Can narrowing of the mandibular canal on pre-operative panoramic radiography predict close anatomical contact of the mandibular canal with the mandibular third molar? A meta-analysis
- 12 Downloads
Inferior alveolar nerve injury is a common complication following mandibular third molar extraction. Accurate pre-operative assessment of the anatomical relationship between the mandibular third molar and the mandibular canal could help to avoid this injury. We performed a eta-analysis to investigate whether panoramic radiography could be used to assess the relationship between these two structures.
PubMed, EMBASE, SpringerLink, Cochrane Library, and Web of Science databases were searched independently by two researchers from January 2008 to May 2018.
Seven articles were identified. Statistical analyses were performed using Revman 5.3 and Meta-disc 1.4 software tools. The pooled sensitivity and specificity were 0.19 (95%CI:0.16–0.22) and 0.90 (95%CI:0.88–0.92), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 2.34 (95%CI:1.42–3.87) and 0.86 (95%CI:0.78–0.96), respectively. The area under the curve was 0.86 (95%CI:0.78–0.96).
According to the sign of narrowing of the mandibular canal, panoramic radiology used to assess the relationship between the mandibular third molar and the mandibular canal yielded high specificity, but low sensitivity. The absence of narrowing of the mandibular canal indicated that there was no close contact between these two structures. However, the presence of narrowing of the mandibular canal could not be used to accurately evaluate the relationship between these two structures, although it might indicate a high probability of close anatomical contact between these two structures. Further tests should be performed for providing adequate pre-operative risk assessment while planning for the surgery to reduce the risk of inferior alveolar nerve injury, as well as to enable an open discussion with the patient to decrease the risk of medical disputes.
KeywordsMandibular third molar Mandibular canal Panoramic radiology Meta-analysis
Compliance with ethical standards
Conflict of interest
Author Qin Liye, Author Zhou Zhongwei, Author Sun Xiaojuan, Author Wang Min, Author Liu Pingping and Author Cao Kun declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
- 2.Agbaje JO, Heijsters G, Salem AS, Van Slycke S, Schepers S, Politis C, et al. Coronectomy of deeply impacted lower third molar: incidence of outcomes and complications after one year follow-up. J Oral Maxillofac Res. 2015;6:e1.Google Scholar
- 3.Winstanley KL, Otway LM, Thompson L, Brook ZH, King N, Koong B, et al. Inferior alveolar nerve injury: correlation between indicators of risk on panoramic radiographs and the incidence of tooth and mandibular canal contact on cone-beam computed tomography scans in a Western Australian population. J Investig Clin Dent. 2018;9:e12323.CrossRefGoogle Scholar
- 5.Rodriguez YBR, Beltrami R, Tagliabo A, Rizzo S, Lupi SM. Differences between panoramic and cone beam-CT in the surgical evaluation of lower third molars. J Clin Exp Dent. 2017;9(2):e259-e65.Google Scholar
- 15.Elkhateeb SM, Awad SS. Accuracy of panoramic radiographic predictor signs in the assessment of proximity of impacted third molars with the mandibular canal. J Taibah Univ Med Sci. 2018;13:254–61.Google Scholar