Risk stratification against inferior alveolar nerve injury after lower third molar extraction by scoring on cone-beam computed tomography image. 2020

Seiko Kubota, and Tomoaki Imai, and Mitsuhiro Nakazawa, and Narikazu Uzawa
Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.

The study aimed to stratify the risk of inferior alveolar nerve injury (IANI) after lower third molar (LM3) surgery with a scoring system using identified predictive factors based on cone-beam computed tomography (CBCT) images. In a case-control study, the primary outcome was IANI occurrence. The control group included randomly selected patients without IANI. Predictor variables included patient demographics, surgical situations, Pell-Gregory classification, and inferior alveolar canal (IAC)-associated factors on CBCT. Study variables were analyzed using logistic regression models. Risk stratification was assessed by a scoring system that was constructed using independent predictors. The 858 patients who underwent LM3 surgery (1177 teeth) after CBCT scan were divided into case (25 patients, 2.9%, 27 teeth) and control (235 patients, 300 teeth) groups. In the multivariate model, lingual/inter-radicular position of IAC [odds ratio (OR) 7.21; P < 0.001; assigned score, 2], multiple roots closed to the IAC with cortical perforation (OR 3.72; P = 0.015; 1), and age > 30 years (OR 4.99; P = 0.008; 2) were associated with an increased IANI-risk. The IANI-risk scoring system could be stratified into low- and high-risk groups at a cutoff score of 3 (sensitivity, 68.0%; specificity, 90.6%; positive predictive value, 17.8%; positive likelihood ratio, 7.23). In conclusion, the high-risk group of IANI after LM3 surgery corresponded to individuals with multiple factors: lingual/inter-radicular IAC position to LM3, multiple roots with perforated IAC, and increased age (> 30 years). Raising awareness of the higher probability for IANI is needed for patients with multiple aforementioned factors.

UI MeSH Term Description Entries
D008334 Mandible The largest and strongest bone of the FACE constituting the lower jaw. It supports the lower teeth. Mylohyoid Groove,Mylohyoid Ridge,Groove, Mylohyoid,Grooves, Mylohyoid,Mandibles,Mylohyoid Grooves,Mylohyoid Ridges,Ridge, Mylohyoid,Ridges, Mylohyoid
D008340 Mandibular Nerve A branch of the trigeminal (5th cranial) nerve. The mandibular nerve carries motor fibers to the muscles of mastication and sensory fibers to the teeth and gingivae, the face in the region of the mandible, and parts of the dura. Alveolar Nerve, Inferior,Auriculotemporal Nerve,Buccal Nerve,Deep Temporal Nerve,Lateral Pterygoid Nerve,Masseteric Nerve,Mental Nerve,Mylohyoid Nerve,Auriculotemporal Nerves,Buccal Nerves,Deep Temporal Nerves,Inferior Alveolar Nerve,Inferior Alveolar Nerves,Lateral Pterygoid Nerves,Mandibular Nerves,Masseteric Nerves,Mental Nerves,Mylohyoid Nerves,Nerve, Auriculotemporal,Nerve, Buccal,Nerve, Deep Temporal,Nerve, Inferior Alveolar,Nerve, Lateral Pterygoid,Nerve, Mandibular,Nerve, Masseteric,Nerve, Mental,Nerve, Mylohyoid,Pterygoid Nerve, Lateral,Pterygoid Nerves, Lateral,Temporal Nerve, Deep,Temporal Nerves, Deep
D008964 Molar, Third The aftermost permanent tooth on each side in the maxilla and mandible. Tooth, Wisdom,Teeth, Wisdom,Molars, Third,Third Molar,Third Molars,Wisdom Teeth,Wisdom Tooth
D011862 Radiography, Panoramic Extraoral body-section radiography depicting an entire maxilla, or both maxilla and mandible, on a single film. Orthopantomography,Panoramic Radiography,Pantomography,Orthopantomographies,Panoramic Radiographies,Pantomographies,Radiographies, Panoramic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014081 Tooth Extraction The surgical removal of a tooth. (Dorland, 28th ed) Extraction, Tooth,Extractions, Tooth,Tooth Extractions
D016022 Case-Control Studies Comparisons that start with the identification of persons with the disease or outcome of interest and a control (comparison, referent) group without the disease or outcome of interest. The relationship of an attribute is examined by comparing both groups with regard to the frequency or levels of outcome over time. Case-Base Studies,Case-Comparison Studies,Case-Referent Studies,Matched Case-Control Studies,Nested Case-Control Studies,Case Control Studies,Case-Compeer Studies,Case-Referrent Studies,Case Base Studies,Case Comparison Studies,Case Control Study,Case Referent Studies,Case Referrent Studies,Case-Comparison Study,Case-Control Studies, Matched,Case-Control Studies, Nested,Case-Control Study,Case-Control Study, Matched,Case-Control Study, Nested,Case-Referent Study,Case-Referrent Study,Matched Case Control Studies,Matched Case-Control Study,Nested Case Control Studies,Nested Case-Control Study,Studies, Case Control,Studies, Case-Base,Studies, Case-Comparison,Studies, Case-Compeer,Studies, Case-Control,Studies, Case-Referent,Studies, Case-Referrent,Studies, Matched Case-Control,Studies, Nested Case-Control,Study, Case Control,Study, Case-Comparison,Study, Case-Control,Study, Case-Referent,Study, Case-Referrent,Study, Matched Case-Control,Study, Nested Case-Control
D054893 Cone-Beam Computed Tomography Computed tomography modalities which use a cone or pyramid-shaped beam of radiation. CAT Scan, Cone-Beam,Cone-Beam CT,Tomography, Cone-Beam Computed,Tomography, Volume Computed,CT Scan, Cone-Beam,Cone-Beam Computer-Assisted Tomography,Cone-Beam Computerized Tomography,Volume CT,Volume Computed Tomography,Volumetric CT,Volumetric Computed Tomography,CAT Scan, Cone Beam,CAT Scans, Cone-Beam,CT Scan, Cone Beam,CT Scans, Cone-Beam,CT, Cone-Beam,CT, Volume,CT, Volumetric,Computed Tomography, Cone-Beam,Computed Tomography, Volume,Computed Tomography, Volumetric,Computer-Assisted Tomography, Cone-Beam,Computerized Tomography, Cone-Beam,Cone Beam CT,Cone Beam Computed Tomography,Cone Beam Computer Assisted Tomography,Cone Beam Computerized Tomography,Cone-Beam CAT Scan,Cone-Beam CAT Scans,Cone-Beam CT Scan,Cone-Beam CT Scans,Scan, Cone-Beam CAT,Scan, Cone-Beam CT,Scans, Cone-Beam CAT,Scans, Cone-Beam CT,Tomography, Cone Beam Computed,Tomography, Cone-Beam Computer-Assisted,Tomography, Cone-Beam Computerized,Tomography, Volumetric Computed
D061221 Trigeminal Nerve Injuries Traumatic injuries to the TRIGEMINAL NERVE. It may result in extreme pain, abnormal sensation in the areas the nerve innervates on face, jaw, gums and tongue and can cause difficulties with speech and chewing. It is sometimes associated with various dental treatments. Cranial Nerve V Injury,Fifth Cranial Nerve Injuries,Fifth Cranial Nerve Injury,Fifth-Nerve Palsy, Traumatic,Fifth-Nerve Trauma,Injury, Cranial Nerve V,Injury, Fifth Cranial Nerve,Traumatic Fifth-Nerve Palsy,Trigeminal Nerve Avulsion,Trigeminal Nerve Contusion,Trigeminal Nerve Injury,Trigeminal Nerve Transection,Trigeminal Nerve Trauma,Trigeminal Neuropathy, Traumatic,Avulsion, Trigeminal Nerve,Avulsions, Trigeminal Nerve,Contusion, Trigeminal Nerve,Contusions, Trigeminal Nerve,Fifth Nerve Palsy, Traumatic,Fifth Nerve Trauma,Fifth-Nerve Palsies, Traumatic,Fifth-Nerve Traumas,Injuries, Trigeminal Nerve,Injury, Trigeminal Nerve,Nerve Avulsion, Trigeminal,Nerve Avulsions, Trigeminal,Nerve Contusion, Trigeminal,Nerve Contusions, Trigeminal,Nerve Injuries, Trigeminal,Nerve Injury, Trigeminal,Nerve Transection, Trigeminal,Nerve Transections, Trigeminal,Nerve Trauma, Trigeminal,Nerve Traumas, Trigeminal,Neuropathies, Traumatic Trigeminal,Neuropathy, Traumatic Trigeminal,Palsies, Traumatic Fifth-Nerve,Palsy, Traumatic Fifth-Nerve,Transection, Trigeminal Nerve,Transections, Trigeminal Nerve,Trauma, Fifth-Nerve,Trauma, Trigeminal Nerve,Traumas, Fifth-Nerve,Traumas, Trigeminal Nerve,Traumatic Fifth Nerve Palsy,Traumatic Fifth-Nerve Palsies,Traumatic Trigeminal Neuropathies,Traumatic Trigeminal Neuropathy,Trigeminal Nerve Avulsions,Trigeminal Nerve Contusions,Trigeminal Nerve Transections,Trigeminal Nerve Traumas,Trigeminal Neuropathies, Traumatic
D018570 Risk Assessment The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988) Assessment, Risk,Benefit-Risk Assessment,Risk Analysis,Risk-Benefit Assessment,Health Risk Assessment,Risks and Benefits,Analysis, Risk,Assessment, Benefit-Risk,Assessment, Health Risk,Assessment, Risk-Benefit,Benefit Risk Assessment,Benefit-Risk Assessments,Benefits and Risks,Health Risk Assessments,Risk Analyses,Risk Assessment, Health,Risk Assessments,Risk Benefit Assessment,Risk-Benefit Assessments

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