Assessing the need for computed tomography for lower-third-molar extraction: a survey among 322 dentists

Area of Science:

• Dentistry
• Radiology
• Medical Imaging

Background:

• Orthopantomograms (OPTs) are crucial for evaluating the relationship between inferior alveolar nerves (IAN) and third molar roots.
• Assessing this relationship helps predict the risk of iatrogenic neurological lesions post-extraction.
• Computed tomography (CT) or cone-beam CT may be indicated for high-risk cases.

Purpose of the Study:

• To investigate dentists' judgment on the necessity of CT scans based on OPTs.
• To determine if dentists adhere to justification, appropriateness, and optimization criteria when prescribing radiation-involved examinations.
• To evaluate dentists' prescribing habits for CT versus other radiographic methods.

Main Methods:

• A web-based survey was distributed to 2,713 Italian dentists in the Veneto region.
• Participants reviewed 20 OPTs and answered a questionnaire regarding the need for CT or periapical X-rays.
• Respondents' answers were evaluated against gold standard CT images for appropriateness and over/under-prescription tendencies.

Main Results:

• The survey achieved a 11.9% response rate, consistent with web-based surveys.
• Dentists' assessments generally aligned with the gold standard, yielding a mean appropriateness rating of 0.636.
• Overlap between the mandibular canal and third molar roots was the most frequently identified risk factor. CT recommendations increased with the number of risk indicators. 54.9% found periapical X-rays useful when CT was not recommended, citing its necessity for extraction.

Conclusions:

• The study indicates a generally cautious approach by dentists when deciding on CT prescriptions.
• There is a tendency among surveyed dentists to overprescribe CT examinations for third molar assessments.
• Dentists' decisions were influenced by radiographic signs indicating potential IAN injury risk.