Revista de Odontologia da UNESP
https://revodontolunesp.com.br/article/doi/10.1590/1807-2577.01324
Revista de Odontologia da UNESP
Original Article

Tomographic prevalence of juxta-apical radiolucency and adjacent structures: a cross-sectional study

Prevalência tomográfica da radiolucência justapical e estruturas adjacentes: um estudo transversal

Natália Mariane RIGO; Gilson Cesar Nobre FRANCO; Caique Mariano PEDROSO; Thais ALBACH; Adrielli Guimarães FERREIRA; Marcela CLAUDINO; Marcelo Carlos BORTOLUZZI; Amanda Regina FISCHBORN

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Abstract

Objective: The aim of this study was to evaluate juxta-apical radiolucency (JAR) prevalence and its relationship with adjacent structures using cone-beam computed tomography (CBCT).

Material and method: CBCT scans were analyzed from a database from 2017 to 2021 of adult patients with mandibular third molars to visualize the presence of JAR. Third molars associated with JAR were classified according to impaction depth, angulation, and root development. JAR was also classified according to its relationship with the mandibular canal and its cortical area, size, and location. The chi-square test and the Mann-Whitney Test were performed to compare the age of patients and gender regarding the presence or absence of JAR.

Result: 1097 CBCT scans were collected from the database during the evaluation period, and after the application of the eligibility criteria, 155 scans were included in the analysis. Thirty-one third molars showed the presence of JAR with a 20% prevalence. Most cases were observed to be unilateral (84%), located mesially (53%), and medium-sized (53%), in contact with the mandibular canal with cortical presence (50%), visualized in third molars mostly mesioangular (36%), partially intraosseous (86%), and with complete root development (92%). No significant differences were detected between gender and age concerning the presence of JAR.

Conclusion: High JAR prevalence was observed, which was frequently in contact with the mandibular canal, being considered a potential risk for nerve damage.

Keywords

Cone-beam computed tomography; third molar; mandibular nerve; periapical tissue; mandibular nerve injuries; tooth extraction

Resumo

Objetivo: O objetivo deste estudo foi avaliar a prevalência da radiolucência justa-apical (RJA) e sua relação com estruturas adjacentes por meio da tomografia computadorizada de feixe cônico (TCFC).

Material e método: Exames de TCFC foram analisados a partir de um banco de dados de 2017 a 2021 de pacientes adultos com terceiros molares inferiores para avaliação da presença de RJA. Os terceiros molares associados a RJA foram classificados de acordo com a profundidade de impactação, angulação e desenvolvimento radicular. A RJA também foi classificada de acordo com sua relação com o canal mandibular e sua área cortical, tamanho e localização.

Resultado: 1.097 exames de TCFC foram coletados do banco de dados durante o período de avaliação e, após a aplicação dos critérios de elegibilidade, 155 exames foram incluídos na análise. Trinta e um terceiros molares apresentaram presença de RJA com prevalência de 20%. Observou-se que a maioria dos casos eram unilaterais (84%), localizados mesialmente (53%), e de tamanho médio (53%), em contato com o canal mandibular com presença cortical (50%), visualizados em terceiros molares principalmente mesioangulares (36%), parcialmente intraósseo (86%) e com desenvolvimento radicular completo (92%). Não foram detectadas diferenças entre sexo e idade quanto à presença de RJA.

Conclusão: Os dados obtidos revelaram alta prevalência de RJA, frequentemente em contato com o canal mandibular, sendo considerado um risco potencial para lesão do nervo alveolar inferior.

Palavras-chave

Tomografia computadorizada de feixe cônico; terceiro molar; nervo mandibular; tecido periapical; lesões do nervo mandibular; extração dentária.

References

1 Renton T, Hankins M, Sproate C, McGurk M. A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars. Br J Oral Maxillofac Surg. 2005 Feb;43(1):7-12. http://doi.org/10.1016/j.bjoms.2004.09.002. PMid:15620767.

2 Renton T. Prevention of iatrogenic inferior alveolar nerve injuries in relation to dental procedures. Dent Update. 2010 Jul-Aug;37(6):350-2, 354-6, 358-60 passim. http://doi.org/10.12968/denu.2010.37.6.350. PMid:20929149.

3 Sedaghatfar M, August MA, Dodson TB. Panoramic radiographic findings as predictors of inferior alveolar nerve exposure following third molar extraction. J Oral Maxillofac Surg. 2005 Jan;63(1):3-7. http://doi.org/10.1016/j.joms.2004.05.217. PMid:15635549.

4 Gilvetti C, Haria S, Gulati A. Is juxta-apical radiolucency a reliable risk factor for injury to the inferior alveolar nerve during removal of lower third molars? Br J Oral Maxillofac Surg. 2019 Jun;57(5):430-4. http://doi.org/10.1016/j.bjoms.2018.11.022. PMid:31005348.

5 Umar G, Bryant C, Obisesan O, Rood JP. Correlation of the radiological predictive factors of inferior alveolar nerve injury with cone beam computed tomography findings. Oral Surg. 2010 Aug;3(3):72-82. http://doi.org/10.1111/j.1752-248X.2010.01088.x.

6 Kapila R, Harada N, Araki K, Sano T, Goto TK. Relationships between third-molar juxta-apical radiolucencies and mandibular canals in panoramic and cone beam computed tomography images. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014 May;117(5):640-4. http://doi.org/10.1016/j.oooo.2014.02.002. PMid:24725991.

7 Nascimento EHL, Oenning ACC, Freire BB, Gaêta-Araujo H, Haiter-Neto F, Freitas DQ. Comparison of panoramic radiography and cone beam CT in the assessment of juxta-apical radiolucency. Dentomaxillofac Radiol. 2018;47(1):20170198. http://doi.org/10.1259/dmfr.20170198. PMid:28871830.

8 Nascimento EHL, Oenning ACC, Nadaes MR, Ambrosano GMB, Haiter-Neto F, Freitas DQ. Juxta-apical radiolucency: prevalence, characterization, and association with the third molar status. J Oral Maxillofac Surg. 2018;76(4):716-24. http://doi.org/10.1016/j.joms.2017.11.023. PMid:29247624.

9 Salunkhe SS, Waingade M, Jangam DK, Khandare N. Radiographic evaluation of retromolar canals and juxta apical radiolucency on cone beam computed tomography. Int J Curr Res. 2017;9(3):55309-15.

10 Yalcin ED, Artas A. Juxta-apical radiolucency and relations with surrounding structures on cone-beam computed tomography. Br J Oral Maxillofac Surg. 2020 Apr;58(3):309-13. http://doi.org/10.1016/j.bjoms.2019.12.004. PMid:31902604.

11 Badawy IN, El Prince NH, El Ashwah AA. Evaluation of panoramic x-ray versus cone beam computerized tomography in surgical removal of horizontally impacted mandibular third molars. Alex Dent J. 2016 Dec;41(3):277-82. http://doi.org/10.21608/adjalexu.2016.58039.

12 Jhamb A, Dolas RS, Pandilwar PK, Mohanty S. Comparative efficacy of spiral computed tomography and orthopantomography in preoperative detection of relation of inferior alveolar neurovascular bundle to the impacted mandibular third molar. J Oral Maxillofac Surg. 2009 Jan;67(1):58-66. http://doi.org/10.1016/j.joms.2008.06.014. PMid:19070749.

13 Nguyen E, Grubor D, Chandu A. Risk factors for permanent injury of inferior alveolar and lingual nerves during third molar surgery. J Oral Maxillofac Surg. 2014 Dec;72(12):2394-401. http://doi.org/10.1016/j.joms.2014.06.451. PMid:25236821.

14 Winter GB. Impacted mandibular third molar [Internet]. St. Louis: American Medical Book; 1926 [cited 2024 June 11]. Available from: https://wellcomecollection.org/works/szjum4za/items?canvas=5.

15 Nolla CM. The development of the permanent teeth. J Dent Child [Internet]. 1960;27:254-66. [cited 2024 June 11]. Available from: https://www.dentalage.co.uk/wp-content/uploads/2014/09/nolla_cm_1960_development_perm_teeth.pdf

16 Nascimento EHL, Oenning ACC, Nadaes MR, Ambrosano GMB, Haiter-Neto F, Freitas DQ. Juxta-apical radiolucency: relation to the mandibular canal and cortical plates based on cone beam CT imaging. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;123(3):401-7. http://doi.org/10.1016/j.oooo.2016.12.001. PMid:28153124.

17 Hasani M, Razavi N, Haghnegahdar A, Zarifi M. Evaluating the presence of IAN injury in patients with juxta-apical radiolucency after third molar surgery: a retrospective cohort study. BMC Oral Health. 2021;21(1):428. http://doi.org/10.1186/s12903-021-01785-9. PMid:34482829.

18 Hatano Y, Kurita K, Kuroiwa Y, Yuasa H, Ariji E. Clinical evaluations of coronectomy (intentional partial odontectomy) for mandibular third molars using dental computed tomography: a case-control study. J Oral Maxillofac Surg. 2009 Sep;67(9):1806-14. http://doi.org/10.1016/j.joms.2009.04.018. PMid:19686914.

19 Neves FS, Souza TC, Almeida SM, Haiter-Neto F, Freitas DQ, Bóscolo FN. Correlation of panoramic radiography and cone beam CT findings in the assessment of the relationship between impacted mandibular third molars and the mandibular canal. Dentomaxillofac Radiol. 2012 Oct;41(7):553-7. http://doi.org/10.1259/dmfr/22263461. PMid:22282507.

20 Gu L, Zhu C, Chen K, Liu X, Tang Z. Anatomic study of the position of the mandibular canal and corresponding mandibular third molar on cone-beam computed tomography images. Surg Radiol Anat. 2018 Jun;40(6):609-14. http://doi.org/10.1007/s00276-017-1928-6. PMid:29079941.

21 Wanzeler AMV, Silveira HLDD, Buligon RP, Corsetti A, Vieira HT, Arús NA, et al. Can CBCT change the level of confidence of oral maxillofacial surgeons in mandibular third molar management? Braz Oral Res. 2022;36(1):e078. http://doi.org/10.1590/1807-3107bor-2022.vol36.0078. PMid:35703704.
 


Submitted date:
06/11/2024

Accepted date:
08/13/2024

672bb993a953953aff6e7e34 rou Articles
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