Risk of Postsurgical Inferior Alveolar Nerve Injury in At-Risk Patients Based on Tomographic Imaging Features:
Claudine Thereza-Bussolaro1, Nathalia Fagundes2, Cristine C Stefani3
1Professor, Department of Dentistry, University of Cuiaba, Cuiaba, Brazil; Mike Petryk School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Background:
Reported risk of inferior alveolar nerve (IAN) injury following mandibular third molar surgery varies widely and is typically presented without stratification by tomographic risk factors, limiting individualized risk assessment and surgical planning.
Purpose:
The purpose was to estimate the risk of IAN injury in at-risk patients according to tomographic factors, including mandibular canal (MC) position, MC shape, MC cortical status, and third molar morphology.
Data Source:
This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and was registered in PROSPERO. MEDLINE, EMBASE, Web of Science, Scopus, Cochrane Library, and Google Scholar were searched using a PEO-based strategy, without language or date restrictions.
Study Selection:
Prospective and retrospective cohort studies reporting the risk of IAN injury after third molar surgery with preoperative CBCT and objective neurosensory testing were included. Studies relying solely on subjective assessments, lacking CBCT data, or involving unrelated procedures or outcomes were excluded. Study selection was performed independently by 2 reviewers.
Data Extraction(S) And Synthesis:
Data were extracted by one reviewer and independently verified by a second. Risk of bias was assessed using the Joanna Briggs Institute tool. Meta-analyses were performed using random-effects models. Statistical heterogeneity was assessed with I2 and Tau2, and certainty of evidence was evaluated using GRADE.
Main Outcome(S) And Measures(S):
The primary outcome was objectively confirmed postoperative IAN injury, stratified according to the CBCT-based tomographic features.
Results:
Of 1,039 records screened, 11(1.05%) studies were included. The pooled overall risk of IAN injury was 9.52% (95% CI: 7.18 to 12.53%), increasing to 14.76% (95% CI: 11.37 to 18.94%) in high-risk cases. Stratified analyses demonstrated substantial variation by tomographic feature, with risk ranging from 1.34 to 27.47% according to MC position, 6.56 to 18.36% by MC shape, 15.65% in the absence of MC cortical bone, and 0.39% when cortical bone was present.
Conclusion And Relevance:
Based on a certainty of evidence that ranged from low to very low, CBCT-based tomographic features are associated with markedly different risks of IAN injury, underscoring the importance of risk-stratified preoperative assessment in at-risk cases. These findings may enhance surgical planning and patient counseling and highlight the need for high-quality studies to refine risk prediction.
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