The use of cone beam CT for the removal of wisdom teeth changes the surgical approach compared with panoramic radiography: a pilot study

This prospective study evaluated the role of cone beam computed tomography (CBCT) in the treatment of patients with impacted mandibular third molars at increased risk of inferior alveolar nerve (IAN) injury. Subjects with an increased risk of IAN injury, as diagnosed on panoramic radiographs, were enrolled in this study and underwent additional CBCT imaging. Two oral maxillofacial surgeons independently planned the surgical technique and estimated the risk of IAN injury on panoramic radiographs and on CBCT images. A test of symmetry and the McNemar test were executed to calculate the differences between the two imaging modalities. The study sample comprised 40 patients (mean age 27.6 years) presenting 53 mandibular third molars. Risk assessment for IAN injury based on panoramic radiography compared with CBCT imaging differed significantly (P < 0.005). After reviewing the CBCT images, significantly more subjects were reclassified to a lower risk for IAN injury compared with the panoramic radiograph assessments. This change in risk assessment also resulted in a significantly different surgical approach (P < 0.03). The results of this study show that CBCT contributes to optimal risk assessment and, as a consequence, to more adequate surgical planning, compared with panoramic radiography.