third molar surgery? A meta-analysis. J Maxillofac Oral Surg 2013;12(3):359-64.
- Mezzour M, El Harti K, El Wady W. Predicting third molar removal difficulty: radiological assessment. Acta Scientfic Dental Sciences 2017;1(6):13-9.
- 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.
- de Melo Albert DG, Gomes AC, do Egito Vasconcelos BC, de Oliveira e Silva ED, Holanda GZ. Comparison of orthopantomographs and conventional tomography images for assessing the relationship between impacted lower third molars and the mandibular canal. J Oral Maxillofac Surg 2006;64(7):1030-7.
- 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.
- Maegawa H, Sano K, Kitagawa Y, Ogasawara T, Miyauchi K, Sekine J, et al. Preoperative assessment of the relationship between the mandibular third molar and the mandibular canal by axial computed tomography with coronal and sagittal reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96(5):639-46.
- Miller CS, Nummikoski PV, Barnett DA, Langlais RP. Cross-sectional tomography. A diagnostic technique for determining the buccolingual relationship of impacted mandibular third molars and the inferior alveolar neurovascular bundle. Oral Surg Oral Med Oral Pathol 1990;70(6):791-7.
- 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.
- Patel PS, Shah JS, Dudhia BB, Butala PB, Jani YV, 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.
- Orhan BK, Yılmaz D, Ozemre MO, Kamburoğlu K, Gulen O, Gulsahi A. Evaluation of Mandibular Third Molar Region in a Turkish Population Using Cone-Beam Computed Tomography. Curr Med Imaging. 2020;16(9):1105-1110.
Pre-operative examination of inferior alveolar nerve and impacted lower third molars relation by panoramic radiography and cone beam computerized tomography: Are panoramic radiographies still standard diagnostic tools for impacted lower third molars?
Abstract
Objectives: The aim of this study was to evaluate the compatibility of radiological markers of the impacted lower third molar (LTM) relationship to inferior alveolar nerve (IAN) in panoramic radiographs (PR) with cone beam computerized tomography (CBCT) images.
Materials and Methods: PR and CBCT images of the patients who were referred for LTM removal between September-December 2021 were used. LTM were classified according to the Pederson Difficulty Index in PR. If relation between the teeth and IAN was detected, then CBCT images were investigated to verify the relation.
Results: 52 LTM were included to the study because of having CBCT images. According to Pederson Index 14 teeth were classified as very difficult, 38 as moderately difficult. In PR examination a relationship with the IAN was observed in 44 teeth. When the CBCT images of 44 teeth were examined, 7 of these showed no relationship. On the other hand, when the CBCT images of the 8 teeth, which were classified as ‘no relationship’ in PR images, were examined, it was determined that 4 of them had relationship. Thus, 41 of the 52 teeth were related to the IAN. The CBCT images of 41 of the 52 teeth confirmed for the proximity of the IAN, 14 of them were classified as very difficult, 27 of them were classified as moderately difficult.
Conclusion: These findings indicate that if IAN-LTM relation is suspicious according to PR and teeth classified as difficult or very difficult according to Pederson’s Index, CBCT is necessary before the surgery.
References
- Del Lhano NC, Ribeiro RA, Martins CC, Assis N, Devito KL. Panoramic versus CBCT used to reduce inferior alveolar nerve paresthesia after third molar extractions: a systematic review and meta-analysis. Dentomaxillofac Radiol 2020;49(4):20190265.
- Reia VCB, de Toledo Telles-Araujo G, Peralta-Mamani M, Biancardi MR, Rubira CMF, Rubira-Bullen IRF. Diagnostic accuracy of CBCT compared to panoramic radiography in predicting IAN exposure: a systematic review and meta-analysis. Clin Oral Investig 2021;25(8):4721-33.
- 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.
- Gulicher D, Gerlach KL. Sensory impairment of the lingual and inferior alveolar nerves following removal of impacted mandibular third molars. Int J Oral Maxillofac Surg 2001;30(4):306-12.
- Kipp DP, Goldstein BH, Weiss WW, Jr. Dysesthesia after mandibular third molar surgery: a retrospective study and analysis of 1,377 surgical procedures. J Am DEnt Assoc 1980;100(2):185-92.
- 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.
- Juodzbalys G, Daugela P. Mandibular third molar impaction: review of literature and a proposal of a classification. J Oral Maxillofac Res 2013;4(2):e1.
- Hashimoto K, Kawashima S, Kameoka S, Akiyama Y, Honjoya T, Ejima K, et al. Comparison of image validity between cone beam computed tomography for dental use and multidetector row helical computed tomography. Dentomaxillofac Radiol 2007;36(8):465-71.
- Nagaraj M, Chitre AP. Mandibular third molar and inferior alveolar canal. J Maxillofac Oral Surg 2009;8(3):233-6.
- Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Berge SJ. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg 2009;38(9):964-71.
- Roeder F, Wachtlin D, Schulze R. Necessity of 3D visualization for the removal of lower wisdom teeth: required sample size to prove non-inferiority of panoramic radiography compared to CBCT. Clin Oral Investig 2012;16(3):699-706.
- Akter M, Rahman QB, Uddin MW, Kundu GC, Banik S, Imon AA. Pre-operative assessment of mandibular third molar and inferior alveolar canal using orthopantomography and cone beam computed tomography. Bangabandhu Sheikh Mujib Med Univ J 2016;9:220-2.
- Winter GB. Principles of exodontia applied to the impacted third molar. American Medical Books. St Louis: MO; 1926.
- Pell GJ, Gregory BT. Impacted mandibular third molars: Classification nad modified techniques for removal. Dent Digest 1933;39(330).
- Pederson GW. Surgical removal of tooth. In: Pederson GW, editor, Oral Surgery. Philadelphia: WB Saunders; 1988.
- Cakir M, Karaca IR, Peker E, Ogutlu F. Effects of Inferior Alveolar Nerve Neurosensory Deficits on Quality of Life. Niger J Clin Pract 2018;21(2):206-11.
- 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.
- Howe EL, Poyton HE. Prevention of damage to the inferior dental nerve during the extraction of mandibular third molars. British Dental Journal 1960;109:355-63.
- 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.
- Uzun C, Sumer AP, Sumer M. Assessment of the reliability of radiographic signs on panoramic radiographs to determine the relationship between mandibular third molars and the inferior alveolar canal. Oral Surg Oral Med Oral Pathol Oral Radiol 2020;129(3):260-71.
- Al Ali S, 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.
- 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 (Basel) 2021;11(12).
- Neugebauer J, Shirani R, Mischkowski RA, Ritter L, Scheer M, Keeve E, et al. Comparison of cone-beam volumetric imaging and combined plain radiographs for localization of the mandibular canal before removal of impacted lower third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105(5):633-43.
- 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.
- Suomalainen A, Venta I, Mattila M, Turtola L, Vehmas T, Peltola JS. Reliability of CBCT and other radiographic methods in preoperative evaluation of lower third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109(2):276-84.
- Lubbers HT, Matthews F, Damerau G, Kruse AL, Obwegeser JA, Gratz KW, 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.
- Ülker-Yalçın GM, Ersan N, Çapar GD, Tomruk-Özçakır C, İlgüy D, Şençift MK. Alt yirmi yaş dişlerinin mandibular kanalla olan ilişkisinin panoramik radyografilerde ve konik ışınlı bilgisayarlı tomografi görüntülerinde incelenmesi. Yeditepe J Denr 2016;12(1):41-5.
- Bali A, Bali D, Sharma A. Is Pederson index a true predictive difficulty index for impacted mandibular third molar surgery? A meta-analysis. J Maxillofac Oral Surg 2013;12(3):359-64.
- Mezzour M, El Harti K, El Wady W. Predicting third molar removal difficulty: radiological assessment. Acta Scientfic Dental Sciences 2017;1(6):13-9.
- 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.
- de Melo Albert DG, Gomes AC, do Egito Vasconcelos BC, de Oliveira e Silva ED, Holanda GZ. Comparison of orthopantomographs and conventional tomography images for assessing the relationship between impacted lower third molars and the mandibular canal. J Oral Maxillofac Surg 2006;64(7):1030-7.
- 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.
- Maegawa H, Sano K, Kitagawa Y, Ogasawara T, Miyauchi K, Sekine J, et al. Preoperative assessment of the relationship between the mandibular third molar and the mandibular canal by axial computed tomography with coronal and sagittal reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96(5):639-46.
- Miller CS, Nummikoski PV, Barnett DA, Langlais RP. Cross-sectional tomography. A diagnostic technique for determining the buccolingual relationship of impacted mandibular third molars and the inferior alveolar neurovascular bundle. Oral Surg Oral Med Oral Pathol 1990;70(6):791-7.
- 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.
- Patel PS, Shah JS, Dudhia BB, Butala PB, Jani YV, 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.
- Orhan BK, Yılmaz D, Ozemre MO, Kamburoğlu K, Gulen O, Gulsahi A. Evaluation of Mandibular Third Molar Region in a Turkish Population Using Cone-Beam Computed Tomography. Curr Med Imaging. 2020;16(9):1105-1110.
There are 37 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Oral and Maxillofacial Surgery, Oral and Maxillofacial Radiology |
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 1, 2023 |
| Submission Date | July 13, 2023 |
| Published in Issue | Year 2023 Volume: 9 Issue: 3 |
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