Does a Preoperative Cone Beam Ct Reduce Complication Rates in the Surgical Removal of Complex Lower Third Molars? A Retrospective Study Including 486 Cases
BackroundThis study was designed to analyse the value of preoperative Cone Beam CTs prior to the surgical removal of complex lower third molars. Furthermore, the aim was to assess injuries to the inferior alveolar nerve bundle and postoperative neurological disorders depending on the position of the lower third molar and theinferior alveolar nerve bundle.MethodsPreoperative Cone Beam CTs and Orthopantomographs of 324 patients were analysed concerning the location of the lower third molars in
... third molars in relation to the mandible and the inferior alveolar nerve bundle. Surgery protocols of all patients who underwent the surgical removal of at least one complex lower third molar were analysed concerning patient data, length of surgery, intraoperative haemorrhage, intraoperative exposure of the inferior alveolar nerve bundle, postoperative swelling and postoperative neurological disorders. The data was then compared to data from international studies.ResultsIn all 324 patients a permanent neurological damage was not found. Temporary neurological damage was recorded in 13 cases (2.6%). A caudal nerve position with no measurable distance to the root of the lower third molar was associated with the highest risk of a temporal neurological damage. A vestibular touching nerve route also correlated with postoperative sensitivity impairment.ConclusionsThree-dimensional radiographic imaging,in our patient group, does not significantly affect the risk for complications during the surgical removal of complex lower third molars,but allows the surgeon to choose the best surgical approch for a fast and most atraumatic operation. Therefore, it should only be utilized for risk assessment, especially in cases of symptom-free lower third molars. A preoperative orthopantomogram still can be accepted as standard for radiographic imaging. The interpretation of the orthopantomogram may lead to the indication for three-dimensional imaging, if signs of increased surgery risk are present.