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Gong Z, Feng W, Su X, Choi C. System for automatically assessing the likelihood of inferior alveolar nerve injury. Comput Biol Med 2024; 169:107923. [PMID: 38199211 DOI: 10.1016/j.compbiomed.2024.107923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/20/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024]
Abstract
Inferior alveolar nerve (IAN) injury is a severe complication associated with mandibular third molar (MM3) extraction. Consequently, the likelihood of IAN injury must be assessed before performing such an extraction. However, existing deep learning methods for classifying the likelihood of IAN injury that rely on mask images often suffer from limited accuracy and lack of interpretability. In this paper, we propose an automated system based on panoramic radiographs, featuring a novel segmentation model SS-TransUnet and classification algorithm CD-IAN injury class. Our objective was to enhance the precision of segmentation of MM3 and mandibular canal (MC) and classification accuracy of the likelihood of IAN injury, ultimately reducing the occurrence of IAN injuries and providing a certain degree of interpretable foundation for diagnosis. The proposed segmentation model demonstrated a 0.9 % and 2.6 % enhancement in dice coefficient for MM3 and MC, accompanied by a reduction in 95 % Hausdorff distance, reaching 1.619 and 1.886, respectively. Additionally, our classification algorithm achieved an accuracy of 0.846, surpassing deep learning-based models by 3.8 %, confirming the effectiveness of our system.
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Affiliation(s)
- Ziyang Gong
- Department of Computer Engineering, Gachon University, Seongnam-si, 13120, Republic of Korea
| | - Weikang Feng
- College of Information Science and Engineering, Hohai University, Changzhou, 213000, China
| | - Xin Su
- College of Information Science and Engineering, Hohai University, Changzhou, 213000, China
| | - Chang Choi
- Department of Computer Engineering, Gachon University, Seongnam-si, 13120, Republic of Korea.
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Carvalho J, Lotz M, Rubi L, Unger S, Pfister T, Buhmann J, Stadlinger B. Preinterventional Third-Molar Assessment Using Robust Machine Learning. J Dent Res 2023; 102:1452-1459. [PMID: 37944556 PMCID: PMC10683342 DOI: 10.1177/00220345231200786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Machine learning (ML) models, especially deep neural networks, are increasingly being used for the analysis of medical images and as a supporting tool for clinical decision-making. In this study, we propose an artificial intelligence system to facilitate dental decision-making for the removal of mandibular third molars (M3M) based on 2-dimensional orthopantograms and the risk assessment of such a procedure. A total of 4,516 panoramic radiographic images collected at the Center of Dental Medicine at the University of Zurich, Switzerland, were used for training the ML model. After image preparation and preprocessing, a spatially dependent U-Net was employed to detect and retrieve the region of the M3M and inferior alveolar nerve (IAN). Image patches identified to contain a M3M were automatically processed by a deep neural network for the classification of M3M superimposition over the IAN (task 1) and M3M root development (task 2). A control evaluation set of 120 images, collected from a different data source than the training data and labeled by 5 dental practitioners, was leveraged to reliably evaluate model performance. By 10-fold cross-validation, we achieved accuracy values of 0.94 and 0.93 for the M3M-IAN superimposition task and the M3M root development task, respectively, and accuracies of 0.9 and 0.87 when evaluated on the control data set, using a ResNet-101 trained in a semisupervised fashion. Matthew's correlation coefficient values of 0.82 and 0.75 for task 1 and task 2, evaluated on the control data set, indicate robust generalization of our model. Depending on the different label combinations of task 1 and task 2, we propose a diagnostic table that suggests whether additional imaging via 3-dimensional cone beam tomography is advisable. Ultimately, computer-aided decision-making tools benefit clinical practice by enabling efficient and risk-reduced decision-making and by supporting less experienced practitioners before the surgical removal of the M3M.
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Affiliation(s)
- J.S. Carvalho
- ETH Zurich, Department of Computer Science, Zurich, Switzerland
- ETH AI Center, Zurich, Switzerland
| | - M. Lotz
- University of Zurich, Center for Dental Medicine, Zurich, Switzerland
| | - L. Rubi
- ETH Zurich, Department of Computer Science, Zurich, Switzerland
| | - S. Unger
- University of Zurich, Center for Dental Medicine, Zurich, Switzerland
| | - T. Pfister
- University of Zurich, Center for Dental Medicine, Zurich, Switzerland
| | - J.M. Buhmann
- ETH Zurich, Department of Computer Science, Zurich, Switzerland
- ETH AI Center, Zurich, Switzerland
| | - B. Stadlinger
- University of Zurich, Center for Dental Medicine, Zurich, Switzerland
- ETH AI Center, Zurich, Switzerland
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Chun SY, Kang YH, Yang S, Kang SR, Lee SJ, Kim JM, Kim JE, Huh KH, Lee SS, Heo MS, Yi WJ. Automatic classification of 3D positional relationship between mandibular third molar and inferior alveolar canal using a distance-aware network. BMC Oral Health 2023; 23:794. [PMID: 37880603 PMCID: PMC10598947 DOI: 10.1186/s12903-023-03496-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
The purpose of this study was to automatically classify the three-dimensional (3D) positional relationship between an impacted mandibular third molar (M3) and the inferior alveolar canal (MC) using a distance-aware network in cone-beam CT (CBCT) images. We developed a network consisting of cascaded stages of segmentation and classification for the buccal-lingual relationship between the M3 and the MC. The M3 and the MC were simultaneously segmented using Dense121 U-Net in the segmentation stage, and their buccal-lingual relationship was automatically classified using a 3D distance-aware network with the multichannel inputs of the original CBCT image and the signed distance map (SDM) generated from the segmentation in the classification stage. The Dense121 U-Net achieved the highest average precision of 0.87, 0.96, and 0.94 in the segmentation of the M3, the MC, and both together, respectively. The 3D distance-aware classification network of the Dense121 U-Net with the input of both the CBCT image and the SDM showed the highest performance of accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve, each of which had a value of 1.00. The SDM generated from the segmentation mask significantly contributed to increasing the accuracy of the classification network. The proposed distance-aware network demonstrated high accuracy in the automatic classification of the 3D positional relationship between the M3 and the MC by learning anatomical and geometrical information from the CBCT images.
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Affiliation(s)
- So-Young Chun
- Interdisciplinary Program in Bioengineering, Graduate School of Engineering, Seoul National University, Seoul, South Korea
| | - Yun-Hui Kang
- Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital, Seoul, South Korea
| | - Su Yang
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Se-Ryong Kang
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | | | - Jun-Min Kim
- Department of Electronics and Information Engineering, Hansung University, Seoul, South Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Won-Jin Yi
- Interdisciplinary Program in Bioengineering, Graduate School of Engineering, Seoul National University, Seoul, South Korea.
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea.
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea.
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Starch-Jensen T, Gacic B, Konstantinovic VS, Valls Ontañón A, Sapundzhiev A, Pavlov N, Pechalova P, Szalma J, Mottl R, Tamme T, Tiigimäe-Saar J, Ivask O, Božič V, Jovanovski T, Dovšak T, Țenț PA, Brucoli M, Rocchetti V, Boffano P. Patient's perception of recovery following surgical removal of mandibular third molars. A prospective european multi-center study. J Craniomaxillofac Surg 2023; 51:635-643. [PMID: 37858483 DOI: 10.1016/j.jcms.2023.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/25/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023] Open
Abstract
This study evaluated patient's perception of recovery following surgical removal of mandibular third molars (SRM3s) including analyze of potential risk factors associated with impaired convalescent. Patient related parameters combined with preoperative questionnaires including Modified Dental Anxiety Scale, Oral Health Impact Profile-14, and Decayed, Missing, Filled Teeth index were correlated with questionnaires assessing pain, swelling, trismus, sick leave, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment, impaired sensation of the lip, chin, and tongue, one month following SRM3s. Totally, 412 patients (223 females, 189 males) with mean age of 29.4 years were included. Treatment satisfaction and willingness to undergo similar surgery were reported by 92% and 95%, although 21% reported that the surgery and postoperative period had been worse than expected. Mean days with pain, sick leave, and swelling were 3.6, 2.1, and 3.6, respectively. Preoperative symptoms, dental anxiety level, and prolonged surgical time were associated with increased pain and swelling (P < 0.05). Pell and Gregory classification (I-IIIC) were associated with impaired sensation of the lower lip and chin (P < 0.05). Consequently, results from this study improve the surgeon's ability to predict parameters that predisposed to impaired recovery and neurosensory disturbances following SRM3s.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark.
| | - Bojan Gacic
- School of Dental Medicine, University of Belgrade, Serbia
| | | | | | - Angel Sapundzhiev
- Department of Oral Surgery, Faculty of Dental Medicine, Medical University of Plovdiv, Bulgaria
| | - Nikolay Pavlov
- University Hospital "St. Georgi", Clinic of Maxillofacial Surgery, Plovdiv, Bulgaria
| | - Petia Pechalova
- Department of Oral Surgery, Faculty of Dental Medicine, Medical University of Plovdiv, Bulgaria
| | - József Szalma
- Department of Oral Maxillofacial Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Radovan Mottl
- Department of Dentistry, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital, Hradec Kralove, 500 05, Hradec Kralove, Czech Republic
| | - Tiia Tamme
- Department of Maxillofacial Surgery, Institute of Dentistry, University of Tartu, L. Puusepa 8, Tartu, 51014, Estonia
| | - Janne Tiigimäe-Saar
- Department of Maxillofacial Surgery, Institute of Dentistry, University of Tartu, L. Puusepa 8, Tartu, 51014, Estonia
| | - Oksana Ivask
- Department of Maxillofacial Surgery, Institute of Dentistry, University of Tartu, L. Puusepa 8, Tartu, 51014, Estonia
| | - Veronika Božič
- Clinical Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Trajche Jovanovski
- Clinical Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Tadej Dovšak
- Clinical Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Paul Andrei Țenț
- Department of Oral and Maxillo-Facial Surgery, University of Oradea, Oradea, Romania
| | - Matteo Brucoli
- Division of Oral and Maxillo-Facial Surgery, Novara University Hospital, Novara, Italy
| | | | - Paolo Boffano
- Division of Dentistry, Vercelli Hospital, Vercelli, Italy
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Monaco G, Angelino C, Vignudelli E, Ferri A, Felice P. What is the Incidence of Late Complications Associated With Lower Third Molar Coronectomy? 10-Year Follow-Up Results. J Oral Maxillofac Surg 2023; 81:1279-1285. [PMID: 37463659 DOI: 10.1016/j.joms.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 05/04/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Coronectomy is an operation to manage impacted third molars (M3s) considered at high risk for mandibular nerve injury but long-term outcomes are still lacking. The purpose of this study was to estimate the risk of late complications occurring within 10 years following lower M3 coronectomy. METHODS The investigators designed a prospective cohort study and enrolled a sample of 94 patients treated with coronectomy of third mandibular molars at the Unit of Oral and Maxillofacial Surgery of the University of Bologna, from 2009 to 2012. This follow-up study included all of the patients from the original study who completed 10 years of follow-up. The primary outcome variables is postoperative late complication occurring between 5 and 10 years after coronectomy coded as present or absent. Late complications were defined as root exposure, nerve injury, pulpitis, periapical infection, and reoperation. The secondary outcome variable was probing pocket depth. Covariates examined were age, smoking and type of M3 impaction. Descriptive statistical analyses were performed. RESULTS The inception cohort was composed of 94 subjects who had 116 coronectomies (k) completed. The study cohort was composed of subjects with 10 years of follow-up and included 48 subjects (k = 60) with a mean age of 28.99 ± 8.9 years. Between years 5 and 10 of follow-up, 2 subjects (4%) have complications; all root exposures diagnosed at years 8 or 9 after surgery. In another case root removal was required for orthodontics reason. No case of nerve injury to the inferior alveolar nerve occurred, and no periapical infection was observed around the residual roots. The mean 10-year probing pocket depth was 3.31 ± 0.92 mm (1,66-5,66 mm). There were too few complications to identify risk factors for late complications. CONCLUSIONS Within all the limitations of this study, the results of this prospective study imply that coronectomy is a useful surgical technique for the treatment of M3s at high neurological risk, to avoid nerve injury to the inferior alveolar nerve. In addition, after coronectomy, retained roots did not develop late infection or periapical infection in the long term. However, in a few cases, removal of retained roots was required at 10 years, due to root migration in the oral cavity. The risk for late complications is uncommon, but persistent.
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Affiliation(s)
- Giuseppe Monaco
- Unit of Oral Surgery, Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Claudia Angelino
- Unit of Oral Surgery, Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Bologna, Italy.
| | - Elisabetta Vignudelli
- Unit of Oral Surgery, Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Agnese Ferri
- Unit of Oral Surgery, Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Pietro Felice
- Unit of Oral Surgery, Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
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Lin X, Xin W, Huang J, Jing Y, Liu P, Han J, Ji J. Accurate mandibular canal segmentation of dental CBCT using a two-stage 3D-UNet based segmentation framework. BMC Oral Health 2023; 23:551. [PMID: 37563606 PMCID: PMC10416403 DOI: 10.1186/s12903-023-03279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 08/02/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVES The objective of this study is to develop a deep learning (DL) model for fast and accurate mandibular canal (MC) segmentation on cone beam computed tomography (CBCT). METHODS A total of 220 CBCT scans from dentate subjects needing oral surgery were used in this study. The segmentation ground truth is annotated and reviewed by two senior dentists. All patients were randomly splitted into a training dataset (n = 132), a validation dataset (n = 44) and a test dataset (n = 44). We proposed a two-stage 3D-UNet based segmentation framework for automated MC segmentation on CBCT. The Dice Similarity Coefficient (DSC) and 95% Hausdorff Distance (95% HD) were used as the evaluation metrics for the segmentation model. RESULTS The two-stage 3D-UNet model successfully segmented the MC on CBCT images. In the test dataset, the mean DSC was 0.875 ± 0.045 and the mean 95% HD was 0.442 ± 0.379. CONCLUSIONS This automatic DL method might aid in the detection of MC and assist dental practitioners to set up treatment plans for oral surgery evolved MC.
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Affiliation(s)
- Xi Lin
- Clinic of Stomatology of the Shantou University Medical College, No. 22, Xinling Road, Shantou, Guangdong China
| | - Weini Xin
- Clinic of Stomatology of the Shantou University Medical College, No. 22, Xinling Road, Shantou, Guangdong China
- Department of Stomatology of Shantou University Medical College, No. 22, Xinling Road, Shantou, Guangddong China
| | - Jingna Huang
- Clinic of Stomatology of the Shantou University Medical College, No. 22, Xinling Road, Shantou, Guangdong China
| | - Yang Jing
- Huiying Medical Technology Co., Ltd, Room A206, B2, Dongsheng Science and Technology Park, Haidian District, Beijing, China
| | - Pengfei Liu
- Huiying Medical Technology Co., Ltd, Room A206, B2, Dongsheng Science and Technology Park, Haidian District, Beijing, China
| | - Jingdan Han
- Huiying Medical Technology Co., Ltd, Room A206, B2, Dongsheng Science and Technology Park, Haidian District, Beijing, China
| | - Jie Ji
- Network and Information Center, Shantou University, No. 243, University Road, Shantou, Guangdong China
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Leung YY, Hung KF, Li DTS, Yeung AWK. Application of Cone Beam Computed Tomography in Risk Assessment of Lower Third Molar Surgery. Diagnostics (Basel) 2023; 13:diagnostics13050919. [PMID: 36900063 PMCID: PMC10001295 DOI: 10.3390/diagnostics13050919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023] Open
Abstract
Risks of lower third molar surgery like the inferior alveolar nerve injury may result in permanent consequences. Risk assessment is important prior to the surgery and forms part of the informed consent process. Traditionally, plain radiographs like orthopantomogram have been used routinely for this purpose. Cone beam computed tomography (CBCT) has offered more information from the 3D images in the lower third molar surgery assessment. The proximity of the tooth root to the inferior alveolar canal, which harbours the inferior alveolar nerve, can be clearly identified on CBCT. It also allows the assessment of potential root resorption of the adjacent second molar as well as the bone loss at its distal aspect as a consequence of the third molar. This review summarized the application of CBCT in the risk assessment of lower third molar surgery and discussed how it could aid in the decision-making of high-risk cases to improve safety and treatment outcomes.
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Affiliation(s)
- Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
- Correspondence:
| | - Kuo Feng Hung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Dion Tik Shun Li
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Andy Wai Kan Yeung
- Oral and Maxillofacial Radiology, Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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James O, Oyeneyin AO, Adeyemi MO, Erinoso OA, Adekunle AA, Adeyemo WL. Neurosensory Deficits of Inferior Alveolar Nerve Following Impacted Mandibular Third Molar Extraction: Comparison of One-Stage Complete Extraction with Two-Stage Partial Coronectomy Surgical Technique. J Maxillofac Oral Surg 2023; 22:178-186. [PMID: 36703659 PMCID: PMC9871121 DOI: 10.1007/s12663-021-01601-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/31/2021] [Indexed: 01/29/2023] Open
Abstract
Objectives Inferior alveolar nerve neurosensory deficit is a worrisome complication of surgical extraction of impacted mandibular third molars. A novel approach using two-stage partial coronectomy has been proposed as an alternative surgical procedure to reduce this complication. This study compared neurosensory deficits of inferior alveolar nerve following impacted mandibular third molar extraction using one-stage complete extraction with the two-stage partial coronectomy technique. Material and Methods Subjects with mesioangular or horizontal impacted mandibular third molar with an intimate relationship with inferior dental canal who met the inclusion criteria were recruited for the study. Subjects were divided into one-stage and two-stage partial coronectomy techniques. The subjects were evaluated for the presence of inferior alveolar neurosensory deficit, and the relationships of neurosensory nerve deficit with sex, age and type of impaction. Results Neurosensory deficit was observed in 5 subjects (7.8%), with all cases seen in the one-stage group. This difference was statistically significant (p = 0.03). The relationship between the incidence of neurosensory deficit and age, sex, type of impaction, surgical difficulty, operating time and root morphology was not statistically significant (p > 0.05). Conclusion Findings from this study suggest partial coronectomy compared to one-stage complete extraction reduces the incidence of Inferior alveolar nerve neurosensory deficit.
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Affiliation(s)
- Olutayo James
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Aliyu Ope Oyeneyin
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
| | - Michael Olayinka Adeyemi
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olufemi Akinwunmi Erinoso
- Department of Oral and Maxillofacial Surgery, Lagos State University Teaching Hospital Ikeja, Lagos, Nigeria
| | - Adeola Adegbayi Adekunle
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
| | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
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Automatic Machine Learning-based Classification of Mandibular Third Molar Impaction Status. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2023. [DOI: 10.1016/j.ajoms.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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10
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Godard A, Millot G. Early lingual nerve suture under local anesthesia after wisdom tooth extraction: a case report. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2023. [DOI: 10.1051/mbcb/2022036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Introduction: Lingual nerve injury is one of the operative risks of mandibular wisdom tooth avulsion surgery. The anatomical relationship of the nerve to the medial side of the socket of the mandibular third molar must be known when performing the procedure. When a lesion occurs, the diagnosis may be delayed by the effect of anesthesia. In the case of a complete section, repair can be considered by direct suture of the nerve margins. It is recommended to perform this suture as soon as possible. In most cases, the lingual nerve suture is performed remotely and under general anesthesia. Observation: The case presented here describes the early repair of a lingual nerve transection after avulsion of a mandibular third molar. The procedure has been performed under local anesthesia one day after surgery and consisted of a direct suture using the previous surgical approach. Conclusion: This allows for a simplified treatment of this complication, thus shortening the management time.
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Gumber TK, Kandiara P, Bhullar RS, Dhawan A, Kapila S, Singh B. Assessment and Correlation of Variation in Lingual Cortical Plate Thickness with Different Angulations of Impacted Mandibular Third Molar Using Cone Beam Computed Tomography in North Indian Population. J Maxillofac Oral Surg 2022. [PMID: 37534344 PMCID: PMC10390454 DOI: 10.1007/s12663-022-01835-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose The extraction of impacted mandibular third molar is associated with various types of intraoperative and postoperative complications, one of them is injury to lingual nerve. The present study aims to assess and correlate the variation in lingual cortical plate thickness with different angulations and determine the topographic relationship between the root apex of impacted mandibular third molar and lingual cortical plate using Cone Beam Computed Tomography (CBCT). Methods This prospective cohort study enrolled 140 patients with impacted mandibular third molars who underwent preoperative CBCT imaging. The CBCT images were used to evaluate the outcome variables such as lingual cortical plate thickness and topographical relationship between root apex of impacted mandibular third molar and lingual cortical plate. The predictor variables included age, gender, inclination of third molar, mesiodistal angle, buccolingual angle and lingual plate morphology. Results The temporary lingual nerve paresthesia was reported by 1 patient (0.71%) out of 140 patients. The lingual bone in distoangular and vertical impacted third molar was found to be 1.20 times thicker than mesioangular and horizontal teeth. Lingual bone thinning at mid-root level was observed in maximum number of cases with mesioangular teeth (68.5%), whereas horizontal impacted teeth showed lingual bone thinning (90.9%) at root apex level. The mean buccolingual angle of impacted mandibular third molar was found to be significantly associated with lingual bone perforation (p value = 0.0258). The morphology of lingual plate was observed as undercut type (37.14%) followed by slanted (36.43%), parallel (19.29%) and round type (7.14%). Conclusion Increase in buccolingual angle of impacted mandibular third molar decreases lingual bone thickness which is the natural barrier for protecting injury to lingual nerve. Also undercut and slanted lingual plate shapes were recognised as risk factors for contact/perforation between root apex and lingual plate. Therefore, proper screening and planning of high risk patients before third molar extraction is crucial.
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Takebe K, Imai T, Kubota S, Nishimoto A, Amekawa S, Uzawa N. Deep learning model for the automated evaluation of contact between the lower third molar and inferior alveolar nerve on panoramic radiography. J Dent Sci 2022. [DOI: 10.1016/j.jds.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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13
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Ariji Y, Mori M, Fukuda M, Katsumata A, Ariji E. Automatic visualization of the mandibular canal in relation to an impacted mandibular third molar on panoramic radiographs using deep learning segmentation and transfer learning techniques. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:749-757. [PMID: 36229373 DOI: 10.1016/j.oooo.2022.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/01/2022] [Accepted: 05/31/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to create and assess a deep learning model using segmentation and transfer learning methods to visualize the proximity of the mandibular canal to an impacted third molar on panoramic radiographs. STUDY DESIGN The panoramic radiographs containing the mandibular canal and impacted third molar were collected from 2 hospitals (Hospitals A and B). A total of 3200 areas were used for creating and evaluating learning models. A source model was created using the data from Hospital A, simulatively transferred to Hospital B, and trained using various amounts of data from Hospital B to create target models. The same data were then applied to the target models to calculate the Dice coefficient, Jaccard index, and sensitivity. RESULTS The performance of target models trained using 200 or more data sets was equivalent to that of the source model tested using data obtained from the same hospital (Hospital A). CONCLUSIONS Sufficiently qualified models could delineate the mandibular canal in relation to an impacted third molar on panoramic radiographs using a segmentation technique. Transfer learning appears to be an effective method for creating such models using a relatively small number of data sets.
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Affiliation(s)
- Yoshiko Ariji
- Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, Nagoya, Japan; Department of Oral Radiology, Osaka Dental University, School of Dentistry, Osaka, Japan
| | - Mizuho Mori
- Department of Oral Radiology, Asahi University School of Dentistry, Mizuho, Japan
| | - Motoki Fukuda
- Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, Nagoya, Japan
| | - Akitoshi Katsumata
- Department of Oral Radiology, Asahi University School of Dentistry, Mizuho, Japan
| | - Eiichiro Ariji
- Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, Nagoya, Japan.
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A Fused Deep Learning Architecture for the Detection of the Relationship between the Mandibular Third Molar and the Mandibular Canal. Diagnostics (Basel) 2022; 12:diagnostics12082018. [PMID: 36010368 PMCID: PMC9407570 DOI: 10.3390/diagnostics12082018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 12/01/2022] Open
Abstract
The study aimed to generate a fused deep learning algorithm that detects and classifies the relationship between the mandibular third molar and mandibular canal on orthopantomographs. Radiographs (n = 1880) were randomly selected from the hospital archive. Two dentomaxillofacial radiologists annotated the data via MATLAB and classified them into four groups according to the overlap of the root of the mandibular third molar and mandibular canal. Each radiograph was segmented using a U-Net-like architecture. The segmented images were classified by AlexNet. Accuracy, the weighted intersection over union score, the dice coefficient, specificity, sensitivity, and area under curve metrics were used to quantify the performance of the models. Also, three dental practitioners were asked to classify the same test data, their success rate was assessed using the Intraclass Correlation Coefficient. The segmentation network achieved a global accuracy of 0.99 and a weighted intersection over union score of 0.98, average dice score overall images was 0.91. The classification network achieved an accuracy of 0.80, per class sensitivity of 0.74, 0.83, 0.86, 0.67, per class specificity of 0.92, 0.95, 0.88, 0.96 and AUC score of 0.85. The most successful dental practitioner achieved a success rate of 0.79. The fused segmentation and classification networks produced encouraging results. The final model achieved almost the same classification performance as dental practitioners. Better diagnostic accuracy of the combined artificial intelligence tools may help to improve the prediction of the risk factors, especially for recognizing such anatomical variations.
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15
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Yamada SI, Hasegawa T, Yoshimura N, Hakoyama Y, Nitta T, Hirahara N, Miyamoto H, Yoshimura H, Ueda N, Yamamura Y, Okuyama H, Takizawa A, Nakanishi Y, Iwata E, Akita D, Itoh R, Kubo K, Kondo S, Hata H, Koyama Y, Miyamoto Y, Nakahara H, Akashi M, Kirita T, Shibuya Y, Umeda M, Kurita H. Prevalence of and risk factors for postoperative complications after lower third molar extraction: A multicenter prospective observational study in Japan. Medicine (Baltimore) 2022; 101:e29989. [PMID: 35960058 PMCID: PMC9371489 DOI: 10.1097/md.0000000000029989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Lower third molar extraction is the most common surgical treatment among routine dental and oral surgical procedures. while the surgical procedures for lower third molar extraction are well established, the difficulty of tooth extraction and the frequency of postoperative complications differ depending on the patient's background. To establish a management protocol for the lower third molars, the prevalence of and risk factors for postoperative complications after lower third molar extraction were investigated in a large number of Japanese patients in a multicenter prospective study. During 6 consecutive months in 2020, 1826 lower third molar extractions were performed at the 20 participating institutions. The medical records of the patients were reviewed, and relevant data were extracted. The prevalence of and risk factors for postoperative complications were analyzed. The prevalence of postoperative complications after lower third molar extraction was 10.0%. Multivariate analysis indicated that age (≤32 vs >32, odds ratio [OR]: 1.428, 95% confidence interval [95% CI]: 1.040-1.962, P < .05), the radiographic anatomical relationship between the tooth roots and mandibular canal (overlapping of the roots and canal vs no close anatomical relationship between the roots and the superior border of the canal, OR: 2.078, 95% CI: 1.333-3.238, P < .01; overlapping of the roots and canal vs roots impinging on the superior border of the canal, OR: 1.599, 95% CI: 1.050-2.435, P < .05), and impaction depth according to the Pell and Gregory classification (position C vs position A, OR: 3.7622, 95% CI: 2.079-6.310, P < .001; position C vs position B, OR: 2.574, 95% CI: 1.574-4.210, P < .001) are significant independent risk factors for postoperative complications after lower third molar extraction. These results suggested that higher age and a deeply impacted tooth might be significant independent risk factors for postoperative complications after lower third molar extraction.
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Affiliation(s)
- Shin-ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
- * Correspondence: Shin-ichi Yamada, DDS, PhD, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan (e-mail: )
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuhiko Yoshimura
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
- Oral Disease Center, Aizawa Hospital, Matsumoto, Japan
| | - Yusuke Hakoyama
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
- Oral Disease Center, Aizawa Hospital, Matsumoto, Japan
| | - Tetsuya Nitta
- Department of Dentistry and Oral Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Narihiro Hirahara
- Department of Dentistry and Oral Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Hironori Miyamoto
- Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hitoshi Yoshimura
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Nobuhiro Ueda
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Yoshiko Yamamura
- Department of Oral Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hideki Okuyama
- Department of Dentistry and Oral Surgery, Asama General Hospital, Saku, Japan
| | - Atsushi Takizawa
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
- Department of Dentistry and Oral Surgery, Hokushin General Hospital, Nakano, Japan
| | - Yoshitaka Nakanishi
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
- Department of Oral Surgery, Asama Nanroku Komoro Medical Center, Komoro, Japan
| | - Eiji Iwata
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Daisuke Akita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
- Department of Dentistry and Oral Surgery, Okaya City Hospital, Okaya, Japan
| | - Ryuichi Itoh
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
- Department of Dentistry and Oral Surgery, Suwa Central Hospital, Chino, Japan
| | - Kiriko Kubo
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
- Department of Dentistry and Oral Surgery, Iida Municipal Hospital, Iida, Japan
| | - Seiji Kondo
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hironobu Hata
- Department of Dentistry and Oral Surgery, Hokkaido Cancer Center, National Hospital Organization, Sapporo, Japan
| | - Yoshito Koyama
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
- Department of Dentistry and Oral Surgery, Omachi General Hospital, Omachi, Japan
| | - Youji Miyamoto
- Department of Oral Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hirokazu Nakahara
- Department of Dentistry and Oral Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Yasuyuki Shibuya
- Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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16
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Maxillary Tuberosity Fractures Following Third Molar Extraction, Prevalence, and Risk Factors. J Craniofac Surg 2022; 33:e708-e712. [PMID: 35765135 DOI: 10.1097/scs.0000000000008654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the prevalence of maxillary tuberosity fractures in an adult population and to examine the different risk factors associated with these fractures. MATERIALS AND METHODS This is a retrospective study; data was collected from medical records of patients who underwent a non-surgical extraction of a maxillary third molar tooth between January 2017 and March 2019. All extractions were performed by 2 maxillofacial specialists. RESULTS A total of 403 extracted maxillary third molar teeth were included in the study. Out of them 73 cases of tuberosity fractures were recorded (18.1%). No significant difference in the number of recorded fractures was found between the 2 surgeons. The mean age of patients was 32.8 ± 11.5. In the age group of 30 years and under a fractures rate of 12.1% was recorded compared to 25.0% in the age group of over 30 (P = 0.001). Divergent or extremely curved root morphology were associated with a higher risk for fractures (30.7%) compared to convergent root morphology (13.1%) (P < 0.001). Borderline significance (P = 0.069) was observed for extractions of teeth with caries lesions (21.9%) compared to teeth with no caries lesions (14.6%). CONCLUSIONS The risk of developing a tuberosity fracture during an extraction of an upper wisdom tooth increases with age by 3.1% per year. Teeth with a caries lesion or teeth with divergent or extremely curved root morphology are associated with a higher risk for tuberosity fractures. Although, distoangular teeth had reduced risk of developing a tuberosity fractures. Data collected in this study may help to evaluate the risk factors associated with tuberosity fractures, and can assist in minimizing complications during extractions.
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17
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Awad S, ElKhateeb SM. Prediction of neurosensory disorders after impacted third molar extraction based on cone beam CT Maglione's classification: A pilot study. Saudi Dent J 2021; 33:601-607. [PMID: 34803307 PMCID: PMC8589609 DOI: 10.1016/j.sdentj.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/08/2020] [Accepted: 08/04/2020] [Indexed: 10/26/2022] Open
Abstract
Background Surgical difficulty assessment in the extraction of impacted mandibular third molars is a constant challenge for oral surgeons. Aim The first aim was to apply Maglione's new classification on patients that needed surgical extraction of impacted mandibular third molars, and the second aim was to study the correlation of the classification classes with the occurrence of postoperative neurosensory disorders. Materials & methods The present prospective clinical trial pilot study was conducted on patients attending oral and maxillofacial surgery clinics from February 2017 until January 2018 for the surgical extraction of impacted lower third molars. Results Fifty-one out of sixty-nine patients made the surgical removal of one impacted mandibular third molar. The most common subclass was 1B (24.6%), followed by subclass 3B (23.2%). Subclass 3A and 4B showed an equal distribution of (11.6%) each, and then subclass 2B (10%). The most significant subclass was 4B with (5.9%) neurosensory disturbance. None of the patients had a permanent disturbance. Conclusion Maglione's classification offers unique detailed description of the buccolingual relationship of MTM with IAC that could be used as a future reliable radiographic guide to reduce the risk of post-operative neurosensory disturbances after MTM surgical removal.
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Affiliation(s)
- Sally Awad
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Egypt.,Department of Oral & Maxillofacial Surgery, Taibah University, Almadinah Almunawarah, Saudi Arabia
| | - Sara M ElKhateeb
- Department of Basic Dental Sciences, College of Dentistry, Princess Nourah Bint Abdurahman University, Riyadh, Saudi Arabia.,Department of Oral Medicine, Periodontology, Diagnosis and Oral Radiology, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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18
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Lahoud P, Diels S, Niclaes L, Van Aelst S, Willems H, Van Gerven A, Quirynen M, Jacobs R. Development and validation of a novel artificial intelligence driven tool for accurate mandibular canal segmentation on CBCT. J Dent 2021; 116:103891. [PMID: 34780873 DOI: 10.1016/j.jdent.2021.103891] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The objective of this study is the development and validation of a novel artificial intelligence driven tool for fast and accurate mandibular canal segmentation on cone beam computed tomography (CBCT). METHODS A total of 235 CBCT scans from dentate subjects needing oral surgery were used in this study, allowing for development, training and validation of a deep learning algorithm for automated mandibular canal (MC) segmentation on CBCT. Shape, diameter and direction of the MC were adjusted on all CBCT slices using a voxel-wise approach. Validation was then performed on a random set of 30 CBCTs - previously unseen by the algorithm - where voxel-level annotations allowed for assessment of all MC segmentations. RESULTS Primary results show successful implementation of the AI algorithm for segmentation of the MC with a mean IoU of 0.636 (± 0.081), a median IoU of 0.639 (± 0.081), a mean Dice Similarity Coefficient of 0.774 (± 0.062). Precision, recall and accuracy had mean values of 0.782 (± 0.121), 0.792 (± 0.108) and 0.99 (± 7.64×10-05) respectively. The total time for automated AI segmentation was 21.26 s (±2.79), which is 107 times faster than accurate manual segmentation. CONCLUSIONS This study demonstrates a novel, fast and accurate AI-driven module for MC segmentation on CBCT. CLINICAL SIGNIFICANCE Given the importance of adequate pre-operative mandibular canal assessment, Artificial Intelligence could help relieve practitioners from the delicate and time-consuming task of manually tracing and segmenting this structure, helping prevent per- and post-operative neurovascular complications.
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Affiliation(s)
- Pierre Lahoud
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; Department of Oral Health Sciences, Periodontology and Oral Microbiology, University Hospitals of Leuven, Belgium.
| | | | - Liselot Niclaes
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium
| | - Stijn Van Aelst
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium
| | | | | | - Marc Quirynen
- Department of Oral Health Sciences, Periodontology and Oral Microbiology, University Hospitals of Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven & Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
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19
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Klatt JC, Sorowka T, Kluwe L, Smeets R, Gosau M, Hanken H. Does a preoperative cone beam CT reduce complication rates in the surgical removal of complex lower third molars? A retrospective study including 486 cases. Head Face Med 2021; 17:33. [PMID: 34389020 PMCID: PMC8364039 DOI: 10.1186/s13005-021-00271-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 05/24/2021] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Jan C Klatt
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Tony Sorowka
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Lan Kluwe
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Henning Hanken
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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20
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Deep learning-based evaluation of the relationship between mandibular third molar and mandibular canal on CBCT. Clin Oral Investig 2021; 26:981-991. [PMID: 34312683 DOI: 10.1007/s00784-021-04082-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objective of our study was to develop and validate a deep learning approach based on convolutional neural networks (CNNs) for automatic detection of the mandibular third molar (M3) and the mandibular canal (MC) and evaluation of the relationship between them on CBCT. MATERIALS AND METHODS A dataset of 254 CBCT scans with annotations by radiologists was used for the training, the validation, and the test. The proposed approach consisted of two modules: (1) detection and pixel-wise segmentation of M3 and MC based on U-Nets; (2) M3-MC relation classification based on ResNet-34. The performances were evaluated with the test set. The classification performance of our approach was compared with two residents in oral and maxillofacial radiology. RESULTS For segmentation performance, the M3 had a mean Dice similarity coefficient (mDSC) of 0.9730 and a mean intersection over union (mIoU) of 0.9606; the MC had a mDSC of 0.9248 and a mIoU of 0.9003. The classification models achieved a mean sensitivity of 90.2%, a mean specificity of 95.0%, and a mean accuracy of 93.3%, which was on par with the residents. CONCLUSIONS Our approach based on CNNs demonstrated an encouraging performance for the automatic detection and evaluation of the M3 and MC on CBCT. Clinical relevance An automated approach based on CNNs for detection and evaluation of M3 and MC on CBCT has been established, which can be utilized to improve diagnostic efficiency and facilitate the precision diagnosis and treatment of M3.
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21
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Kim D, Doty RL. Positive Long-Term Effects of Third Molar Extraction on Taste Function. Chem Senses 2021; 46:6308464. [PMID: 34161573 DOI: 10.1093/chemse/bjab032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Taste and other neurosensory defects have been reported postoperatively in a number of patients who have undergone mandibular third molar extraction (TME). Although the taste deficits are generally believed to resolve within a year, the long-term effects of TME remain unknown. We retrospectively examined the whole-mouth taste function of 891 individuals who had received TMEs, on average, more than 2 decades earlier, and 364 individuals who had not undergone TME. All had been extensively tested for chemosensory function at the University of Pennsylvania Smell and Taste Center over the course of the last 20 years. The whole-mouth identification test incorporated 2 presentations each of 5 different concentrations of sucrose, sodium chloride, citric acid, and caffeine. Analyses of covariance (age = covariate) found those with histories of TME to exhibit better overall test scores for all 4 taste qualities than nonoperated controls. Such scores were not associated with the time since the TME. In both groups, women outperformed men and function declined with age. The basis of this phenomenon, which requires confirmation from prospective studies, is unknown, but could reflect sensitization of CN VII nerve afferents or the partial release of the tonic inhibition that CN VII exerts on CN IX via central nervous system processes.
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Affiliation(s)
- Dane Kim
- School of Dental Medicine, 240 S. 40th Street, Philadelphia, PA 19104, USA.,Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Richard L Doty
- Smell and Taste Center, Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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22
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Daware SN, Balakrishna R, Deogade SC, Ingole YS, Patil SM, Naitam DM. Assessment of postoperative discomfort and nerve injuries after surgical removal of mandibular third molar: A prospective study. J Family Med Prim Care 2021; 10:1712-1717. [PMID: 34123917 PMCID: PMC8144789 DOI: 10.4103/jfmpc.jfmpc_280_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/23/2019] [Accepted: 01/14/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: The surgical removal of mandibular third molar (M3) teeth may result in a number of complications including pain, swelling, bleeding, alveolar osteitis or nerve dysfunction. Most of these problems are temporary, but in some cases, nerve paresthesia may become permanent and lead to functional problems. Aims and Objectives: This study aims at measuring the clinical severity of pain, swelling, muscle trismus, infection, dry socket and any nerve injury-related paresthesia after surgical removal of M3. It also assesses the validity of the postoperative symptom severity and identifies the most frequent occurrences and postoperative complications. Material and Methods: The prospective study data was collected from 163 patients visiting the Department of Oral and Maxillofacial Surgery, for surgical extraction of impacted M3. Postoperative assessment was done after 1 week at the time of suture removal for pain, swelling, wound closure, postoperative bleeding, dry socket, infection, paresthesia and trismus. Pain intensity in the form of visual analogue scale, clinical swelling determination using thread measure, trismus assessment by differences in mouth opening, paresthesia/anesthesia by questioning about tongue, chin and lip sensibility and performing neurosensory tests like 2-point discrimination, pin prick and light touch. Patients with neurosensory disturbance were followed for 6 months. Results: This study confirmed the previously reported prevalence rates of neurological deficit and demonstrated 2% incidence of lingual nerve injury where no symptom lasted for more than 12 weeks. Inferior alveolar nerve paresthesia not reported in case series. Most of the patients reported with mild pain, mild swelling and trismus at seventh postoperative day at the time of suture removal. Conclusion: Although third molar surgery is a secure and low morbidity procedure, the risk of complications will always exist and it increases with increased surgical difficulty, hence the patient should always be educated about the risks and benefits of surgery in order to ensure adequate surgical management of impacted M3.
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Affiliation(s)
- Surendra N Daware
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Medical Campus, Medical Square, Nagpur, Maharashtra, India
| | - Ramdas Balakrishna
- Department of Oral and Maxillofacial Surgery, KLE Dental College and Hospital, Bangalore, Karnataka, India
| | - Suryakant C Deogade
- Prosthodontics and Crown and Bridge, Government Dental College and Hospital, Medical Campus, Medical Square, Nagpur, Maharashtra, India
| | - Yogesh S Ingole
- Prosthodontics and Crown and Bridge, Government Dental College and Hospital, Medical Campus, Medical Square, Nagpur, Maharashtra, India
| | - Sushant M Patil
- Prosthodontics and Crown and Bridge, Government Dental College and Hospital, Medical Campus, Medical Square, Nagpur, Maharashtra, India
| | - Dinesh M Naitam
- Department of Dentistry, Government Medical College and Hospital, Akola, Maharashtra, India
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23
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Radiographic Position of Impacted Mandibular Third Molars and Their Association with Pathological Conditions. Int J Dent 2021; 2021:8841297. [PMID: 33833805 PMCID: PMC8012125 DOI: 10.1155/2021/8841297] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/13/2020] [Accepted: 02/28/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives This study aimed to assess the radiographic position of impacted mandibular third molars (IMTMs) and their association with pathological conditions. Materials and Methods The impaction depth, relationship with ramus, and angulation of 1600 IMTMs and their association with 2nd molar distal caries and root resorption, pathological conditions, and proximity to the mandibular canal were evaluated on panoramic radiographs. The IMTM position was determined based on the depth of impaction according to the Pell and Gregory classification, relationship with ramus according to the Pell and Gregory classification, and angulation according to the Winter's classification. The classical and Bayesian logistic regressions were applied to analyze the effect of IMTM position on the associated complications using the odds ratio (OR) and 95% confidence interval (credible interval for Bayesian models). Two-tailed P value < 0.05 was considered statistically significant. Results Of 1600 IMTMs evaluated in this study, 195 (12.2%), 252 (15.8%), and 119 (7.4%) had caused second molar distal caries, second molar root resorption, and pathological lesions, respectively, and 872 (54.5%) had contact with the mandibular canal. Impaction angulation was a risk factor for second molar distal caries (maximum OR = 5.01, 95% CI: 3.12-8.18). Changed angulation and greater impaction depth were the risk factors for second molar root resorption (minimum OR = 1.64, 95% CI: 0.58-4.02). Decreased distance between the ramus and distal side of the second molar was a risk factor for associated pathological lesions (minimum OR = 2.73, 95% CI: 1.79-4.25). Mesioangular and horizontal angulations and greater impaction depth were the risk factors for contact with the mandibular canal (maximum OR = 3.44, 95% CI: 2.6-4.57 and minimum OR = 1.3, 95% CI: 094-1.8). Conclusions The frequency of complications associated with IMTMs was low, but considerable. The occurrence of these conditions might be affected by the impaction position. Thus, regular follow-ups are recommended in order to be able to surgically intervene when the first signs of pathologies arise.
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Three-Dimensional Classification of Lower Third Molars and Their Relationship to the Mandibular Canal. J Oral Maxillofac Surg 2021; 79:1611-1620. [PMID: 33775651 DOI: 10.1016/j.joms.2021.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To develop a novel classification making full use of radiographic three-dimensional (3D) information to describe the position, geometric configuration of a mandibular third molar (M3M) and its spatial relation to neighboring structures such as the mandibular canal (MC). The classification presented in this study helps to establish a common language and serves as a framework for further studies, for example, on 3D parameters influencing prognosis of the M3M and level of difficulty associated with its removal. MATERIAL AND METHODS A total of 8 parameters were included in the classification including position, the cranio-caudal height, the number of roots of the M3M as well as its spatial relationship to the MC, its course, its deformation, and distance to the M3M. The classification was retrospectively applied to a sample of 483 patients and these data were statistically evaluated. RESULTS The most commonly observed categories were the (+) vertical position (39.8%); the cranio-caudal height A (38.7%); 2 roots (83.2%); and the spatial relationship no contact caudal (37.5%). Contact between the M3M and inferior alveolar nerve was observed in 58% of all cases. A deformation of the MC was found in 81% of cases. CONCLUSIONS Our novel classification aims to provide a more holistic description of parameters defining 3D M3M position, as well as its spatial relation to relevant neighboring structures. It creates a uniform terminology that can be applied in practice by surgeons and radiologists, and also serves as a foundation for further research projects, such that results from similarly designed studies could be compared.
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Bigagnoli S, Greco C, Costantinides F, Porrelli D, Bevilacqua L, Maglione M. CBCT Radiological Features as Predictors of Nerve Injuries in Third Molar Extractions: Multicenter Prospective Study on a Northeastern Italian Population. Dent J (Basel) 2021; 9:dj9020023. [PMID: 33669928 PMCID: PMC7924829 DOI: 10.3390/dj9020023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/04/2021] [Accepted: 02/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Neurological alterations are one of the main complications occurring after the third molar extractions. The aim of this prospective multicenter cohort study was to find out Cone Beam Computed Tomography (CBCT) features and distribution of neurological complications in patients undergoing lower third molar surgery and to determine the radiological and patient-related factors that could be correlated to the occurrence of inferior alveolar and lingual nerves injury. Material and Methods: 378 patients who underwent lower third molar extraction from March 2018 to March 2019 were included. Clinical and radiological data were collected. CBCT features were recorded following Maglione et al. classification. Symptoms and characteristics of patients who experienced neurological alterations were evaluated. Results: 193 patients needed a second-level radiological exam (CBCT). In these patients, the most common feature was Maglione class 3: a higher frequency of apical or buccal mandibular canals in direct contact with the tooth was observed. 3.17% of the patients developed a neurological complication. Maglione class 4, increased age, and operative time were all positively correlated with neurological alterations. Conclusions: while the buccal or apical position of the mandibular canal was the more common findings, the lingual position was found to have a higher correlation with a negative outcome. Age and operative time were also found to be risk factors for developing nerve injury in the considered population.
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Affiliation(s)
- Stefano Bigagnoli
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
| | - Christian Greco
- Unit of Dentistry, Merano Hospital, via Giacomo Rossini 5, 39012 Merano, Italy;
| | - Fulvia Costantinides
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
| | - Davide Porrelli
- Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy;
| | - Lorenzo Bevilacqua
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
- Correspondence:
| | - Michele Maglione
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
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Loureiro RM, Sumi DV, Tames HLVC, Ribeiro SPP, Soares CR, Gomes RLE, Daniel MM. Cross-Sectional Imaging of Third Molar-Related Abnormalities. AJNR Am J Neuroradiol 2020; 41:1966-1974. [PMID: 32912872 DOI: 10.3174/ajnr.a6747] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/19/2020] [Indexed: 01/21/2023]
Abstract
Third molars may be associated with a wide range of pathologic conditions, including mechanical, inflammatory, infectious, cystic, neoplastic, and iatrogenic. Diagnosis of third molar-related conditions can be challenging for radiologists who lack experience in dental imaging. Appropriate imaging evaluation can help practicing radiologists arrive at correct diagnoses, thus improving patient care. This review discusses the imaging findings of various conditions related to third molars, highlighting relevant anatomy and cross-sectional imaging techniques. In addition, key imaging findings of complications of third molar extraction are presented.
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Affiliation(s)
- R M Loureiro
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - D V Sumi
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - H L V C Tames
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - S P P Ribeiro
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - C R Soares
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - R L E Gomes
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - M M Daniel
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Kaleem A, Amailuk P, Hatoum H, Tursun R. The Trigeminal Nerve Injury. Oral Maxillofac Surg Clin North Am 2020; 32:675-687. [PMID: 32912777 DOI: 10.1016/j.coms.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Trigeminal nerve branches are never far from the operating field of the oral and maxillofacial surgeon. Increasingly the surgeon is required to provide accurate diagnosis and grading of trigeminal nerve injury, and surgical management by oral and maxillofacial surgeons will become common. Although trauma and ablative procedures for head and neck pathology can cause injuries, dentoalveolar surgical procedures remain an important cause of injury to the fifth cranial nerve, with the third division being the main branch affected. Oral and maxillofacial surgeons should be aware of strategies of avoiding iatrogenic injury, and know when referral and surgical management are appropriate.
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Affiliation(s)
- Arshad Kaleem
- Division of Oral & Maxillofacial Surgery, Department of Surgery, University of Miami, Deering Medical Plaza, 9380 Southwest 150th Street, Suite 170, Miami, FL 33176, USA
| | - Paul Amailuk
- Department of oral and maxillofacial surgery, Gold Coast University Hospital, 1 hospital Boulevard, Queensland 4215, Australia
| | - Hisham Hatoum
- Division of Oral & Maxillofacial Surgery, Department of Surgery, University of Miami, Deering Medical Plaza, 9380 Southwest 150th Street, Suite 170, Miami, FL 33176, USA
| | - Ramzey Tursun
- Division of Oral & Maxillofacial Surgery, Department of Surgery, University of Miami, Deering Medical Plaza, 9380 Southwest 150th Street, Suite 170, Miami, FL 33176, USA.
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Rapaport B, Brown J. Systematic review of lingual nerve retraction during surgical mandibular third molar extractions. Br J Oral Maxillofac Surg 2020; 58:748-752. [DOI: 10.1016/j.bjoms.2020.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/25/2020] [Indexed: 11/26/2022]
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Schulze RKW, Drage NA. Cone-beam computed tomography and its applications in dental and maxillofacial radiology. Clin Radiol 2020; 75:647-657. [PMID: 32451060 DOI: 10.1016/j.crad.2020.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
Cone-beam computed tomography (CBCT) was first used in dental and maxillofacial radiology (DMFR) at the end of the 1990s. Since then, it has been successfully established as the standard three-dimensional radiographic imaging technique in DMFR, with a wide variety of applications in this field. This manuscript briefly reviews the background information on the technology and summarises available data on effective dose and dose optimisation. In addition, typical clinical applications and indications of the technique in DMFR are presented.
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Affiliation(s)
- R K W Schulze
- Department of Oral and Maxillofacial Surgery, Section of Oral Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - N A Drage
- Department of Dental and Maxillofacial Radiology, University Dental Hospital, Cardiff, UK
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Leung YY. Management and prevention of third molar surgery-related trigeminal nerve injury: time for a rethink. J Korean Assoc Oral Maxillofac Surg 2019; 45:233-240. [PMID: 31728330 PMCID: PMC6838349 DOI: 10.5125/jkaoms.2019.45.5.233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/19/2019] [Indexed: 12/26/2022] Open
Abstract
Trigeminal nerve injury as a consequence of lower third molar surgery is a notorious complication and may affect the patient in long term. Inferior alveolar nerve (IAN) and lingual nerve (LN) injury result in different degree of neurosensory deficit and also other neurological symptoms. The long term effects may include persistent sensory loss, chronic pain and depression. It is crucial to understand the pathophysiology of the nerve injury from lower third molar surgery. Surgery remains the most promising treatment in moderate-to-severe nerve injuries. There are limitations in the current treatment methods and full recovery is not commonly achievable. It is better to prevent nerve injury than to treat with unpredictable results. Coronectomy has been proved to be effective in reducing IAN injury and carries minimal long-term morbidity. New technologies, like the roles of erythropoietin and stem cell therapy, are being investigated for neuroprotection and neural regeneration. Breakthroughs in basic and translational research are required to improve the clinical outcomes of the current treatment modalities of third molar surgery-related nerve injury.
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Affiliation(s)
- Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong
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Al Ali S, Jaber M. Correlation of panoramic high-risk markers with the cone beam CT findings in the preoperative assessment of the mandibular third molars. J Dent Sci 2019; 15:75-83. [PMID: 32257003 PMCID: PMC7109491 DOI: 10.1016/j.jds.2019.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/17/2019] [Indexed: 01/24/2023] Open
Abstract
Background/purpose Preoperative radiographic examination of mandibular third molars (MTM) is essential to prevent inferior alveolar nerve (IAN) injury. The aim of this study was to assess the panoramic radiography (PAN) signs considered as indicators of increased risk of IAN injury and to correlate them with the cone beam CT (CBCT) findings. Materials and methods 58 patients who had MTMs extraction between January 2012 and January 2018. OPG were evaluated for the following signs: interruption of the roof of the canal, root darkening, roots deflection and narrowing, canal deviation, superimposition between the MTM roots and mandibular canal. Loss of canal cortication, root grooving, thinning and perforation of lingual cortex were assessed in CBCT images. Chi-square test and multivariate logistic regression tests were used to test the relationship between PAN signs and CBCT findings. Results A total of 79 MTMs were examined. Loss of canal cortication in CBCT was seen in 22 (27.8%) of the cases. Root darkening in PAN images was the most frequent radiographic sign. Canal deviation and interruption of white line in PAN demonstrated a statistically significant correlation with the loss of canal cortication between the MTM and the mandibular canal on CBCT images (p = 0.004 and p = 0.012, respectively). No statistically significant association was observed for the other PAN signs and CBCT findings. Conclusion Canal deviation and interruption of white lines were associated with loss of canal cortication on CBCT, indicating a direct contact between the roots and the mandibular canal which required a further assessment prior to the extraction.
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Affiliation(s)
- Shaima Al Ali
- Department of Oral Surgery, Hamdan Bin Mohamed College of Dental Medicine, United Arab Emirates
| | - Mohamed Jaber
- College of Dentistry, Ajman University, United Arab Emirates
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Risk stratification against inferior alveolar nerve injury after lower third molar extraction by scoring on cone-beam computed tomography image. Odontology 2019; 108:124-132. [DOI: 10.1007/s10266-019-00438-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/04/2019] [Indexed: 12/18/2022]
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Coronectomy: A Surgical Option for Impacted Third Molars in Close Proximity to the Inferior Alveolar Nerve—A 5-Year Follow-Up Study. J Oral Maxillofac Surg 2019; 77:1116-1124. [DOI: 10.1016/j.joms.2018.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/19/2018] [Accepted: 12/15/2018] [Indexed: 11/18/2022]
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Self-assessed neurological disturbances after surgical removal of impacted lower third molar: a pragmatic prospective study on 423 surgical extractions in 247 consecutive patients. Clin Oral Investig 2018; 23:3257-3265. [PMID: 30474748 DOI: 10.1007/s00784-018-2747-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 11/19/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim of this study was to assess the combined role of current radiographic risk indicators and patient age in predicting lower lip sensitivity disturbances after surgical removal of impacted lower third molars. The question was which combinations indicate low or high risk. MATERIALS AND METHODS A prospective study was implemented involving 247 consecutive outpatients who underwent 423 surgical extractions. The predictor variables were patient age and risk indicators observed on panoramic radiographs. The outcome variable was the incidence of self-assessed lip sensitivity alterations. The extractions were subdivided into four groups according to the predictors. RESULTS Two hundred forty-five teeth were extracted in patients younger than 25 years and 178 in patients 25 years old or older; radiographic risk indicators were associated with 226 out of 423 teeth (53.43%). No permanent neurological damage was observed. Transient lip sensitivity alterations were observed in five cases (1.18%; 95% confidence interval = 0.4 to 2.7%), all in the older group with radiographic risk indicators. CONCLUSIONS The data indicate a low overall incidence of transient lip sensitivity impairment that occurred only in the presence of radiographic risk indicators in patients aged ≥ 25 years. CLINICAL RELEVANCE Informed consent should include the possibility of inferior alveolar nerve injury in mature patients with radiographic risk indicators. Prophylactic removal of impacted teeth with radiographic signs of risk may be indicated when the patient is not yet aged 25 years.
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LEUNG YY. Guided bone regeneration to reduce root migration after coronectomy of lower third molar: a randomized clinical trial. Clin Oral Investig 2018; 23:1595-1604. [DOI: 10.1007/s00784-018-2594-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
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Renton T. Risk assessment of M3Ms and decisions on ordering a CBCT and prescribing a coronectomy. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/denu.2017.44.10.957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tara Renton
- Professor of Oral Surgery, King's College London, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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Nemsi H, Tellili N, Bouanene I, Tlili M, Khenfir F, Khalfi MS, Amor FB. Classification of impacted mandibular third molars using cone beam computed tomography based on neurological risks: N.R.C. ACTA ACUST UNITED AC 2017. [DOI: 10.1051/mbcb/2017015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Mesiolingual root rotation for horizontal mandibular third molar extraction: position classification and surgical simulation. Sci Rep 2017; 7:14405. [PMID: 29089549 PMCID: PMC5663974 DOI: 10.1038/s41598-017-14914-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/19/2017] [Indexed: 11/16/2022] Open
Abstract
Extracting horizontal mandibular 3rd molars face considerable difficulty due to the large bone and adjacent tooth resistances. This study aims at evaluating the effectiveness of a novel method-mesiolingual root rotation to extract wisdom teeth of this type. In this study, 73 horizontal teeth extracted using piezosurgery were reviewed and classified based on impaction depth: position I, II, III refers to the highest portion of the crown on a level with upper 1/3, middle 1/3, lower 1/3 of the 2rd molar’s root. Based on the surgical simulations on their 3D CBCT reconstructions, traditional method(crown distal rotation) and novel method(root mesiolingual rotation) are applied. 79.17% of teeth in position I and 57.89% of teeth in position II were designed using traditional method, 83.33% teeth in position III were designed using the novel method(p < 0.05). The surgeries were performed according to the designs. Two cases in position II using traditional method were found temporary inferior alveolar nerve(IAN) injury; while only one case in position III using novel method got temporary IAN and lingual nerve injury. Our study suggested that root mesiolingual rotation is an effective method to extract the horizontal mandibular 3rd molars, especially the deep impacted ones.
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Baensch F, Kriwalsky MS, Kleffmann W, Kunkel M. Third Molar Complications in the Elderly—A Matched-Pairs Analysis. J Oral Maxillofac Surg 2017; 75:680-686. [DOI: 10.1016/j.joms.2016.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/19/2016] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
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La Monaca G, Vozza I, Giardino R, Annibali S, Pranno N, Cristalli MP. Prevention of neurological injuries during mandibular third molar surgery: technical notes. ANNALI DI STOMATOLOGIA 2017; 8:45-52. [PMID: 29299188 PMCID: PMC5749373 DOI: 10.11138/ads/2017.8.2.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgery to the mandibular third molar is common, and injuries to the inferior alveolar nerve and the lingual nerve are well-recognized complications of this procedure. The aim of these technical notes is to describe operative measures for reducing neurological complications during mandibular third molar surgery. The following procedure should be used to prevent damage to the inferior alveolar nerve: a well-designed mucoperiosteal flap, to obtain appropriate access to the surgical area; a conservative ostectomy on the distal and distal-lingual side; tooth sectioning, to facilitate its removal by decreasing the retention zones; tooth dislocation in the path of withdrawal imposed by the curvature of the root apex; and careful socket debridement, when the roots of the extracted tooth are in intimate contact with the mandibular canal. To prevent injury to the lingual nerve, it is important (I) to assess the integrity of the mandibular inner cortex and exclude the presence of fenestration, which could cause the dislocation of the tooth or its fragment into the sublingual or submandibular space; (II) to avoid inappropriate or excessive dislocation proceedings, in order to prevent lingual cortex fracture; (III) to perform horizontal mesial-distal crown sectioning of the lingually inclined tooth; (IV) to protect the lingual flap with a retractor showing the cortical ridge; and (V) to pass the suture not too apically and from the inner side in a buccal-lingual direction in the retromolar area.
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Affiliation(s)
- Gerardo La Monaca
- Department of Sense Organs, “Sapienza” University of Rome, Rome, Italy
| | - Iole Vozza
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Rita Giardino
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Susanna Annibali
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Nicola Pranno
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Maria Paola Cristalli
- Department of Biotechnologies and Medical Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
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Cone beam computed tomography in pre-surgical assessment of mandibular third molars. Evid Based Dent 2016; 17:117-118. [PMID: 27980326 DOI: 10.1038/sj.ebd.6401206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
DesignMulticentre, randomised controlled clinical trial.InterventionPatients referred for third molar removal received a digital panoramic radiograph(PR). Adults with one or more lower third molars in a close relationship with the mandibular canal were eligible for the study. Patients randomised to the cone beam computed tomography (CBCT) group received a high resolution CBCT scan in addition to the PR. All lower third molar extractions were performed under local anaesthesia without sedation and without antibiotic prophylaxis. Information on variables such as experience of the surgeon, duration of surgery and technique for third molar removal were recorded.Outcome measureThe primary outcome measure was the number of patient-reported altered sensations one week after surgery. Secondary outcomes included the number of patients with an objective IAN injury; permanent IAN injury (>6 months); occurrence of other postoperative complications (wound infection, alveolar osteitis); Oral Health Related Quality of Life-14, questionnaire responses; pain (VAS score); duration of surgery; number of emergency visits; and number of missed days of work or study.ResultsThree hundred and forty-one patients with 477 lower third molars were randomised from three centres. Two hundred and sixty-eight patients with 320 mandibular third molars were analysed according to the intention-to-treat principle for the primary and secondary outcomes. The overall incidence of patient-reported altered sensations one week after surgery was 6.3%. At one week there was no difference in subjective IAN injury between the CBCT and PR group. No significant differences were noted between the two groups for any of the secondary outcomes recorded.ConclusionsAlthough CBCT is a valuable diagnostic adjunct for identification of an increased risk for IAN injury, the use of CBCT does not translate into a reduction of IAN injury and other postoperative complications, after removal of the complete mandibular third molar. In these selected cases with a high risk for IAN injury, an alternative strategy, such as monitoring or a coronectomy, might be more appropriate.
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Pippi R, Santoro M, D’Ambrosio F. Accuracy of cone-beam computed tomography in defining spatial relationships between third molar roots and inferior alveolar nerve. Eur J Dent 2016; 10:454-458. [PMID: 28042257 PMCID: PMC5166298 DOI: 10.4103/1305-7456.195168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Cone-beam computed tomography (CBCT) has been proposed in surgical planning of lower third molar extraction. The aim of the present study was to assess the reliability of CBCT in defining third molar root morphology and its spatial relationships with the inferior alveolar nerve (IAN). MATERIALS AND METHODS Intraoperative and radiographic variables of 74 lower third molars were retrospectively analyzed. Intraoperative variables included IAN exposure, number of roots, root morphology of extracted third molars, and presence/absence of IAN impression on the root surface. Radiographic variables included presence/absence of the cortex separating IAN from the third molar roots on CBCT examination, number of roots and root morphology on both orthopantomography (OPG) and CBCT. The statistical association between variables was evaluated using the Fisher's exact test. RESULTS In all cases of intraoperative IAN exposure, the cortex appeared discontinuous on CBCT images. All cases, in which the cortical bone was continuous on CBCT images, showed no association with nerve exposure. In all cases in which nerve impression was identified on the root surface, the IAN cortex showed interruptions on CBCT images. No nerve impression was identified in any of the cases, in which the cortex appeared continuous on CBCT images. CBCT also highlighted accessory roots and apical anomalies/curvatures, not visible on the OPG. CONCLUSIONS CBCT seems to provide reliable and accurate information about the third molar root morphology and its relationship with the IAN.
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Affiliation(s)
- Roberto Pippi
- Department of Odontostomatological and Maxillo Facial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Marcello Santoro
- Department of Odontostomatological and Maxillo Facial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Ferdinando D’Ambrosio
- Department of Sensory Organs, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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Use of Fibrin Glue as an Adjunct in the Repair of Lingual Nerve Injury: Case Report. J Oral Maxillofac Surg 2016; 74:1899.e1-4. [PMID: 27235179 DOI: 10.1016/j.joms.2016.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 11/20/2022]
Abstract
This report describes a case of lingual nerve injury repair using a novel technique in which Tisseel fibrin glue was used to stabilize an Axoguard nerve conduit placed around the site of primary neurorrhaphy to decrease the number of sutures required for stabilization. Five months postoperatively, the patient subjectively had increased sensation and improved taste in the left lingual nerve distribution. At neurosensory examination, the patient exhibited functional neurosensory recovery (S3+ on the Medical Research Council Scale).
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Ge J, Yang C, Zheng J, Qian W. Piezosurgery for the Lingual Split Technique in Lingual Positioned Impacted Mandibular Third Molar Removal: A Retrospective Study. Medicine (Baltimore) 2016; 95:e3192. [PMID: 27015214 PMCID: PMC4998409 DOI: 10.1097/md.0000000000003192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to evaluate the effect and safety of lingual split technique using piezosurgery for the extraction of lingual positioned impacted mandibular 3rd molars with the goal of proposing a more minimally invasive choice for this common surgery.Eighty-nine consecutive patients with 110 lingual positioned impacted mandibular 3rd molars requiring extraction were performed the lingual split technique using piezosurgery. One sagittal osteotomy line and 2 transverse osteotomy line were designed for lingual and occlusal bone removal. The success rate, operative time, postoperative outcome, and major complications (including nerve injury, mandible fracture, severe hematoma or edema, and severe pyogenic infection) were documented and analyzed.All impacted mandibular 3rd molars were successfully removed (110/110). The average time of operation was 14.6 minutes (ranged from 7 to 28 minutes). One hundred and seven extraction sites (97.3%) were primary healing. Pain, mouth opening, swelling, and PoSSe scores on postoperative 7-day were 0.34 ± 0.63, 3.88 ± 0.66(cm), 2.4 ± 0.2(cm), and 23.7 ± 5.9, respectively. There were 6 cases (5.5%) had lingual nerve disturbance and 3 cases (2.7%) developed inferior alveolar nerve impairment, and achieved full recovery within 2 months by neurotrophic drug treatment.Our study suggested piezosurgery for lingual split technique provided an effective way for the extraction of lingual positioned and deeply impacted mandibular 3rd molar.
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Affiliation(s)
- Jing Ge
- From the Department of Oral Surgery (JG, CY, WQ); and Department of Oral-Maxillofacial Head and Neck Surgery (JZ), Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
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45
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Long-term morbidities of coronectomy on lower third molar. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:5-11. [DOI: 10.1016/j.oooo.2015.07.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/13/2015] [Indexed: 11/17/2022]
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46
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Jain N, Thomas S, Prabhu S, Jain S, Pathak AD, Pillai A, Satpathy M. Influence of tooth sectioning technique and various risk factors in reducing the IAN injury following surgical removal of an impacted mandibular third molar. Oral Maxillofac Surg 2015; 20:149-56. [PMID: 26711938 DOI: 10.1007/s10006-015-0540-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/17/2015] [Indexed: 11/26/2022]
Abstract
A prospective study on 100 patients presented with a mesioangular impacted mandibular third molar in close proximity to the inferior alveolar nerve canal (IANC) was done to evaluate the efficacy of tooth sectioning in reducing the incidence of inferior alveolar nerve (IAN) injury during their surgical removal. The patients were divided into two groups: group A, where tooth sectioning was not performed, and group B, where tooth sectioning was performed. Patients were recalled 7 days, 15 days, 30 days, 3 months, and 6 months postoperatively for evaluation of nerve injury and its recovery. A total of 13 patients suffered from nerve damage out of which 10 patients (10/50 or 20 %) belonged to group A and 3 patients (3/50 or 6 %) belonged to group B. All patients showed complete recovery from nerve damage within 6 months except 1 patient. The result of the study showed that tooth sectioning significantly reduces the incidence of nerve damage by 14 %. Deviation of the IANC, increased depth of the impacted tooth, intraoperative hemorrhage within socket/nerve exposure, and increased duration of procedure were found to be the significant risk factors associated with nerve injury.
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Affiliation(s)
- Neha Jain
- Department of Oral and Maxillofacial Surgery, People's Dental Academy, Room No 101, Bhopal, India.
| | - Shaji Thomas
- Department of Oral and Maxillofacial Surgery, People's College of Dental Science & Research Centre, Bhopal, India
| | - S Prabhu
- Department of Oral and Maxillofacial Surgery, People's Dental Academy, Room No 101, Bhopal, India
| | | | - Ashutosh Dutt Pathak
- Department of Oral and Maxillofacial Surgery, RKDF Dental College & Research Centre, Bhopal, India
| | - Ajay Pillai
- Department of Oral and Maxillofacial Surgery, People's College of Dental Science & Research Centre, Bhopal, India
| | - Mrinal Satpathy
- Department of Oral and Maxillofacial Surgery, People's Dental Academy, Room No 101, Bhopal, India
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Ghaeminia H, Gerlach NL, Hoppenreijs TJM, Kicken M, Dings JP, Borstlap WA, de Haan T, Bergé SJ, Meijer GJ, Maal TJ. Clinical relevance of cone beam computed tomography in mandibular third molar removal: A multicentre, randomised, controlled trial. J Craniomaxillofac Surg 2015; 43:2158-67. [PMID: 26596360 DOI: 10.1016/j.jcms.2015.10.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 08/31/2015] [Accepted: 10/06/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aims of this study were to investigate the effectiveness of cone beam computed tomography (CBCT) compared to panoramic radiography (PR), prior to mandibular third molar removal, in reducing patient morbidity, and to identify risk factors associated with inferior alveolar nerve (IAN) injury. MATERIAL AND METHODS This multicentre, randomised, controlled trial was performed at three centres in the Netherlands. Adults with an increased risk for IAN injury, as diagnosed from PR, were included in the study. In one arm of the study, patients underwent an additional CBCT prior to third molar surgery. In a second arm of the study, no additional radiographs were acquired. The primary outcome measure was the number of patient-reported altered sensations 1 week after surgery. As secondary outcome measures, the number of patients with objective IAN injury, with long-term (>6 months) IAN injury, the occurrence of other postoperative complications, the Oral Health Related Quality of Life-14 (OHIP-14) questionnaire responses, postoperative pain (visual analogue scale score), duration of surgery, number of emergency visits, and number of missed days of work or study were scored. RESULTS A total of 268 patients with 320 mandibular third molars were analysed according to the intention-to-treat principle. The overall incidence of IAN injury 1 week after surgery was 6.3%. No significant differences between CBCT and PR for temporary IAN injury (p = 0.64) and all other secondary outcomes were registered. A lingual position of the mandibular canal (MC) and narrowing, in which the diameter of the MC lumen was decreased at the contact area between the MC and the roots, were significant risk factors for temporary IAN injury. CONCLUSION Although CBCT is a valuable diagnostic adjunct for identification of an increased risk for IAN injury, the use of CBCT does not translate into a reduction of IAN injury and other postoperative complications, after removal of the complete mandibular third molar. In these selected cases of a high risk for IAN injury, an alternative strategy, such as monitoring or a coronectomy, might be more appropriate. (http://clinicaltrials.gov, NCT02071030).
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Affiliation(s)
- H Ghaeminia
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | - N L Gerlach
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | - Th J M Hoppenreijs
- Rijnstate Hospital Arnhem, Department of Oral and Maxillofacial Surgery, Wagnerlaan 55, 6815AD Arnhem, The Netherlands.
| | - M Kicken
- Rijnstate Hospital Arnhem, Department of Oral and Maxillofacial Surgery, Wagnerlaan 55, 6815AD Arnhem, The Netherlands.
| | - J P Dings
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | - W A Borstlap
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands; ZBC Private Clinic Nijmegen, Oral and Maxillofacial Surgery, Groenewoudseweg 315, 6524 TX Nijmegen, The Netherlands.
| | - T de Haan
- Radboud University Medical Center, Department of Health Evidence, Geert Grooteplein-Noord 21, 6525 GA Nijmegen, The Netherlands.
| | - S J Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands; ZBC Private Clinic Nijmegen, Oral and Maxillofacial Surgery, Groenewoudseweg 315, 6524 TX Nijmegen, The Netherlands.
| | - G J Meijer
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands; Radboud University Medical Center, Implantology & Periodontology, Phillips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands.
| | - T J Maal
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
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Multivariate assessment of site of lingual nerve. Br J Oral Maxillofac Surg 2015; 53:347-51. [PMID: 25662169 DOI: 10.1016/j.bjoms.2015.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 01/15/2015] [Indexed: 12/15/2022]
Abstract
Injury to the lingual nerve can cause debilitating symptoms. The nerve lies in the retromolar region and its anatomical site can vary within patients and according to sex, age, and dentate status. To our knowledge, no previous studies have recorded its course from multiple bony landmarks and examined the association between age, dentate status, and sex, in the same sample. We dissected 30 white cadavers and took primary and secondary reference points from the internal oblique ridge. We measured the distance to the lingual nerve in sagittal, vertical, and horizontal planes, and recorded the position where the nerve was closest to the lingual plate. We dissected 46 hemimandibles (23 male, mean age 79 years, range 52-100) of which 26 were from the left side. Mean (SD) sagittal, vertical, and horizontal distances from the primary reference point were 9.29 (3.41)mm, 9.15 (3.87)mm, and 0.57 (0.56)mm, respectively. Mean (SD) vertical and horizontal distances from the secondary point were 7.79 (5.45) mm and 0.59 (0.64)mm, respectively. The proximity of the nerve to the lingual plate varied widely (range -13.00 to 15.17mm from the primary reference point). Dentate status was significant for the sagittal measurement from the primary point, and the vertical measurement from the secondary point. Differences in age, sex, or site of the contralateral nerve were not significant (n=16 pairs). Our findings suggest that the site of the nerve is consistent between and within subjects for sex and age, but not for dentate status. The association between the nerve and the lingual plate varied, which suggests that care must be taken when operating in the area.
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Kohara K, Kurita K, Kuroiwa Y, Goto S, Umemura E. Usefulness of mandibular third molar coronectomy assessed through clinical evaluation over three years of follow-up. Int J Oral Maxillofac Surg 2015; 44:259-66. [DOI: 10.1016/j.ijom.2014.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 09/02/2014] [Accepted: 10/03/2014] [Indexed: 11/27/2022]
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50
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Nguyen E, Grubor D, Chandu A. Risk Factors for Permanent Injury of Inferior Alveolar and Lingual Nerves During Third Molar Surgery. J Oral Maxillofac Surg 2014; 72:2394-401. [DOI: 10.1016/j.joms.2014.06.451] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 11/28/2022]
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