Radiographic assessment of lower third molar prior to surgery: A report of four cases

Objective: To familiarize the practitioner and specialist with the usual false features noticed in routine radiographs taken prior to surgery so that complicated treatment could be avoided. Materials and Methods: All the cases reported for lower third molar surgery underwent routine radiographic evaluation such as Intra-oral X-ray and OPG (Orthopantomograph) to assess the severity and the surgical outcome in relation to the anatomy, root morphology and the associated anatomical structures. The surgery was planned with selective surgical procedure giving due consideration to factors such as minimal incision, flap reflection, bone cutting and selective tooth sectioning. We noticed four cases showing different radiographic features in the root architecture and the anatomy of the third molar when compared with the same tooth structure observed during removal. Completing the surgical procedure was a challenge. Results: To our clinical experience differences noticed between the radiographic appearance and the existing clinical scenario are common. This is because the radiographs routinely used are only two dimensional whereas the unique architecture of the mandible and third molar may lead to inaccurate interpretation of radiographic appearance. Therefore, the radiographic view should not be considered as the primary factor determining the surgical procedure and the skill and the judgment of the surgeon would have an overriding influence. Conclusion: Radiographs used for assessment of lower third molar surgery is no more considered as an accurate investigation tool but may only support the surgical treatment planning.