Badawy, I., El Prince, N., El Ashwah, A. (2016). EVALUATION OF PANORAMIC X-RAY VERSUS CONE BEAM COMPUTERIZED TOMOGRAPHY IN SURGICAL REMOVAL OF HORIZONTALLY IMPACTED MANDIBULAR THIRD MOLARS. Alexandria Dental Journal, 41(3), 277-282. doi: 10.21608/adjalexu.2016.58039
Ingy N. Badawy; Nagy H. El Prince; Adham A. El Ashwah. "EVALUATION OF PANORAMIC X-RAY VERSUS CONE BEAM COMPUTERIZED TOMOGRAPHY IN SURGICAL REMOVAL OF HORIZONTALLY IMPACTED MANDIBULAR THIRD MOLARS". Alexandria Dental Journal, 41, 3, 2016, 277-282. doi: 10.21608/adjalexu.2016.58039
Badawy, I., El Prince, N., El Ashwah, A. (2016). 'EVALUATION OF PANORAMIC X-RAY VERSUS CONE BEAM COMPUTERIZED TOMOGRAPHY IN SURGICAL REMOVAL OF HORIZONTALLY IMPACTED MANDIBULAR THIRD MOLARS', Alexandria Dental Journal, 41(3), pp. 277-282. doi: 10.21608/adjalexu.2016.58039
Badawy, I., El Prince, N., El Ashwah, A. EVALUATION OF PANORAMIC X-RAY VERSUS CONE BEAM COMPUTERIZED TOMOGRAPHY IN SURGICAL REMOVAL OF HORIZONTALLY IMPACTED MANDIBULAR THIRD MOLARS. Alexandria Dental Journal, 2016; 41(3): 277-282. doi: 10.21608/adjalexu.2016.58039
EVALUATION OF PANORAMIC X-RAY VERSUS CONE BEAM COMPUTERIZED TOMOGRAPHY IN SURGICAL REMOVAL OF HORIZONTALLY IMPACTED MANDIBULAR THIRD MOLARS
1Bachelor of Dentistry, BDS, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
2Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
3Assistant Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University Alexandria, Egypt
Abstract
INTRODUCTION: Computerized scanning technology has been in use for 30 years. Originally, it was called Computerized Axial Tomography or CAT. Today, with advances in miniaturization and computer software and a revolution in imaging, CAT scan technology has been moved from the hospital to the private dental office in the form of Cone Beam Computerized Tomography (CBCT), which will be an alternative radiographic study over the standard panoramic images. OBJECTIVES: This study evaluated the advantage of CBCT over panoramic X-ray in surgical removal of horizontally impacted mandibular third molars. MATERIALS AND METHODS: This study was conducted on twenty patients selected from the Out-patient Clinic of the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, diagnosed by horizontally impacted mandibular third molar class II position B. All patients were diagnosed clinically and radiographically. Patients were divided randomly in two groups, 10 patients were diagnosed preoperatively by CBCT film (study group) and the other 10 patients were diagnosed by panoramic radiographic film (control group). Intraoperative and postoperative evaluation was carried out to monitor postoperative pain, inferior alveolar nerve paresthesia, trismus and postoperative edema at 3rd, 7th and 15th day. RESULTS: Patients in the study group experienced statistically significant less pain and less postoperative edema than those in the control group (p=0.05, and p=0.048 respectively). There was no statistically significant difference between the two groups regarding the trismus and no patients in both groups suffered of alveolar nerve paresthesia. Less postoperative pain was diagnosed in the study group than in the control group. No inferior alveolar nerve paresthesia was found in the two groups. There was no significant difference between the two groups regarding the trismus. Less postoperative edema was found in the study group than in the control group. CONCLUSIONS: CBCT showed higher specificity to the inferior alveolar nerve localization as compared to panoramic x-ray. Hence, it is recommended that CBCT imaging is to be considered included in the diagnostic work-up prior to surgical removal of deeply impacted third molars.
1. Ziccardi VB, Zuniga JR. Nerve injuries after third molar removal. Oral Maxillofac Surg Clin North Am. 2007; 19: 105-15. 2. JerjesW,UpileT,ShahP,NhembeF,GudkaD,KafasP,et al. 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. 2010; 109:335-45. 3. Marciani RD. Third molar removal: an overview of indications, imaging, evaluation, and assessment of risk. Oral Maxillofac Surg Clin North Am. 2007; 19: 1-13. 4. Svendsen H, Maertens JKM. Etiology of third molar impaction. In: An dreasen JO, Petersen JK, Laskin DM (eds). Textbook and Color Atlas of Tooth Impactions. Copenhagen: Munskgaard; 1997. pp 223-7. 5. Nakagawa Y, Ishii H, Nomura Y, Watanabe NY, Hoshiba D, Kobayashi K, et al. Third molar position: reliability of panoramic radiography. J Oral Maxillofac Surg. 2007; 65: 1303-8. 6. RoodJP,ShehabBA.Theradiologicalpredictionofinferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg. 1990; 28:20-5. 7. GhaeminiaH,MeijerGJ,SoehardiA,BorstlapWA,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; 40:834-9. 8. GhaeminiaH,MeijerGJ,SoehardiA,BorstlapWA,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; 38:964-71. 9. Pell GJ, Gregory BT. Impacted mandibular third molars: classification and modified techniques for removal. Dent Digest. 1933, 19:430, Obiechania AE. Update in the technique of third molar surgery. Ann of Ibadan Postgrad Med 2003;140-45
10. Ghanbari JA, Makvandi A, Pazouki A. Quality of sleep for hospitalized patients in Rasoul-Akram hospital. Med J Islam Repub Iran. 2014; 21:73. 11. XuGZ,YangC,FanXD,YuCQ,CaiXY,WangY,etal. 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: e215-e9. 12. Nakayama K, Nonoyama M, Takaki Y, Kagawa T, Yuasa K, Izumi K, et al. Assessment of the relationship between IMTM and inferior alveolar nerve with dental 3-dimensional computed tomography. J Oral Maxillofac Surg. 2009;67: 2587-91. 13.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: 3-7. 14. 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: 1867-72. 15.Lübbers HT, Matthews F, Damerau G, Kruse AL, Obwegeser JA, Grätz KW, et al. No plane is the best one- the volume is! Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 113: 421. 16.Lübbers 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; 111:547- 50. 17. Momin MA, Matsumoto K, Ejima K, Asaumi R, Kawai T, Arai Y, et al. Correlation of mandibular impacted tooth and bone morphology determined by cone beam computed topography on a premise of third molar operation. Surg Radiol Anat. 2013; 35:311-8. 18. Neves FS, Souza TC, Almeida SM, Haiter-Neto DQ, Freitas FN, Bóscolo FN. Correlation of panoramic radiography and cone beam CT findings in the assessment of the relationship between IMTM and the mandibular canal. Dentomaxillofac Radiol. 2012; 41:553-7. 19. 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; 51:868-73. 20.Ghaeminia H, Meijer G J, Soehardi A, Borstlap WA, Mulder J, Vlijmen OJ, Bergé SJ, Maal TJ. 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. 21. 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 Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109:276-84. 22. Pippi R. A case of inferior alveolar entrapment in the roots of a partially erupted mandibular third molar. J Oral Maxillofac Surg. 2010; 68:1170-3. 23.Renton T, Hankins M, Sproate C, McGurk M. A randomised 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. 24. de Santana-Santos T, de Souza-Santos aA, Martins-Filho PR, da Silva LC, de Oliveira E Silva ED, Gomes AC. Prediction of postoperative facial swelling, pain and trismus following third molar surgery based on preoperative variables. Med Oral Patol Oral Cir Bucal. 2013; 18:65-70.