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Does a preoperative Cone Beam CT reduce complication rates in the surgical removal of complex lower third molars? A retrospective study including 486 cases.
Jan Klatt
Universitatsklinikum Hamburg-Eppendorf
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7774-3852
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Backround This study was designed to analyse the value of preoperative Cone Beam CTs (CBCT) prior to the surgical removal of complex lower third molars. Furthermore, the aim was to assess injuries to the inferior alveolar nerve (IAN) bundle and postoperative neurological disorders depending on the position of the lower third molar and the inferior alveolar nerve bundle.
Methods In this retrospective examination preoperative Cone Beam CTs and Orthopantomographs (OPT) of 324 patients were analysed concerning the location of the lower 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.
Results In 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. If a mesioangulation (Winter) or a Pell and Gregory Type IIIC appears in the OPT, risk of neurological damage is at its highest.
Conclusions Three-dimensional radiographic imaging, in our patient group, does not significantly affect the risk for complications during the surgical removal of complex lower third molars. 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.
An intraoperative exposure of the IAN bundle does not necessarily predict simultaneous neurological damage. Exposure of the IAN bundle is no indication for a discontinuation of the surgery.
Keywords
cone-beam computed tomography, radiography, third molar, extraction, inferior alveolar nerve
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Posted 21 Dec, 2020
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Review #3 received
Received 15 Jan, 2021
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On 01 Jan, 2021
Review #2 received
Received 29 Dec, 2020
Reviewer #2 agreed
On 22 Dec, 2020
Review #1 received
Received 08 Dec, 2020
Reviewer #1 agreed
On 07 Dec, 2020
Editor assigned
On 06 Dec, 2020
Reviewers invited
Invitations sent on 06 Dec, 2020
Submission checks complete
On 06 Dec, 2020
Editor invited
On 06 Dec, 2020
No comments provided
Editorial decision: Major revision
On 06 Nov, 2020
Review #1 received
Received 19 Jul, 2020
Review #2 received
Received 08 Jul, 2020
Reviewer #2 agreed
On 26 Jun, 2020
Reviewer #1 agreed
On 24 Jun, 2020
Reviewers invited
Invitations sent on 23 Jun, 2020
Editor assigned
On 11 Jun, 2020
Editor invited
On 10 Jun, 2020
Submission checks complete
On 03 Jun, 2020
First submitted
On 30 May, 2020
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Subject Areas
Head & Neck Surgery
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This preprint is under consideration at Head & Face Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Does a preoperative Cone Beam CT reduce complication rates in the surgical removal of complex lower third molars? A retrospective study including 486 cases.
Jan Klatt
Universitatsklinikum Hamburg-Eppendorf
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7774-3852
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 2
Posted 21 Dec, 2020
No community comments so far
Review #3 received
Received 15 Jan, 2021
Reviewer #3 agreed
On 01 Jan, 2021
Review #2 received
Received 29 Dec, 2020
Reviewer #2 agreed
On 22 Dec, 2020
Review #1 received
Received 08 Dec, 2020
Reviewer #1 agreed
On 07 Dec, 2020
Editor assigned
On 06 Dec, 2020
Reviewers invited
Invitations sent on 06 Dec, 2020
Submission checks complete
On 06 Dec, 2020
Editor invited
On 06 Dec, 2020
No comments provided
Editorial decision: Major revision
On 06 Nov, 2020
Review #1 received
Received 19 Jul, 2020
Review #2 received
Received 08 Jul, 2020
Reviewer #2 agreed
On 26 Jun, 2020
Reviewer #1 agreed
On 24 Jun, 2020
Reviewers invited
Invitations sent on 23 Jun, 2020
Editor assigned
On 11 Jun, 2020
Editor invited
On 10 Jun, 2020
Submission checks complete
On 03 Jun, 2020
First submitted
On 30 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Head & Neck Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Backround This study was designed to analyse the value of preoperative Cone Beam CTs (CBCT) prior to the surgical removal of complex lower third molars. Furthermore, the aim was to assess injuries to the inferior alveolar nerve (IAN) bundle and postoperative neurological disorders depending on the position of the lower third molar and the inferior alveolar nerve bundle.
Methods In this retrospective examination preoperative Cone Beam CTs and Orthopantomographs (OPT) of 324 patients were analysed concerning the location of the lower 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.
Results In 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. If a mesioangulation (Winter) or a Pell and Gregory Type IIIC appears in the OPT, risk of neurological damage is at its highest.
Conclusions Three-dimensional radiographic imaging, in our patient group, does not significantly affect the risk for complications during the surgical removal of complex lower third molars. 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.
An intraoperative exposure of the IAN bundle does not necessarily predict simultaneous neurological damage. Exposure of the IAN bundle is no indication for a discontinuation of the surgery.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9