Risk assessment of inferior alveolar nerve injury after wisdom tooth removal using 3D AI-driven models: A within-patient study

Fernando Fortes Picoli; Rocharles Cavalcante Fontenele; Frederic Van der Cruyssen; Iraj Ahmadzai; Trigeminal Nerve Injuries Research Group; Constantinus Politis; Maria Alves Garcia Silva; Reinhilde Jacobs

doi:10.1016/j.jdent.2023.104765

Risk assessment of inferior alveolar nerve injury after wisdom tooth removal using 3D AI-driven models: A within-patient study

J Dent. 2023 Dec:139:104765. doi: 10.1016/j.jdent.2023.104765. Epub 2023 Oct 28.

Authors

Fernando Fortes Picoli¹, Rocharles Cavalcante Fontenele², Frederic Van der Cruyssen³, Iraj Ahmadzai⁴, Trigeminal Nerve Injuries Research Group⁵, Constantinus Politis³, Maria Alves Garcia Silva⁶, Reinhilde Jacobs⁷

Affiliations

¹ OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium; School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil.
² OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium; Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Sao Paulo, Brazil.
³ OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
⁴ OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.
⁵ Trigerminal nerve injuries research group available at https://omfsimpath.be/research1/trigeminal%20nerve%20injuries-2.html, Leuven, Belgium.
⁶ School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil.
⁷ OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: reinhilde.jacobs@ki.se.

PMID: 38353315
DOI: 10.1016/j.jdent.2023.104765

Abstract

Objective: To compare a three-dimensional (3D) artificial intelligence (AI)- driven model with panoramic radiography (PANO) and cone-beam computed tomography (CBCT) in assessing the risk of inferior alveolar nerve (IAN) injury after mandibular wisdom tooth (M3M) removal through a within-patient controlled trial.

Methods: From a database of 6,010 patients undergoing M3M surgery, 25 patients met the inclusion criteria of bilateral M3M removal with postoperative unilateral IAN injury. In this within-patient controlled trial, preoperative PANO and CBCT images were available, while 3D-AI models of the mandibular canal and teeth were generated from the CBCT images using the Virtual Patient Creator AI platform (Relu BV, Leuven, Belgium). Five examiners, who were blinded to surgical outcomes, assessed the imaging modalities and assigned scores indicating the risk level of IAN injury (high, medium, or low risk). Sensitivity, specificity, and area under receiver operating curve (AUC) for IAN risk assessment were calculated for each imaging modality.

Results: For IAN injury risk assessment after M3M removal, sensitivity was 0.87 for 3D-AI, 0.89 for CBCT versus 0.73 for PANO. Furthermore, the AUC and specificity values were 0.63 and 0.39 for 3D-AI, 0.58 and 0.28 for CBCT, and 0.57 and 0.41 for PANO, respectively. There was no statistically significant difference (p>0.05) among the imaging modalities for any diagnostic parameters.

Conclusion: This within-patient controlled trial study revealed that risk assessment for IAN injury after M3M removal was rather similar for 3D-AI, PANO, and CBCT, with a sensitivity for injury prediction reaching up to 0.87 for 3D-AI and 0.89 for CBCT.

Clinical significance: This within-patient trial is pioneering in exploring the application of 3D AI-driven models for assessing IAN injury risk after M3M removal. The present results indicate that AI-powered 3D models based on CBCT might facilitate IAN risk assessment of M3M removal.

Keywords: Artificial intelligence; Cone-beam computed tomography; Nerve damage; Panoramic radiography; Wisdom teeth.

Publication types

Controlled Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Artificial Intelligence
Cone-Beam Computed Tomography / methods
Humans
Mandible / diagnostic imaging
Mandible / surgery
Mandibular Nerve / diagnostic imaging
Molar, Third* / diagnostic imaging
Molar, Third* / surgery
Radiography, Panoramic / methods
Risk Assessment
Tooth Extraction* / adverse effects
Trigeminal Nerve Injuries* / etiology