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Proximity of mandibular third molar root(s) to surrounding cortical bone: cone beam computed tomography (CBCT) and panoramic findings

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Abstract

Purpose

We evaluated the relationship between mandibular third molar roots (M3Ms) and surrounding cortical bone using cone beam computed tomography (CBCT) and panoramic findings. We studied (a) the location of mandibular third molar roots in relation with cortical bone in terms of contact, penetration, and perforation on CBCT; (b) the relationship between characteristics of a root in panoramic findings and the CBCT image (entire and segmentally); and (c) the relationship of the root plane in panoramic findings vs. CBCT.

Material and methods

One hundred five teeth with 224 roots of mandibular third molar from 73 patients were evaluated by using cone beam computed tomography and panoramic image.

Result

The relationships were assessed using 105 images of impacted M3Ms: 104/105 (99%) showed cortical bone involvement (30.4% penetration and 68.6% perforation). The more apical the segment, the higher the proportion of perforation. Most (79.9%) of the M3M roots involved a lingual cortex with 46.9% penetration and 49.2% perforation. The panoramic signs of segmental root images—viz. clear and blurred—were not associated with cortical penetration or perforation. Panoramic signs of individual root images—in the same and different planes—could be used to predict root plane M3M roots. The same appearance in the panoramic image was significantly related to the same plane of the root in CBCT (p-value 0.048).

Conclusion

These findings could contribute to enhanced radiological assessment and surgical planning.

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References

  1. Bouloux GF, Fracds F, Steed MB, Perciaccante VJ (2007) Complications of third molar surgery. Oral and Maxillofacial Surgery Clinics 19(1):117–118

    Article  Google Scholar 

  2. Aznar-Arasa L, Figueiredo R, Gay-Escoda C (2012) Iatrogenic displacement of lower third molar roots into the sublingual space: report of 6 cases. Journal of Oral Maxillofacial Surgery 70(2):107–115

    Article  Google Scholar 

  3. Brauer HU (2009) Unusual complications associated with third molar surgery: a systematic review. Quintessence Int 40(7):565–572

    PubMed  Google Scholar 

  4. Huang IY, Chen CM, Chang SW, Yang CF, Chen CH, Chen CM (2007) Surgical management of accidentally displaced mandibular third molar into the pterygomandibular space: a case report. Kaohsiung J Med Sci 23(7):370–374

    Article  Google Scholar 

  5. Jolly SS, Rattan V, Rai SK (2014) Intraoral management of displaced root into submandibular space under local anesthesia–a case report and review of literature. The Saudi Dental Journal 26(4):181–184

    Article  Google Scholar 

  6. Stacy G (1964) Perforation of the lingual alveolar plate in association with mandibular third molars: report of a case. Oral Surgery, Oral Medicine, Oral Pathology 17(5):586–591

    Article  CAS  Google Scholar 

  7. Ohshima A, Ariji Y, Goto M, Izumi M, Naitoh M, Kurita K et al (2004) Anatomical considerations for the spread of odontogenic infection originating from the pericoronitis of impacted mandibular third molar: computed tomographic analyses. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 98(5):589–597

    Article  Google Scholar 

  8. Chow AW (2020) Infections of the oral cavity, neck, and head. In: Bennett JE, Dolin R, Blaser MJ (eds) Mandell, Douglas, and Bennett’s principles and practice of infectious diseases, 9th edn. Elsevier, Philadelphia, pp 859–874

    Google Scholar 

  9. Markiewicz MR, Han MD, Miloro M (2019) Complex odontogenic infection. In: Hupp J, Tucker M, Ellis E (eds) Contemporary oral and maxillofacial surgery, 7th edn. Elsevier, Philadelphia, pp 335–363

    Google Scholar 

  10. Tantanapornkul W, Okochi K, Bhakdinaronk A, Ohbayashi N, Kurabayashi T (2009) Correlation of darkening of impacted mandibular third molar root on digital panoramic images with cone-beam computed tomography findings. Dentomaxillofacial Radiology 38(1):11–16

    Article  CAS  Google Scholar 

  11. Harada N, Vasudeva S, Joshi R, Seki K, Araki K, Matsuda Y et al (2013) Correlation between panoramic radiographic signs and high-risk anatomical factors for impacted mandibular third molars. Oral Surg 6(3):129–136

    Article  Google Scholar 

  12. Winter GB (1926) Impacted mandibular third molar. St. Louis: American Medical Book 41

  13. Park K-L (2016) Which factors are associated with difficult surgical extraction of impacted lower third molars? Journal of the Korean Association of Oral Maxillofacial Surgeons 42(5):251–258

    Article  Google Scholar 

  14. Aktop S, Atalı O, Borahan O, Gocmen G, Garip H (2017) Analyses of anatomical relationship between mandibular third molar roots and variations in the lingual undercut of the mandible using cone-beam computed tomography. Journal of Dental Sciences 12(3):261–267

    Article  Google Scholar 

  15. Chan HL, Brooks SL, Fu JH, Yeh CY, Rudek I, Wang HL (2011) Cross-sectional analysis of the mandibular lingual concavity using cone-beam computed tomography. Clin Oral Implant Res 22(2):201–206

    Article  Google Scholar 

  16. Momin M, Matsumoto K, Ejima K, Asaumi R, Kawai T, Arai Y et al (2013) Correlation of mandibular impacted tooth and bone morphology determined by cone-beam computed tomography on a premise of third molar operation. Surgical Radiologic Anatomy 35(4):311–318

    Article  CAS  Google Scholar 

  17. Emes Y, Öncu B, Aybar B, Al-Badri N, Işsever H, Atalay B et al (2015) Measurement of the lingual position of the lower third molar roots using cone-beam computed tomography. Journal of Oral Maxillofacial Surgery 73(1):13–17

    Article  Google Scholar 

  18. Ge J, Zheng J-W, Yang C, Qian W-T (2016) Variations in the buccal-lingual alveolar bone thickness of impacted mandibular third molar: our classification and treatment perspectives. Sci Rep 6:1–9

    Article  Google Scholar 

  19. Tolstunov L, Brickeen M, Kamanin V, Susarla SM, Selvi F (2016) Is the angulation of mandibular third molars associated with the thickness of lingual bone? British Journal of Oral Maxillofacial Surgery 54(8):914–919

    Article  Google Scholar 

  20. Szalma J, Vajta L, Lempel E, Jeges S, Olasz L (2013) Darkening of third molar roots on panoramic radiographs: is it really predominantly thinning of the lingual cortex? International Journal of Oral Maxillofacial Surgery 42(4):483–488

    Article  CAS  Google Scholar 

  21. Nascimento EHL, Oenning ACC, Nadaes MR, Ambrosano GMB, Haiter-Neto F, Freitas DQ (2017) Juxta-apical radiolucency: relation to the mandibular canal and cortical plates based on cone-beam CT imaging. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology 123(3):401–407

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, No. 6 Yothi Road, Ratchathewi District, Bangkok, 10400, Thailand

    Saowapap Wihokrut, Chakorn Vorakulpipat, Pattamawan Manosuthi & Aurasa Waikakul

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  1. Saowapap Wihokrut
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  2. Chakorn Vorakulpipat
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  3. Pattamawan Manosuthi
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  4. Aurasa Waikakul
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Correspondence to Aurasa Waikakul.

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Ethics approval

The ethical approval was given by the Faculty of Dentistry and the Faculty of Pharmacy, Mahidol University, Institutional Review board (MU-DT/PY-IRB), reference number: COA: No. MU-DT/PY-IRB 2017/005.1901.

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The patient consent was not required in this study.

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The authors declare no competing interests.

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Wihokrut, S., Vorakulpipat, C., Manosuthi, P. et al. Proximity of mandibular third molar root(s) to surrounding cortical bone: cone beam computed tomography (CBCT) and panoramic findings . Oral Maxillofac Surg 26, 311–319 (2022). https://doi.org/10.1007/s10006-021-00979-3

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  • DOI: https://doi.org/10.1007/s10006-021-00979-3

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