Skip to main content

Advertisement

SpringerLink
Log in

Can preoperative imaging help to predict postoperative outcome after wisdom tooth removal? A randomized controlled trial using panoramic radiography versus cone-beam CT

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

The primary objective of the study was to compare the postoperative complications following surgical removal of impacted third molars using panoramic radiography (PAN) images- and cone-beam computed tomography (CBCT)-based surgeries for “moderate-risk” cases of impacted third mandibular molars. The secondary objective was to compare the reliability of CBCT with that of PAN in preoperative radiographic determination of the position of the third molar, number of roots, and apical divergence.

Materials and methods

A randomized controlled multicenter trial was conducted to compare the surgical complications of PAN- and CBCT-based surgeries of impacted third molars. The sample consisted of impacted third molars from 256 patients with a close relation to the inferior alveolar nerve (IAN). Exclusion criteria were “no risk” and “high risk” of damage to the IAN based on the assessment of the panoramic radiograph. Patients were divided into two groups: the CBCT group (n = 126) and the PAN group (n = 130). The incidences of IAN sensory disturbance and other postoperative complications were recorded for each group at 7 days after surgery. Statistical analysis (kappa values) was used to compare the diagnoses of five trained dentomaxillofacial radiologists and to relate radiologic diagnoses to perioperative findings. Logistic regression was used to determine whether the imaging modality influenced occurrence of postoperative complications.

Results

Two extractions (1.5 %) in the CBCT group and five (3.8 %) in the PAN group resulted in IAN sensory disturbance (p = 0.45). Logistic regression models did not show that CBCT modality decreased postoperative complications following surgical removal of impacted third molars. Yet, CBCT revealed the number of roots and apical divergence of the roots more reliably than panoramic radiographs.

Conclusions

CBCT was not better than panoramic radiography in predicting postoperative complications for moderate-risk cases of impacted third mandibular molars. Nonetheless, a CBCT buccolingual view can accurately confirm the number of roots and root morphology of the third molar better than PAN.

Clinical relevance

For management of postoperative complications for moderate-risk cases of impacted mandibular third molars, careful preoperative radiographic planning followed by an atraumatic surgical approach seems to be valuable, irrespective of the 2D or 3D nature of the preoperative images.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Leung YY, Cheung LK (2009) Safety of coronectomy versus excision of wisdom teeth: a randomized controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108(6):821–827

    Article  PubMed  Google Scholar 

  2. Cheung LK, Leung YY, Chow LK, Wong MC, Chan EK, Fok YH (2010) Incidence of neurosensory deficits and recovery after lower third molar surgery: a prospective clinical study of 4338 cases. Int J Oral Maxillofac Surg 39(4):320–326

    Article  PubMed  Google Scholar 

  3. Lopes V, Mumenya R, Feinmann C, Harris M (1995) Third molar surgery: an audit of the indications for surgery, post-operative complaints and patient satisfaction. Br J Oral Maxillofac Surg 33(1):33–35

    Article  PubMed  Google Scholar 

  4. Queral-Godoy E, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C (2005) Incidence and evolution of inferior alveolar nerve lesions following lower third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 99(3):259–264

    Article  PubMed  Google Scholar 

  5. Gulicher D, Gerlach KL (2001) Sensory impairment of the lingual and inferior alveolar nerves following removal of impacted mandibular third molars. Int J Oral Maxillofac Surg 30(4):306–312

    Article  PubMed  Google Scholar 

  6. Szalma J, Lempel E, Jeges S, Szabo G, Olasz L (2010) 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 109(2):294–302

    Article  PubMed  Google Scholar 

  7. Blondeau F, Daniel NG (2007) Extraction of impacted mandibular third molars: postoperative complications and their risk factors. J Can Dent Assoc 73(4):325

    PubMed  Google Scholar 

  8. Jerjes W, Upile T, Shah P, Nhembe F, Gudka D, Kafas P, McCarthy E, Abbas S, Patel S, Hamdoon Z, Abiola J, Vourvachis M, Kalkani M, Al-Khawalde M, Leeson R, Banu B, Rob J, El-Maaytah M, Hopper C (2010) Risk factors associated with injury to the inferior alveolar and lingual nerves following third molar surgery-revisited. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109(3):335–345

    Article  PubMed  Google Scholar 

  9. Nakagawa Y, Ishii H, Nomura Y, Watanabe NY, Hoshiba D, Kobayashi K, Ishibashi K (2007) Third molar position: reliability of panoramic radiography. J Oral Maxillofac Surg 65(7):1303–1308

    Article  PubMed  Google Scholar 

  10. Neugebauer J, Shirani R, Mischkowski RA, Ritter L, Scheer M, Keeve E, Zoller JE (2008) 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 105(5):633–642, discussion 643

    Article  PubMed  Google Scholar 

  11. Nakayama K, Nonoyama M, Takaki Y, Kagawa T, Yuasa K, Izumi K, Ozeki S, Ikebe T (2009) Assessment of the relationship between impacted mandibular third molars and inferior alveolar nerve with dental 3-dimensional computed tomography. J Oral Maxillofac Surg 67(12):2587–2591

    Article  PubMed  Google Scholar 

  12. Tantanapornkul W, Okochi K, Bhakdinaronk A, Ohbayashi N, Kurabayashi T (2009) Correlation of darkening of impacted mandibular third molar root on digital panoramic images with cone beam computed tomography findings. Dentomaxillofac Radiol 38(1):11–16

    Article  PubMed  Google Scholar 

  13. Suomalainen A, Venta I, Mattila M, Turtola L, Vehmas T, Peltola JS (2010) Reliability of CBCT and other radiographic methods in preoperative evaluation of lower third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109(2):276–284

    Article  PubMed  Google Scholar 

  14. Tantanapornkul W, Okouchi K, Fujiwara Y, Yamashiro M, Maruoka Y, Ohbayashi N, Kurabayashi T (2007) 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 103(2):253–259

    Article  PubMed  Google Scholar 

  15. Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Berge SJ (2009) 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 38(9):964–971

    Article  PubMed  Google Scholar 

  16. European Commission (2012) Radiation protection 172. Evidence-based guidelines on cone beam CT for dental and maxillofacial radiology. Luxembourg: Office for Offical Publications of the European Communities. Available at: http://ec.europa.eu/energy/nuclear/radiation_protection/publications_en.htm [accessed on May 21, 2012]

  17. Guerrero ME, Shahbazian M, Elsiena Bekkering G, Nackaerts O, Jacobs R, Horner K (2011) The diagnostic efficacy of cone beam CT for impacted teeth and associated features: a systematic review. J Oral Rehabil 38(3):208–216

    Article  PubMed  Google Scholar 

  18. Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG (2010) CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 63(8):e1–e37

    Article  PubMed  Google Scholar 

  19. Jacobs R, Wu CH, Van Loven K, Desnyder M, Kolenaar B, Van Steenberghed D (2002) Methodology of oral sensory tests. J Oral Rehabil 29(8):720–730. doi:10.1046/j.1365-2842.2002.00952.x

    Article  PubMed  Google Scholar 

  20. Rood JP, Shehab BA (1990) The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg 28(1):20–25

    Article  PubMed  Google Scholar 

  21. Mahasantipiya PM, Savage NW, Monsour PA, Wilson RJ (2005) Narrowing of the inferior dental canal in relation to the lower third molars. Dentomaxillofac Radiol 34(3):154–163

    Article  PubMed  Google Scholar 

  22. Monaco G, Montevecchi M, Bonetti GA, Gatto MR, Checchi L (2004) Reliability of panoramic radiography in evaluating the topographic relationship between the mandibular canal and impacted third molars. J Am Dent Assoc 135(3):312–318

    PubMed  Google Scholar 

  23. Kaeppler G (2000) Conventional cross-sectional tomographic evaluation of mandibular third molars. Quintessence Int 31(1):49–56

    PubMed  Google Scholar 

  24. Tammisalo T, Happonen RP, Tammisalo EH (1992) Stereographic assessment of mandibular canal in relation to the roots of impacted lower third molar using multiprojection narrow beam radiography. Int J Oral Maxillofac Surg 21(2):85–89

    Article  PubMed  Google Scholar 

  25. Maegawa H, Sano K, Kitagawa Y, Ogasawara T, Miyauchi K, Sekine J, Inokuchi T (2003) 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 96(5):639–646. doi:10.1016/S1079210403003561

    Article  PubMed  Google Scholar 

  26. Flygare L, Ohman A (2008) Preoperative imaging procedures for lower wisdom teeth removal. Clin Oral Investig 12(4):291–302. doi:10.1007/s00784-008-0200-1

    Article  PubMed  Google Scholar 

  27. Wenzel A, Verdonschot EH (1994) Some considerations in the evaluation of diagnostic tests in dentistry. Dentomaxillofac Radiol 23(4):179–182

    PubMed  Google Scholar 

  28. Muhonen A, Venta I, Ylipaavalniemi P (1997) Factors predisposing to postoperative complications related to wisdom tooth surgery among university students. J Am Coll Health 46(1):39–42. doi:10.1080/07448489709595585

    Article  PubMed  Google Scholar 

  29. Freudlsperger C, Deiss T, Bodem J, Engel M, Hoffmann J (2012) Influence of lower third molar anatomic position on postoperative inflammatory complications. J Oral Maxillofac Surg 70(6):1280–1285

    Article  PubMed  Google Scholar 

  30. Ren YF, Malmstrom HS (2007) Effectiveness of antibiotic prophylaxis in third molar surgery: a meta-analysis of randomized controlled clinical trials. J Oral Maxillofac Surg 65(10):1909–1921

    Article  PubMed  Google Scholar 

  31. de Boer MP, Raghoebar GM, Stegenga B, Schoen PJ, Boering G (1995) Complications after mandibular third molar extraction. Quintessence Int 26(11):779–784

    PubMed  Google Scholar 

  32. Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C (2001) 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 92(4):377–383

    Article  PubMed  Google Scholar 

  33. Sanmarti-Garcia G, Valmaseda-Castellon E, Gay-Escoda C (2012) Does computed tomography prevent inferior alveolar nerve injuries caused by lower third molar removal? J Oral Maxillofac Surg 70(1):5–11

    Article  PubMed  Google Scholar 

  34. Wenzel A, Aagaard E, Sindet-Pedersen S (1998) Evaluation of a new radiographic technique: outcome following removal of mandibular third molars. Dentomaxillofac Radiol 27(5):264–269. doi:10.1038/sj/dmfr/4600358

    Article  PubMed  Google Scholar 

  35. Berge TI, Gilhuus-Moe OT (1993) Per- and post-operative variables of mandibular third-molar surgery by four general practitioners and one oral surgeon. Acta Odontol Scand 51(6):389–397

    Article  PubMed  Google Scholar 

  36. Matzen L, Christensen J, Hintze H, Schou S, Wenzel A (2013) Influence of cone beam CT on treatment plan before surgical intervention of mandibular third molars and impact of radiographic factors on deciding on coronectomy vs surgical removal. Dentomaxillofac Radiol 42(1):98870341

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was accomplished by a doctoral scholarship in the framework of the Interfaculty Council for Development Cooperation (IRO).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Oral Imaging Center, Department of Oral Health Sciences, Faculty of Medicine, University of Leuven, Leuven, Belgium

    Maria Eugenia Guerrero & Reinhilde Jacobs

  2. School of Dentistry, Universidad San Martin de Porres, Lima, Peru

    Raul Botetano

  3. IMAGENES CBCT Diagnostic Center, Lima, Peru

    Jorge Beltran

  4. School of Dentistry, University of Manchester, Manchester, UK

    Keith Horner

Authors
  1. Maria Eugenia Guerrero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raul Botetano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jorge Beltran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keith Horner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Reinhilde Jacobs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Reinhilde Jacobs.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guerrero, M.E., Botetano, R., Beltran, J. et al. Can preoperative imaging help to predict postoperative outcome after wisdom tooth removal? A randomized controlled trial using panoramic radiography versus cone-beam CT. Clin Oral Invest 18, 335–342 (2014). https://doi.org/10.1007/s00784-013-0971-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-013-0971-x

Keywords

Search

Navigation