ArticleBMC oral health2025
Is cone beam computed tomography accurate in predicting inferior alveolar nerve exposure during mandibular third molar extraction?
Article in BMC oral health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Validation of artificial intelligence-assisted CBCT analysis for predicting inferior alveolar nerve proximity to impacted mandibular third molars: a diagnostic accuracy study.BMC oral health · 2026Article
- The Impact of Cone Beam Computed Tomography on Surgical Decision-Making and Risk Assessment in Mandibular Third Molar Extractions: A Prospective Observational Diagnostic Study.Tomography (Ann Arbor, Mich.) · 2026Observational
- CBCT-based evaluation of mandibular third molar impaction and its effects on adjacent second molars in a Saudi population: a retrospective study of 420 scans.BMC oral health · 2026Article
- Automatic Detection and Proximity Quantification of Inferior Alveolar Nerve and Mandibular Third Molar on CBCT: A Systematic Review.Journal of pharmacy & bioallied sciences · 2025Article
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Authors and funding
7 authors.
Funding
Abstract
objectivesThis study aims to evaluate the accuracy of cone beam computed tomography (CBCT) in predicting the exposure of inferior alveolar nerve (IAN) during complicated mandibular third molars (M3M) extraction.
methods115 M3Ms with canal cortical defect signs on preoperative CBCT were extracted. Candidate variables included sex, age, types of CBCT machine, the Winter classification of M3Ms, the size of root entering the canal on CBCT, the size of cortical defect on CBCT. The primary outcome was the exposure of IAN and the exposed neurovascular bundle size which was recorded measured under endoscope. The independent sample t-test, Bland-Altman analysis was performed to assess the agreement between the CBCT and endoscopic measurements. The regression analysis was performed to determine if there was a correlation between the measurements of CBCT and endoscope. The Chi-square test was used to evaluate whether the proportion of IAN exposure in different impacted M3M types were consistent. ANOVA was used to test the correlation between the actual size of exposed IAN and (1) Winter classification types; (2) types of CBCT machine.
results85/115 (73.9%) M3Ms with canal cortical defect signs on preoperative CBCT had intraoperative exposure of IAN. The average length and width of the exposed IAN were 5.89 ± 1.72 mm and 2.48 ± 0.79 mm, which were significantly smaller than the size of root entering the canal on CBCT (9.69 ± 3.05 mm and 3.26 ± 0.87 mm, P < 0.001) but larger than the cortical defect size (5.06 ± 2.05 mm and 2.10 ± 0.54 mm, P < 0.05). The regression analysis showed that IAN exposure was significantly associated with the cortical defect length (0.1 mm) on CBCT (OR = 1.38, P = 0.001). The probability of intraoperative IAN exposure was statistically different among different Winter classifications of M3M and the probability of IAN exposure was higher in non-horizontal impacted type according to Chi-square test results. ANOVA showed statistical difference between exposed IAN length and Winter classification types (p = 0.001).
conclusionsNot all M3Ms with tooth-IAN contact signs on preoperative CBCT indicated intraoperative IAN exposure. The size of root entering the canal on CBCT were mostly larger than the intraoperative endoscopic measurements. IAN exposure can be accurately predicted by the length of cortical defect on CBCT. Non-horizontal impaction predisposed the M3M to a higher risk of intraoperative IAN exposure. CLINICAL RELEVANCE: Endoscope provides the possibility to observe and record the IAN exposure directly. IAN exposure can be accurately predicted by the length of cortical defect instead of the size of root entering the canal on CBCT. Non-horizontal impaction predisposed the M3M to a higher risk of intraoperative IAN exposure. CLINICAL TRIAL NUMBER: Not applicable.
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