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Published on: February 23, 2024
Predictive factors in tomographic imaging for inferior alveolar nerve injury during third-molar surgery: A systematic
Claudine Thereza-Bussolaro1, Nathalia Fagundes2, Camila Pacheco-Pereira2
1School of Dentistry, University of Cuiaba, Mato Grosso, Brazil; Mike Petryk School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Background:
In this systematic review, the authors aimed to summarize existing predictive models for identifying patients at high risk of experiencing inferior alveolar nerve (IAN) injury after third-molar extraction.
Types Of Studies Reviewed:
Retrospective and prospective cohort studies, randomized clinical trials, and nested case-control studies were included. All studies used tomographic imaging obtained before and after surgery to assess patient risk of experiencing an IAN injury after mandibular third-molar extraction, with a focus on the anatomic position, shape, and features of the mandibular canal in relation to IAN injury risk.
Results:
In 18 studies, researchers identified 8 tomographic features that predict IAN injury during third-molar extraction. Sixteen studies had a low risk of bias. The Grading of Recommendations Assessment, Development and Evaluation framework indicated moderate to high certainty of evidence. Significant increases in odds ratios (ORs) (with P < .001) were observed for the absence of cortical bone (OR, 9.87; 95% CI, 4.10 to 23.83), a dumbbell-shaped canal (OR, 8.25; 95% CI, 3.19 to 21.35), and a lingual position (OR, 3.82; 95% CI, 1.95 to 7.39. Patients exhibiting all 3 features had an increased risk of experiencing IAN injury after mandibular third-molar extraction (OR, 5.06; 95% CI, 2.23 to 11.39).
Conclusions And Practical Implications:
Oral and maxillofacial radiologists should report these high-risk features to inform dental surgeons and patients. Less traumatic surgical techniques as well as precautionary measures should be considered to minimize IAN injury risks during third-molar extraction. The protocol was registered in the PROSPERO database (CRD42024582042).
