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Spatial Discrepancies in CBCT-Based Localization of Impacted Mandibular Third Molars.

Zhizheng Li1, Yanping Zou2, Tiantian Wang3

  • 1State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China.

International Dental Journal
|June 18, 2026
PubMed
Summary

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Cone-beam computed tomography (CBCT) shows inaccuracies in locating impacted mandibular third molars (IMTMs). Deeper impactions exhibit greater deviations, requiring careful surgical planning to avoid errors.

Area of Science:

  • Dentistry
  • Oral and Maxillofacial Surgery
  • Radiology

Background:

  • Accurate localization of impacted mandibular third molars (IMTMs) is crucial for safe surgical extraction.
  • Cone-beam computed tomography (CBCT) is widely used for pre-surgical imaging.
  • The precision of CBCT in depicting IMTMs, particularly deeply impacted ones, requires quantitative evaluation.

Purpose of the Study:

  • To quantitatively assess the accuracy of CBCT in localizing impacted mandibular third molars (IMTMs).
  • To evaluate the utility of surgical guides as an image transfer modality for improving localization accuracy.
  • To identify factors influencing CBCT localization discrepancies.

Main Methods:

  • Standardized CBCT scans were performed on patients requiring IMTM extraction.
Keywords:
Cone-beam computed tomographyImpacted third molarLocalization discrepancySurgical guide

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  • Personalized surgical guides were designed and 3D printed for 10 deeply impacted cases (Pell & Gregory Class C) based on CBCT models.
  • Intraoperative measurements compared guide-indicated positions with actual crown positions; horizontal discrepancies were measured in 60 additional cases.

    • Main Results:

    • Actual IMTM positions frequently extended mesially beyond the adjacent second molar.
    • Surgical guide measurements revealed mean mesiodistal deviations of 4.94 ± 1.45 mm and significant vertical discrepancies (superior: 5.21 ± 1.38 mm; inferior: 4.62 ± 0.95 mm).
    • Discrepancies were significantly greater in deeper impactions (Class C) compared to Class B.

    Conclusions:

    • CBCT-based localization of IMTMs in the mandibular retromolar region can exhibit several millimeters of deviation in both mesiodistal and vertical dimensions.
    • Deeper impactions and proximity to the mandibular angle/inferior border increase localization errors.
    • Heightened vigilance is necessary when relying solely on CBCT for surgical planning of deeply impacted IMTMs or retromolar foreign bodies.