Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov-Dec;12(6):818-822.
doi: 10.1016/j.jobcr.2022.08.025. Epub 2022 Sep 10.

Radiographic factors associated with inferior alveolar nerve exposure during mandibular third molar surgery and their influence on neurosensory deficit: A prospective study

Priyanka Bhardwaj  1 , Yogesh Bhardwaj  1 , Rangila Ram  1 , Monika Parmar  1 , Narotam Ghezta  1 , Aditya Sinha  2
Affiliations

Radiographic factors associated with inferior alveolar nerve exposure during mandibular third molar surgery and their influence on neurosensory deficit: A prospective study

Priyanka Bhardwaj et al. J Oral Biol Craniofac Res. 2022 Nov-Dec.

Erratum in

Abstract

Introduction: The inferior alveolar nerve (IAN) can occasionally be observed in the extraction socket of the mandibular third molar (M3M) intraoperatively. Exposure of inferior alveolar neurovascular bundle during surgery primarily depends upon the absence of bony cortex between the canal and root of impacted third molar or either by existence of a very thin cortical lining between two which gets broken during luxation of tooth. Accurate anatomical relationship of inferior alveolar canal with root apex of impacted (M3M) and the location of canal can be determined by Cone beam computed tomography (CBCT).

Material and methods: Initially 200 patients evaluated by Orthopantomogram (OPG) for anatomical relationship of IAN with impacted (M3M) and various radiographic risk factors for nerve injury. Among these 200, 75 showed the presence of two or more than two risk factors for IAN injury which then were further evaluated by using CBCT for presence or absence of cortex of canal and location of canal on buccal, lingual, inferior, and interradicular position.

Conclusion: Cortex of canal is an important barrier between the root apex and inferior alveolar neurovascular bundle. Interruption of cortex on CBCT, the interradicularly and lingually positioned neurovascular bundle become a strong affirmation for intra operative nerve exposure during (M3M) surgery. Although its exposure is affected by various factors such as bone density, sex and age of patient, surgeon's expertise, operative tissue damage, post operative edema, surgical procedure, but neurosensory deficit do not occur simply after the exposure of neurovascular bundle.

Keywords: Cone beam computed; Cone beam computed tomography, CBCT; Cortex of inferior alveolar canal; Impacted mandibular third molar; Mandibular third molar, M3M; Nerve exposure; Orthopantomography; Orthopantomography, Panoramic radiography, OPG; Paresthesia; Tomography.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Coronal section of CBCT depicting three roots and inter-radicular positioning of canal in relation to mesio-buccal and mesiolingual roots, (Orange colour marking shows the positioning of inferior alveolar canal. (41,42).
Fig. 2
Fig. 2
Intraoperative neurovascular bundle exposure in interradicularly located canal.
See this image and copyright information in PMC

References

    1. Su N., Wijk A.V., Berkhout E., et al. Predictive value of panoramic radiography for injury of inferior alveolar nerve after mandibular third molar surgery. J Oral Maxillofac Surg. 2017 Apr;75(4):663–679. - PubMed
    1. Gu L., Zhu C., Chen K., Liu X., Tang Z. Anatomic study of the position of the mandibular canal and corresponding mandibular third molar on cone-beam computed tomography images. Surg Radiol Anat. 2018 Jun;40(6):609–614. - PMC - PubMed
    1. Selvi F., Dodson T.B., Naattestad A., et al. Factors that are associated with injury to inferior alveolar nerve in high risk patients after removal of third molars. Br J Oral Maxillofac Surg. 2013;51:868. - PubMed
    1. Baqain Z.H., AlHadidi A. Cone beam computed tomography: rejuvenating dentistry. Fla Dent J. 2016;7:74.
    1. Ghaeminia H., Meijer G.J., Soehardi A., et al. The use of cone beam CT for the removal of wisdom teeth changes the surgical approach compared with panoramic radiography: a pilot study. Int J Oral Maxillofac Surg. 2011;40:834. - PubMed