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Multimodal Radiomorphometric Evaluation of the Anatomical Relationship between Impacted Mandibular Third Molars and
Anwesha S Samanta1, Anita D Munde1, Sudharani Biradar1
1Department of Oral Medicine and Radiology, Rural Dental College, Pravara Institute of Medical Sciences (DU), Loni, Ahilyanagar, Maharashtra, India.
Background:
Accurate preoperative assessment of impacted mandibular third molars (IMTMs) and their relationship to the inferior alveolar canal is crucial to reduce the risk of inferior alveolar nerve (IAN) injury during extraction. Panoramic radiography (orthopantomography) is routinely used for initial evaluation; however, cone-beam computed tomography (CBCT) offers superior three-dimensional visualization and may improve diagnostic accuracy.
Aim:
The aim of this study was to evaluate panoramic radiographic markers indicative of potential IAN injury and correlate them with CBCT findings in patients with IMTMs.
Materials And Methods:
This cross-sectional observational study included 150 patients presenting with orthopantomographic evidence of IMTMs without associated pathology. Seven panoramic radiographic signs described by Rood et al. - darkening of roots, deflection of roots, narrowing of roots, bifid root apex, diversion of canal, narrowing of canal, and interruption of the white line of the canal - were assessed. CBCT images were evaluated for the absence of corticalization, buccolingual position of the canal relative to the third molar roots, and presence of cortical thinning or perforation.
Results:
Among the panoramic signs, narrowing of roots showed a statistically significant association with lingual cortical perforation on CBCT (6 cases; 17.1%; P < 0.04). Thinning or perforation of the lingual cortex demonstrated a significant correlation with specific panoramic radiographic markers, indicating a higher risk of nerve involvement.
Conclusion:
Panoramic radiography serves as a useful initial diagnostic tool; however, when high-risk radiographic signs are present, CBCT provides more accurate three-dimensional assessment, facilitating improved surgical planning and minimizing the risk of nerve injury.
