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Oral Radiology Oral Surgery

Clinical Case: How do I quantify the risk of nerve injury with wisdom teeth extraction? (VIDEO SOLUTION)

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A wisdom teeth in close proximity to the inferior alveolar nerve

A wisdom teeth in close proximity to the inferior alveolar nerve

This case is presented by Drs Stephen Cho & Ian Furst at Coronation Dental Specialty Group & Cambridge Memorial Hospital

A 56 year old male has a partially impacted wisdom tooth #3.8, communication to the mouth, pericoronitis and a complaint of persistent pain associated with the tooth. You take a panorex and note the overlap of the inferior alveolar nerve. Based on current scientific data, what is the risk, during an extraction, of an intimate association between the tooth and nerve? Is there a scientifically valid way of determining which developing wisdom teeth are likely to become partially impacted?

The video answer to these questions can be viewed below.

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16 Comments

  1. Mark Venditti February 4, 2013

    Wow …. great video and helpful advice.

    Reply
    1. thanks Mark

  2. Robert Kaufmann February 4, 2013

    We have technology that can accurately map the location and relative position of the mandibular canal and its associated structures in relation to the tooth. Furthermore, unlike conventional panoramic or periapical radiography that was shown here (which can introduce significant image distortion) cone beam tomography has no such distortion. Measurements done with cbCTs have almost no error in comparison to conventional film. Perhaps a better recommendation for Dentists would be to refer the patient to the appropriate specialist for cbCT imaging and interpretation prior to removal of the tooth. In that way, anatomic structures can be accurately mapped and anticipated prior to the extraction, with the least risk to patient of post op complications.

    Reply
    1. cbCT for every “at risk” third molar extraction to mitigate the risk of IAN is a compelling hypothesis but one that has been proven false in a recent study (J Oral Maxillofac Surg 70:5-11, 2012). Sanmarti-Garcia et al**, found that the increased knowledge/resolution didn’t change the odds of injury. Should you order a test (especially one that adds radiation exposure) if it doesn’t change the odds of injury? It might change your odds of recommending surgery , but as a means to assess risk, I don’t think it’s so cut and dry.

      **personally I thought the sample size was low and the rate injury high, so I don’t put a lot of weight in this study – but I do think more research is needed before recommending cbCT for everyone.

    2. Dr Ric March 7, 2013

      In spite of all the amazing advance in imagenology with Dental CT Scan, the cone bean, the I-Cat etc. I just want to bring a reminder that it is an auxiliary method of diagnosis that will help and support the clinical disgnosis and help to plan the surgery . iRegarding the relation of the root of the wisdom tooth and the mandibular canal and or inferior alveolar nerve, it give a very accurate picture but always clinical finding it is more important and depending on what you find in each situation during surgery

  3. Jeff Glaizel February 4, 2013

    Thanks for the insight, great knowledge for the general dentist to have and to convey to the patient. This will help with the patient understanding why they are being referred and offer continuity of care.

    Reply
  4. Duy Chinh Doan February 4, 2013

    Great video! Thank you!

    Reply
  5. Atul Joshi February 4, 2013

    Excellent video presentation! Great synopsis of the criteria to assess risk…short and to the point, and particularly like the peer reviewed references for anyone wishing to dig deeper.

    Reply
  6. Elizabeth MacSween February 4, 2013

    Well done and in under three minutes I really learned something extremely useful for my practice! Love this format!
    Look forward to more!

    Reply
  7. Jeff Glaizel February 7, 2013

    What would be of help for a GP would be a decision tree of when to refer for 8s exo….then we could incorporate the knowledge presented on wisdom teeth extraction

    Reply
    1. I’d love to great something like that, but the chances of developing concenus (I think) would be zero. There are so many factors, patient, GP, Surgeon. Good idea though.

  8. Austin Chen February 8, 2013

    Great video with helpful advice. Will look to evaluate the third molars at a earlier stage to be proactive…

    Reply
  9. Ali Farahani February 12, 2013

    I’m SOOOOO proud of Drs. Furst, Cho, O’Keefe and others for bringing Canadian dentists this QUICK, CONCISE and EXPERTLY produced, delivered video on such common clinical pearls!!!

    To the best of my knowledge, this is equally good or better than what the ‘big guns’ south of the border are doing – A+ for
    JCDA!!!

    Reply
    1. Thank you very much Ali.

  10. Jason Lewis February 24, 2013

    All videos are very informative and helpful

    Reply
  11. sac longchamp petit March 22, 2013

    No i know. Thank you for sharing this.

    Reply

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