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Title CBCT Superior To Panoramic Radiography In Displaying The Proximity Of The Inferior Alveolar Canal (IAC) To Impacted 3rd Molars
Clinical Question In patients with impacted lower 3rd molars, does CBCT imaging offer more effective imaging than panoramic radiography to assess the proximity of the IAC to impacted 3rd molars?
Clinical Bottom Line CBCT is a more accurate method than panoramic radiography in evaluating the relationship between impacted mandibular third molars and the IAC. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20123411Suomalainen /201042 teeth in 30 patients 19 women 11 men between 20 and 44 years old Case series with surgical confirmation (gold standard)
Key resultsObservations of the proximity of the IAC and the extraction site were made during removal of twenty-five impacted mandibular 3rd molars. Surgical confirmation was used as a gold standard to assess the accuracy of radiographic measurements. CBCT showed the number of roots more reliably than panoramic radiography and was highly accurate in locating the inferior alveolar canal. CBCT showed a perfect match between intra and inter-observer readings and when compared with the gold standard to locate the IAC.
Evidence Search "Cone-Beam Computed Tomography"[Mesh] AND "Mandibular Nerve"[Mesh]
Comments on
The Evidence
In-vivo surgical confirmation of the relationship of the third molar and the IAC was used as a gold standard for comparison with the radiographic data. This article is reasonable evidence of the superiority of CBCT over panoramic radiography. Two experienced oral radiologists evaluated all of the images independently. Weighted Kappa coefficient and conventional Kappa coefficient were used, and Kappa values were also calculated for inter and intra-observer agreement.
Applicability Patients were referred from experienced oral surgeons when a panoramic radiograph showed a close relationship of the IAC and the third molar. Patients were seen at two separate clinics between June 2008 and December 2008. The accuracy of CBCT helps the oral surgeon predict potential damage to the inferior alveolar nerve and consider alteration of the surgical technique.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (Oral Surgery) (Orthodontics)
Keywords Impacted mandibular third molars, CBCT, inferior alveolar canal
ID# 2076
Date of submission: 07/07/2011spacer
E-mail Faddoul@uthscsa.edu
Author Taoufik Faddoul
Co-author(s) e-mail
Faculty mentor/Co-author Stephen Matteson, DDS
Faculty mentor/Co-author e-mail MATTESON@uthscsa.edu
Basic Science Rationale
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Comments and Evidence-Based Updates on the CAT
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by Lea Al Matny, DDS (San Antonio, Texas) on 11/17/2015
A PubMed search conducted on this topic in November 2015 resulted in a more recent publication: Matzen LH, 2015; PubMed ID: 25135317. This review shows similar results as those mentioned in this CAT, but also suggests the limitation of CBCT usage to cases where one or more signs of close contact between the mandibular canal and the third molar are present in two-dimensional images, and if it is believed that CBCT will change the treatment outcome of the patient.
by Mohannad Hashem (San Antonio, TX) on 07/18/2011
Systematic review concludes that more studies using methodological standards for diagnostic efficacy of CBCT need to be performed. PubMed ID 20678100

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