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Can CT predict the development of oroantral fistula in patients undergoing maxillary third molar removal?

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Abstract

Purpose

In maxillary wisdom tooth extraction, the necessity of CT is unknown. The purpose of this study was to investigate whether CT adding to orthopantomography is useful for predicting oroantral perforation during maxillary third molar extraction.

Methods

Various risk factors for oroantral perforation during maxillary third molar extraction were investigated by univariate and multivariate analyses. We analyzed those of all patients and the patients who underwent CT, respectively. The proximity of the roots to the maxillary sinus floor (root-sinus [RS] classification) and Archer classification were assessed using panoramic radiography. The number of roots and vertical relationship were assessed using CT.

Results

A total of 604 out of 3299 patients underwent CT adding to orthopantomography. In all cases, multivariate analyses except for CT findings showed that the RS classification type III/IV and the Archer classification Type B/C/D in panoramic findings were significantly correlated with oroantral perforation as radiological findings. In cases for which CT was performed, multivariate analyses showed that one root (OR 12.87) and the vertical relationship Type D (OR 5.63) in CT findings, besides the RS classification type III/IV (OR 4.47) in panoramic findings, were significantly related to oroantral perforation.

Conclusion

The RS classification and the Archer classification in panoramic findings can predict the risk of oroantral perforation. The usefulness of CT adding to orthopantomography is limited. However, when the relationship between the upper wisdom tooth and maxillary sinus floor (RS classification) is unclear, to check whether the number of roots is one and the apex of one root is projecting into the maxillary sinus in CT findings, is useful for the prediction.

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Acknowledgements

We received no external sources of funding for this study, either personally or institutionally. We thank Shinsuke Kuroki, Yujiro Hiraoka, Junpei Takeuchi, Akiko Yabase, and Junko Takahashi for their support and advice.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan

    Eiji Iwata, Akira Tachibana & Naoki Takata

  2. Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Takumi Hasegawa, Daisuke Takeda & Masaya Akashi

  3. Department of Oral and Maxillofacial Surgery, Shin-suma General Hospital, Kobe, Japan

    Masaki Kobayashi

  4. Department of Oral and Maxillofacial Surgery, Saiseikai Hyogo-ken Hospital, Kobe, Japan

    Toshiya Oko

  5. Department of Oral and Maxillofacial Surgery, Kobe Central Hospital, Kobe, Japan

    Daisuke Takeda

  6. Department of Oral and Maxillofacial Surgery, Hyogo Prefectural Awaji Medical Center, Awaji, Japan

    Yoshiki Ishida

  7. Department of Oral and Maxillofacial Surgery, Mitsubishi Kobe Hospital, Kobe, Japan

    Tsuyoshi Fujita

  8. Department of Oral and Maxillofacial Surgery, Kawasaki Hospital, Kobe, Japan

    Ikuko Goto

  9. Department of Oral and Maxillofacial Surgery, Kita-Harima Medical Center, Ono, Japan

    Junichiro Takeuchi

Authors
  1. Eiji Iwata
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  2. Takumi Hasegawa
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  3. Masaki Kobayashi
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  4. Akira Tachibana
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  5. Naoki Takata
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  6. Toshiya Oko
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  7. Daisuke Takeda
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  8. Yoshiki Ishida
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  9. Tsuyoshi Fujita
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  10. Ikuko Goto
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  11. Junichiro Takeuchi
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  12. Masaya Akashi
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Contributions

Study design: E Iwata, T Hasegawa.

Acquisition of data: E Iwata E, M Kobayashi, N Takata, T Oko, D Takeda, Y Ishida, T Fujita, I Goto, J Takeuchi.

Analysis and interpretation of data: E Iwata, T Hasegawa, A Tachibana, M Akashi.

Manuscript preparation: E Iwata, T Hasegawa, M Kobayashi, A Tachibana, N Takata, T Oko, D Takeda, Y Ishida, T Fujita, I Goto, J Takeuchi, M Akashi.

Manuscript editing: E Iwata, T Hasegawa, M Akashi.

Manuscript review: E Iwata, T Hasegawa, M Kobayashi, A Tachibana, N Takata, T Oko, D Takeda, Y Ishida, T Fujita, I Goto, J Takeuchi, M Akashi.

Statistical analysis: E Iwata, T Hasegawa, A Tachibana, M Akashi.

Corresponding author

Correspondence to Takumi Hasegawa.

Ethics declarations

Informed consent was obtained from all individual participants included in the study. For patients aged <18 years, informed consent was sought from their parent/guardian. This retrospective study has been conducted in full accordance with the World Medical Association Declaration of Helsinki and was approved by the institutional review board of Kobe University Hospital (authorization number: 170020).

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Iwata, E., Hasegawa, T., Kobayashi, M. et al. Can CT predict the development of oroantral fistula in patients undergoing maxillary third molar removal?. Oral Maxillofac Surg 25, 7–17 (2021). https://doi.org/10.1007/s10006-020-00878-z

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  • DOI: https://doi.org/10.1007/s10006-020-00878-z

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