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Risk stratification against inferior alveolar nerve injury after lower third molar extraction by scoring on cone-beam computed tomography image

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Abstract

The study aimed to stratify the risk of inferior alveolar nerve injury (IANI) after lower third molar (LM3) surgery with a scoring system using identified predictive factors based on cone-beam computed tomography (CBCT) images. In a case–control study, the primary outcome was IANI occurrence. The control group included randomly selected patients without IANI. Predictor variables included patient demographics, surgical situations, Pell–Gregory classification, and inferior alveolar canal (IAC)-associated factors on CBCT. Study variables were analyzed using logistic regression models. Risk stratification was assessed by a scoring system that was constructed using independent predictors. The 858 patients who underwent LM3 surgery (1177 teeth) after CBCT scan were divided into case (25 patients, 2.9%, 27 teeth) and control (235 patients, 300 teeth) groups. In the multivariate model, lingual/inter-radicular position of IAC [odds ratio (OR) 7.21; P < 0.001; assigned score, 2], multiple roots closed to the IAC with cortical perforation (OR 3.72; P = 0.015; 1), and age > 30 years (OR 4.99; P = 0.008; 2) were associated with an increased IANI-risk. The IANI-risk scoring system could be stratified into low- and high-risk groups at a cutoff score of 3 (sensitivity, 68.0%; specificity, 90.6%; positive predictive value, 17.8%; positive likelihood ratio, 7.23). In conclusion, the high-risk group of IANI after LM3 surgery corresponded to individuals with multiple factors: lingual/inter-radicular IAC position to LM3, multiple roots with perforated IAC, and increased age (> 30 years). Raising awareness of the higher probability for IANI is needed for patients with multiple aforementioned factors.

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References

  1. Cheung LK, Leung YY, Chow LK, Wong MC, Chan EK, Fok YH. Incidence of neurosensory deficits and recovery after lower third molar surgery: a prospective clinical study of 4338 cases. Int J Oral Maxillofac Surg. 2010;39:320–6.

    Article  Google Scholar 

  2. 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.

    Article  Google Scholar 

  3. Motamedi MH. Impacted lower third molar and the inferior alveolar nerve. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87:3–4.

    Article  Google Scholar 

  4. Ghaeminia H, Gerlach NL, Hoppenreijs TJ, Kicken M, Dings JP, Borstlap WA, et al. Clinical relevance of cone beam computed tomography in mandibular third molar removal: a multicentre, randomised, controlled trial. J Craniomaxillofac Surg. 2015;43:2158–67.

    Article  Google Scholar 

  5. Leung YY, Cheung LK. Risk factors of neurosensory deficits in lower third molar surgery: an literature review of prospective studies. Int J Oral Maxillofac Surg. 2011;40:1–10.

    Article  Google Scholar 

  6. Rood JP, Shehab BA. The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg. 1990;28:20–5.

    Article  Google Scholar 

  7. Hasegawa T, Ri S, Shigeta T, Akashi M, Imai Y, Kakei Y, et al. Risk factors associated with inferior alveolar nerve injury after extraction of the mandibular third molar—a comparative study of preoperative images by panoramic radiography and computed tomography. Int J Oral Maxillofac Surg. 2013;42:843–51.

    Article  Google Scholar 

  8. Korkmaz YT, Kayipmaz S, Senel FC, Atasoy KT, Gumrukcu Z. Does additional cone beam computed tomography decrease the risk of inferior alveolar nerve injury in high-risk cases undergoing third molar surgery? Does CBCT decrease the risk of IAN injury? Int J Oral Maxillofac Surg. 2017;46:628–35.

    Article  Google Scholar 

  9. Ueda M, Nakamori K, Shiratori K, Igarashi T, Sasaki T, Anbo N, et al. Clinical significance of computed tomographic assessment and anatomic features of the inferior alveolar canal as risk factors for injury of the inferior alveolar nerve at third molar surgery. J Oral Maxillofac Surg. 2012;70:514–20.

    Article  Google Scholar 

  10. Shiratori K, Nakamori K, Ueda M, Sonoda T, Dehari H. Assessment of the shape of the inferior alveolar canal as a marker for increased risk of injury to the inferior alveolar nerve at third molar surgery: a prospective study. J Oral Maxillofac Surg. 2013;71:2012–9.

    Article  Google Scholar 

  11. Selvi F, Dodson TB, Nattestad A, Robertson K, Tolstunov L. Factors that are associated with injury to the inferior alveolar nerve in high-risk patients after removal of third molars. Br J Oral Maxillofac Surg. 2013;51:868–73.

    Article  Google Scholar 

  12. Xu GZ, Yang C, Fan XD, Yu CQ, Cai XY, Wang Y, et al. Anatomic relationship between impacted third mandibular molar and the mandibular canal as the risk factor of inferior alveolar nerve injury. Br J Oral Maxillofac Surg. 2013;51:e215–9.

    Article  Google Scholar 

  13. Matzen LH, Wenzel A. Efficacy of CBCT for assessment of impacted mandibular third molars: a review—based on a hierarchical model of evidence. Dentomaxillofac Radiol. 2015;44:20140189.

    Article  Google Scholar 

  14. Matzen LH, Berkhout E. Cone beam CT imaging of the mandibular third molar: a position paper prepared by the European Academy of DentoMaxilloFacial Radiology (EADMFR). Dentomaxillofac Radiol. 2019;48:20190039.

    Article  Google Scholar 

  15. Wang D, Lin T, Wang Y, Sun C, Yang L, Jiang H, et al. Radiographic features of anatomic relationship between impacted third molar and inferior alveolar canal on coronal CBCT images: risk factors for nerve injury after tooth extraction. Arch Med Sci. 2018;14:532–40.

    Article  Google Scholar 

  16. Tolstunov L. The quest for causes of inferior alveolar nerve injury after extraction of mandibular third molars. J Oral Maxillofac Surg. 2014;72:1644–6.

    Article  Google Scholar 

  17. Kim JW, Cha IH, Kim SJ, Kim MR. Which risk factors are associated with neurosensory deficits of inferior alveolar nerve after mandibular third molar extraction? J Oral Maxillofac Surg. 2012;70:2508–14.

    Article  Google Scholar 

  18. Szalma J, Lempel E, Jeges S, Szabo G, Olasz L. The prognostic value of panoramic radiography of inferior alveolar nerve damage after mandibular third molar removal: retrospective study of 400 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109:294–302.

    Article  Google Scholar 

  19. Imai T, Fujita Y, Motoki A, Takaoka H, Kanesaki T, Ota Y, et al. Surgical approaches for condylar fractures related to facial nerve injury: deep versus superficial dissection. Int J Oral Maxillofac Surg. 2019. https://doi.org/10.1016/j.ijom.2019.02.003(in press).

    Article  PubMed  Google Scholar 

  20. Menard S. Probabilities, odds, odds ratios, and the logit transformation for dichotomous dependent variables. In: Menard S, editor. Applied logistic regression analysis. Thousand Oaks: SAGE Publications Inc; 2001. p. 12–4.

    Google Scholar 

  21. Lopes V, Mumenya R, Feinmann C, Harris M. Third molar surgery: an audit of the indications for surgery, post-operative complaints and patient satisfaction. Br J Oral Maxillofac Surg. 1995;33:33–5.

    Article  Google Scholar 

  22. Pippi R, Santoro M. A multivariate statistical analysis on variables affecting inferior alveolar nerve damage during third molar surgery. Br Dent J. 2015;219:E3.

    Article  Google Scholar 

  23. Nakamori K, Tomihara K, Noguchi M. Clinical significance of computed tomography assessment for third molar surgery. World J Radiol. 2014;6:417–23.

    Article  Google Scholar 

  24. Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Berge SJ. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg. 2009;38:964–71.

    Article  Google Scholar 

  25. Sanmarti-Garcia G, Valmaseda-Castellon E, Gay-Escoda C. Does computed tomography prevent inferior alveolar nerve injuries caused by lower third molar removal? J Oral Maxillofac Surg. 2012;70:5–11.

    Article  Google Scholar 

  26. Guerrero ME, Nackaerts O, Beinsberger J, Horner K, Schoenaers J, Jacobs R. Inferior alveolar nerve sensory disturbance after impacted mandibular third molar evaluation using cone beam computed tomography and panoramic radiography: a pilot study. J Oral Maxillofac Surg. 2012;70:2264–70.

    Article  Google Scholar 

  27. Guerrero ME, Botetano R, Beltran J, Horner K, Jacobs R. Can preoperative imaging help to predict postoperative outcome after wisdom tooth removal? A randomized controlled trial using panoramic radiography versus cone-beam CT. Clin Oral Investig. 2014;18:335–42.

    Article  Google Scholar 

  28. Hasani A, Ahmadi Moshtaghin F, Roohi P, Rakhshan V. Diagnostic value of cone beam computed tomography and panoramic radiography in predicting mandibular nerve exposure during third molar surgery. Int J Oral Maxillofac Surg. 2017;46:230–5.

    Article  Google Scholar 

  29. Susarla SM, Sidhu HK, Avery LL, Dodson TB. Does computed tomographic assessment of inferior alveolar canal cortical integrity predict nerve exposure during third molar surgery? J Oral Maxillofac Surg. 2010;68:1296–303.

    Article  Google Scholar 

  30. Nakamori K, Fujiwara K, Miyazaki A, Tomihara K, Tsuji M, Nakai M, et al. Clinical assessment of the relationship between the third molar and the inferior alveolar canal using panoramic images and computed tomography. J Oral Maxillofac Surg. 2008;66:2308–13.

    Article  Google Scholar 

  31. Sammartino G, Gasparro R, Marenzi G, Trosino O, Mariniello M, Riccitiello F. Extraction of mandibular third molars: proposal of a new scale of difficulty. Br J Oral Maxillofac Surg. 2017;55:952–7.

    Article  Google Scholar 

  32. Kjolle GK, Bjornland T. Low risk of neurosensory dysfunction after mandibular third molar surgery in patients less than 30 years of age. A prospective study following removal of 1220 mandibular third molars. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:411–7.

    Article  Google Scholar 

  33. Tassoker M. What are the risk factors for external root resorption of second molars associated with impacted third molars? A cone-beam computed tomography study. J Oral Maxillofac Surg. 2019;77:11–7.

    Article  Google Scholar 

  34. Tachinami H, Tomihara K, Fujiwara K, Nakamori K, Noguchi M. Combined preoperative measurement of three inferior alveolar canal factors using computed tomography predicts the risk of inferior alveolar nerve injury during lower third molar extraction. Int J Oral Maxillofac Surg. 2017;46:1479–83.

    Article  Google Scholar 

  35. Su N, van Wijk A, Berkhout E, Sanderink G, De Lange J, Wang H, et al. Predictive value of panoramic radiography for injury of inferior alveolar nerve after mandibular third molar surgery. J Oral Maxillofac Surg. 2017;75:663–79.

    Article  Google Scholar 

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Acknowledgements

The authors thank Dr. Eiji Nakatani of the Division of Medical Statistics, Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe in Japan for statistical consultation.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Seiko Kubota, Tomoaki Imai, Mitsuhiro Nakazawa & Narikazu Uzawa

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  1. Seiko Kubota
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  2. Tomoaki Imai
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  3. Mitsuhiro Nakazawa
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  4. Narikazu Uzawa
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Correspondence to Tomoaki Imai.

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This study was approved by the internal review boards (H30-E27) and was conducted in accordance with the Declaration of Helsinki.

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Kubota, S., Imai, T., Nakazawa, M. et al. Risk stratification against inferior alveolar nerve injury after lower third molar extraction by scoring on cone-beam computed tomography image. Odontology 108, 124–132 (2020). https://doi.org/10.1007/s10266-019-00438-2

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