The Association between Panoramic Radiography and Clinical Symptoms During and After Third Molar Surgery in Diagnosis of Inferior Alveor Nerve Involvement

Background and Objective:Radiographic assessment before third molar surgery allows the surgeon to consider any essential modifications in the surgical practice, thus minimizing the risk of damage to the inferior alveolar nerve. This study attempted to evaluate the association between radiographic evidence of inferior alveolar nerve involvement on the preoperative panoramic radiograph and its clinical symptoms during and after mandibular third molar surgery. Materials and Methods:In this cross-sectional study 464 patients went through panoramic radiography, examined by an oral and maxillofacial radiologist. Then, the relationship between the third molar's root and inferior alveolar nerve was determined. Furthermore, the data obtained from each patient such as intraoperative (canal bleeding or nerve exposure) and postoperative (neurosensory deficit) complications were recorded. At the next stage, data were analyzed by SPSS 20 and Fisher’s exact test. Results: The study consisted of 464 patients. 209 (45%) patients out of 464 were suspected of having molarcanal contacts, 143 were observed to have loss of tramlines, 138 cases of which were partial and 118 had no upper canal border. In terms of clinical symptoms during surgery, 445 patients (95.9%) showed no involvement while 6 patients (1.3%) had postoperative paresthesis. Moreover, 8.6% of patients suspected of molar-canal contacts based on radiographic images demonstrated clinical symptoms of intraoperative nerve involvement. However, there was no significant relationship between radiographic findings and symptoms of postoperative nerve deficit (p=0.095). Conclusion: The results demonstrated there is a relationship between radiographic evidence of nerve-canal contact and intraoperative clinical symptoms. Moreover, panoramic radiographs cannot provide a useful tool to predict the risk of postoperative nerve paresthesia.