Does 3-dimensional imaging of the third molar reduce the risk of experiencing inferior alveolar nerve injury owing to extraction?: A meta-analysis

Abstract

Background: Clinicians generally use panoramic radiographic (PR) images to assess the proximity of the mandibular third molar to the inferior alveolar nerve (IAN). However, in cases in which a patient needs to undergo a third-molar extraction, many clinicians also assess computed tomographic (CT) images to prevent nerve damage.

Types of studies reviewed: Two of the authors independently searched MEDLINE (through PubMed), Cochrane Library, Scopus, and Ovid. The authors included randomized or nonrandomized longitudinal studies whose investigators had compared the number of IAN injuries after third-molar extraction in patients who had undergone preoperative CT with patients who had undergone only PR.

Results: The authors analyzed the full text of 26 of the 745 articles they initially selected. They included 6 studies in the meta-analysis. Four of the studies had a high risk of bias, and the investigators of only 1 study had used blinding with the patients. The authors observed no statistically significant differences between groups related to the total number of nerve injuries (risk ratio, 0.96; 95% confidence interval, 0.50 to 1.85; P = .91). The prognosis of the injuries was similar for both groups.

Conclusions and practical implications: Although having preoperative CT images might be useful for clinicians in terms of diagnosing and extracting mandibular third molars, having these CT images does not reduce patients' risk of experiencing IAN injuries nor does it affect their prognosis.

Keywords: Third molar; alveolar nerve; computed tomography; mandibular nerve; panoramic radiography.