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In this clinical, observational cross-sectional study, 218 sets of panoramic (PAN) and cone beam computed tomography (CBCT) images were assessed for impacted lower third molar (ILTM) classification, contact with the mandibular canal (MC), contact and resorption of lower second molar (LSM), intra-operative planning, and postoperative expectations. On regression analysis, differences between 2D and 3D images were observed for impaction classification and positioning (P < .001) and relationship of ILTM with adjacent LSM (P < .001). Treatment planning regarding crown sectioning (P = .006) and root sectioning (P < .001) and for expectation of postoperative complications (P < .001) also showed significant differences between imaging modalities. Changes in classification upon CBCT assessment significantly influenced the option for relaxing incision (P < .025). When CBCT altered the diagnosis of LSM contact area, there was a significant chance of changing the surgical plan to use osteotomy (P < .015), and for crown sectioning (P = .000).
This study demonstrated that the diagnostic classifications regarding ILTM position and relationship with the adjacent LSM and the MC may be different when a 2D or 3D exam is analyzed, and that those differences potentially alter the treatment plan and expectation of postoperative complications. The authors conclude that CBCT-based treatment planning predicted fewer postoperative complications by use of more relaxing incisions, osteotomy, or root sectioning, which would decrease intraoperative time and, consequently, paresthesia in the clinical setting.
This study observed whether changes in diagnosis caused by analysis of three-dimensional images can lead to alterations in the treatment plans of impacted lower third molars (ILTMs).
Sets of panoramic (PAN) - cone beam computed tomography (CBCT) of 218 patients were assessed for ILTM classification, contact with mandibular canal, contact and resorption of the lower second molar (LSM), intraoperative planning and post-operative expectations.
Percentage agreement and McNemar test compared PAN vs CBCT assessments. Logistic regression analyzed the dependency of change in surgical planning considering the changes in diagnostic features; descriptive statistics was used to observe the expectation of post-operative complications and paresthesia. Differences were found between PAN vs CBCT for classification of impaction and positioning, LSM relationship, choice for crown and root sectioning and expectation of post-operative complications (all with p < 0.001). Logistic regression indicated that the change in diagnosis caused by CBCT examination did not change the clinical decision to extract ILTM but altered the planning of intraoperative steps such as osteotomy, crown sectioning and relaxing incision. The expectation of post-operative complications decreased when professionals planned the ILTM removal using tri-dimensional images.
We concluded that changes in the diagnosis after CBCT examination can lead to alterations in the treatment plan of impacted lower third molar.