Clinical and Radiological Correlation with Surgery of Third Mandibular Impacted Molars

Abstract

Overview:Tooth extraction is one of the most common procedures in dentistry and oral maxillofacial medicine. Vigilant investigation of the condition and an accurate preoperative assessment, planning, evaluating indications and contraindications, is needed in all the cases.

The objective: The aim of this study is to evaluate the role of radiographic examinations in diagnosis and surgery planning of lower third molar extraction.

Materials and methods: Review of literature; on pubmed, medline, embase, sciencedirect, and the Cochrane library, using key words of impacted molars, third molars, mandibula, alveolar, dentistry, oral maxillofacial.

Results: During dental and oral maxillofacial daily clinical practice is quite often to face impacted third lower molars, a condition that can lead to a close relation with important anatomical structures. Radiographic examinations are useful in the diagnosis and subsequently in the surgery planning and must submit to principle of justification and optimization. Intraoral radiography and orthopantomography hardly permit to evaluate the buccal or lingual position of the inferior alveolar nerve so to better predict the risk of complications. There are some radiographic signs that suggest the necessity to perform a more accurate radiographic investigation that provides a three-dimensional view of the images. The three-dimensional radiographic methods, by means of sagittal, frontal and axial views, are used to determine anatomical location, proximity, and possible contact of the third molar with the mandibular canal, blood vessels and nerves branches. The beginning of Cone Beam Computed Tomography (CBCT) has reduced the equipment cost but then again above all the radiation exposure for the patients.

Conclusions: In the past few years three-dimensional reconstructive technologies were introduced: besides advantages, in addition to the potential benefit in the reduction of complications related to the patient, also resides in the different approach of the surgeon: stress and duration of dental and oral maxillofacial surgical procedures significantly is reduced because the respective medical specialist know exactly the position of anatomical structures. This information will help the surgeon to determine a possible post-operative paresthesia and plan the better surgical technique.

Keywords: Impacted molars, third molar, surgery, inferior alveolar nerve, OPT, CBCT

DOI: 10.7176/ALST/95-04

Publication date: November 30^th 2022