Skip to main content

Advertisement

SpringerLink
Log in

Assessing the need for computed tomography for lower-third-molar extraction: a survey among 322 dentists

Verifica della necessità di prescrizione di tomografia computerizzata per l’estrazione dei terzi molari inferiori: indagine tra 322 dentisti

  • Dental Radiology / Radiologia Odontoiatrica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

Orthopantomograms (OPT) are used to assess the anatomical relationship between the inferior alveolar nerves (IAN) and the roots of third molars and the related risk of postextraction iatrogenic neurological lesions. When the risk is high, computed tomography (CT) or conebeam CT may be warranted. We investigated how dentists judged the need for CT from OPT to ascertain whether they comply with criteria of justification, appropriateness and optimisation in prescribing examinations involving radiation.

Materials and methods

A total of 2,713 letters were sent to Italian dentists (Veneto region), inviting them to access an Internet Web site showing 20 OPTs and answer a questionnaire on the need for CT or periapical X-ray. The gold standards were CT images corresponding to the OPTs. The respondents’ answers were rated for appropriateness and their tendency to over- or underprescribe CT.

Results

The questionnaire was completed by 11.9% of the dentists contacted. The response rate was compatible with a Web survey. Their answers generally came close to the gold standard, achieving a mean appropriateness rating of 0.636 (range 0–1). An overlap between the mandibular canal and the third-molar root was the anatomical relationship most often noted. Recommendations for CT were proportional to the number of radiographic signs indicating a risk of inferior alveolar nerve injury. Periapical X-ray was considered useful by 54.9% of dentists not recommending CT. The main reason stated for not recommending CT was that it was unnecessary for the purposes of the extraction.

Conclusions

Our survey revealed a cautious approach among the professionals interviewed, who tended to overprescribe CT.

Riassunto

Obiettivo

L’ortopantomografia (OPT) è utilizzata per valutare la vicinanza del nervo alveolare inferiore (NAI) alle radici del terzo molare e il rischio di una lesione neurologica iatrogena post-estrattiva. Quando il rischio è elevato, può essere richiesta la tomografia computerizzata (TC) o TC cone beam. Lo scopo del nostro lavoro è di verificare come viene percepita la necessità di TC dopo visione di OPT da parte di un campione di dentisti, ovvero se vi è rispetto dei criteri di giustificazione, appropriatezza e ottimizzazione nella prescrizione di esami radiologici.

Materiali e metodi

Sono state inviate 2713 lettere a dentisti italiani (regione Veneto), chiedendo di accedere ad un sito internet contenente 20 OPT ed un questionario riguardanti l’indicazione alla TC o alla radiografia endorale. Come gold standard si sono utilizzate le TC corrispondenti alle OPT. Le risposte degli intervistati sono state valutate per correttezza e tendenza a prescrivere o non prescrivere la TC.

Risultati

Ha risposto l’11,9% della popolazione oggetto d’indagine. Il tasso di risposta è compatibile con un sondaggio web. I rispondenti si sono avvicinati al gold standard e l’indice di correttezza totale è stato pari a 0,636 (range di 0–1). La sovrapposizione del canale mandibolare e della radice è la relazione più rilevata. La richiesta di TC è proporzionale al numero di segni rilevati. Il 54,9% di chi non prescrive la TC ritiene utile una radiografia periapicale. Il motivo principale per cui non viene prescritta la TC è per la mancanza di necessità ai fini dell’estrazione.

Conclusioni

Il nostro studio ha rivelato una certa cautela dei professionisti che tendono a sovra-prescrivere la TC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References/Bibliografia

  1. Caissie R, Goulet J, Fortin M, Morielli D (2005) Iatrogenic paresthesia in the third division of trigeminal nerve: 12 years of clinical experience. J Can Dent Assoc 71:185–190

    PubMed  Google Scholar 

  2. Libersa P, Savignat M, Tonnel A (2007) Neurosensory disturbances of the inferior alveolar nerve: a retrospective study of complaints in a 10-year period. J Oral Maxillofac Surg 65:1486–1489

    Article  PubMed  Google Scholar 

  3. Tay AB, Go WS (2004) Effect of exposed inferior alveolar neurovascular bundle during surgical removal of impacted lower third molars. J Oral Maxillofac Surg 62:592–600

    Article  PubMed  Google Scholar 

  4. Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C (2001) Inferior alveolar nerve damage after lower third molar surgical extraction: a prospective study of 1117 surgical extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 92:377–383

    Article  PubMed  Google Scholar 

  5. Renton T, McGurk M (2001) Evaluation of factors predictive of lingual nerve injury in third molar surgery. Br J Oral Maxillofac Surg 39:423–428

    Article  PubMed  CAS  Google Scholar 

  6. Koong B, Pharoah MJ, Bulsara M, Tennant M (2006) Methods of determining the relationship of the mandibular canal and third molars: a survey of Australian oral and maxillofacial surgeons. Aust Dent J 51:64–68

    Article  PubMed  CAS  Google Scholar 

  7. Monaco G, Montevecchi M, Bonetti GA et al (2004) Reliability of panoramic radiography in evaluating the topographic relationship between the mandibular canal and impacted third molars. J Am Dent Assoc 135:312–318

    PubMed  Google Scholar 

  8. Ohman A, Kivijärvi K, Blombäck U, Flygare L (2006) Pre-operative radiographic evaluation of lower third molars with computed tomography. Dentomaxillofac Radiol 35:30–35

    Article  PubMed  CAS  Google Scholar 

  9. Sedaghatfar M, August MA, Dodson TB (2005) Radiographic tips on predicting inferior alveolar nerve exposure. J Evid Based Dent Pract 5:222–223

    Article  Google Scholar 

  10. Bell GW (2004) Use of dental panoramic tomographs to predict the relation between mandibular third molar teeth and the inferior alveolar nerve. Radiological and surgical findings, and clinical outcome. Br J Oral Maxillofac Surg 42:21–27

    Article  PubMed  CAS  Google Scholar 

  11. Gomes AC, Vasconcelos BC, Silva ED et al (2008) Sensitivity and specificity of pantomography to predict inferior alveolar nerve damage during extraction of impacted lower third molars. J Oral Maxillofac Surg 66:256–259

    Article  PubMed  Google Scholar 

  12. Mahasantipiya PM, Savage NW, Monsour PA, Wilson RJ (2005) Narrowing of the inferior dental canal in relation to the lower third molars. Dentomaxillofac Radiol 34:154–163

    Article  PubMed  CAS  Google Scholar 

  13. Better H, Abramovitz I, Shlomi B et al (2004) The presurgical workup before third molar surgery: how much is enough? J Oral Maxillofac Surg 62:689–692

    Article  PubMed  Google Scholar 

  14. Susarla SM, Dodson TB (2007) Preoperative computed tomography imaging in the management of impacted mandibular third molars. J Oral Maxillofac Surg 65:83–88

    Article  PubMed  Google Scholar 

  15. Ngan DC, Kharbanda OP, Geenty JP, Darendeliler MA (2003) Comparison of radiation levels from computed tomography and conventional dental radiographs. Aust Orthod J 19:67–75

    PubMed  Google Scholar 

  16. Gijbels F, Jacobs R, Debaveye D et al (2005) Dosimetry of digital panoramic imaging. Part II: Occupational exposure. Dentomaxillofac Radiol 34:150–153

    Article  PubMed  CAS  Google Scholar 

  17. The Council of the European Union (1997) Council Directive 97/43/Euratom of 30 June 1997 on health protection of individuals against the dangers of ionizing radiation in relation to medical exposure, and repealing Directive 84/466/Euratom. http://ec.europa.eu. Accessed March 2011

  18. American Dental Association (1997) Guidelines for prescribing dental radiographs. http://ada.org/ (Accessed March 2011)

  19. Sedentexct Project (2009) Radiation protection: cone beam CT for dental and maxillofacial radiology. Provisional guidelines (V 1.1 May 2009). http://www.sedentexct.eu/ (Accessed March 2011)

  20. de Melo Albert, Amorim Gomes AC, Cavalcanti B et al (2006) Comparison of orthopantomographs and conventional tomography images for assessing the relationship between impacted lower third molars and the mandibular canal oral. Maxillofac Surg 64:1030–1037

    Google Scholar 

  21. Pawelzik J, Cohnen M, Willers R, Becker J (2002) A comparison of conventional panoramic radiographs with volumetric computed tomography images in the preoperative assessment of impacted. J Oral Maxillofac Surg 60:979–684

    Article  PubMed  CAS  Google Scholar 

  22. Kendall M, Stuart A (1979) The advanced theory of statistics. Hafner, New York

    Google Scholar 

  23. Goodman LA, Kruskal WH (1954) Measures of association for cross classifications. J Am Stat Assoc 49:732–764

    Article  Google Scholar 

  24. Wilcoxon F (1945) Individual comparisons by ranking methods. Biometrics 1:80–83

    Article  Google Scholar 

  25. Robert RC, Bacchetti P, Pogrel MA (2005) Frequency of trigeminal nerve injuries following third molar removal. J Oral Maxillofac Surg 63:732–735

    Article  PubMed  Google Scholar 

  26. Blondeau F, Daniel NG (2007) Extraction of impacted mandibular third molars: postoperative complications and their risk factors. J Can Dent Assoc 73:325

    PubMed  Google Scholar 

  27. Susarla SM, Kaban LB, Donoff RB, Dodson TB (2007) Functional sensory recovery after trigeminal nerve repair. J Oral Maxillofac Surg 65:60–65

    Article  PubMed  Google Scholar 

  28. Jerjes W, Swinson B, Moles DR et al (2006) Permanent sensory nerve impairment following third molar surgery: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102:1–7

    Article  Google Scholar 

  29. Hillerup S (2008) Iatrogenic injury to the inferior alveolar nerve: etiology, signs and symptoms, and observations on recovery. Int J Oral Maxillofac Surg 37:704–709

    Article  PubMed  CAS  Google Scholar 

  30. Nakamori K, Fujiwara K, Miyazaki A et al (2008) Clinical assessment of the relationship between the third molar and the inferior alveolar canal using panoramic images and computed tomography. J Oral Maxillofac Surg 66:2308–2313

    Article  PubMed  Google Scholar 

  31. Rood JP, Shehab BA (1990) The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg 28:20–25

    Article  PubMed  CAS  Google Scholar 

  32. Flygare L, Ohman A (2008) Preoperative imaging procedures for lower wisdom teeth removal. Clin Oral Investig 12:291–302

    Article  PubMed  Google Scholar 

  33. Au-Yeung KM, Ahuja AT, Ching AS, Metreweli C (2001) Dentascan in oral imaging. Clin Radiol 56:700–713

    Article  PubMed  CAS  Google Scholar 

  34. Schulze D, Heiland M, Thurmann H, Adam G (2004) Radiation exposure during midfacial imaging using 4- and 16-slice computed tomography, cone beam computed tomography systems and conventional radiography. Dentomaxillofac Radiol 33:83–86

    Article  PubMed  CAS  Google Scholar 

  35. Stratemann SA, Huang JC, Maki K et al (2008) Comparison of cone beam computed tomography imaging with physical measures. Dentomaxillofac Radiol 37:80–93

    Article  PubMed  CAS  Google Scholar 

  36. Suomalainen A, Vehmas T, Kortesniemi M et al (2008) Accuracy of linear measurements using dental cone beam and conventional multislice computed tomography. Dentomaxillofac Radiol 37:10–17

    Article  PubMed  CAS  Google Scholar 

  37. Carrafiello G, Dizonno M, Colli V Strocchi S et al (2010) Comparative study of jaws with multislice computed tomography and cone-beam tomography. Radiol Med 115:600–611

    Article  PubMed  CAS  Google Scholar 

  38. Tantanapornkul W, Okouchi K, Fujiwara Y et al (2007) A comparative study of cone-beam computed tomography and conventional panoramic radiography in assessing the topographic relationship between the mandibular canal and impacted third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103:253–259

    Article  PubMed  Google Scholar 

  39. Hapcook CP (2006) Dental malpractice claims: percentages and procedures. J Am Dent Assoc 137:1444–1445

    PubMed  Google Scholar 

  40. ISTAT (2008) Le tecnologie dell’informazione e della comunicazione: disponibilità nelle famiglie e utilizzo degli individui. http://www.istat.it/ (Accessed March 2011)

  41. Cook C, Heath F, Thompson RL (2000) A meta-analysis of response rates in web- or internet-based surveys. Educ Psychol Meas 60:821–826

    Article  Google Scholar 

  42. Couper M (2000) Web surveys: a review of issues and approaches. Public Opinion Quarterly 64:464–494

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Oral Surgery, Institute of Clinical Dentistry, University of Padova, Via Venezia 90, 35100, Padova, Italy

    S. Sivolella, E. Gasparini & M. Berengo

  2. Department of Statistical Science, University of Padova, Via C. Battisti 241, 35100, Padova, Italy

    G. Boccuzzo

  3. Department of Radiology, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35100, Padova, Italy

    G. De Conti

Authors
  1. S. Sivolella
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Boccuzzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Gasparini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. De Conti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Berengo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Sivolella.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sivolella, S., Boccuzzo, G., Gasparini, E. et al. Assessing the need for computed tomography for lower-third-molar extraction: a survey among 322 dentists. Radiol med 117, 112–124 (2012). https://doi.org/10.1007/s11547-011-0678-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-011-0678-5

Keywords

Parole chiave

Search

Navigation