The prognostic value of panoramic radiography of inferior alveolar nerve damage after mandibular third molar removal: retrospective study of 400 cases
Received 11 June 2009; received in revised form 17 September 2009; accepted 17 September 2009. published online 21 October 2009.
Objective
The aim of the study was to estimate the accuracy of panoramic radiographic signs predicting inferior alveolar nerve (IAN) paresthesia after lower third molar removal.
Study design
In a case-control study the sample was composed of 41 cases with postoperative IAN paresthesia and 359 control cases without it. The collected data included “classic” specific signs indicating a close spatial relationship between third molar root and inferior alveolar canal (IAC), root curvatures, and the extent of IAC–root tip overlap. Bivariate and multivariate logistic regression analyses were completed to estimate the association between radiographic findings and IAN paresthesia.
Results
The multivariate logistic analysis identified 3 signs significantly associated with IAN paresthesia (P < .001): interruption of the superior cortex of the canal wall, diversion of the canal, and darkening of the root. The sensitivities and specificities ranged from 14.6% to 68.3% and from 85.5% to 96.9%, respectively. The positive predictive values, calculated to factor a 1.1% prevalence of paresthesia, ranged from 3.6% to 10.9%, whereas the negative predictive values >99%.
Conclusion
Panoramic radiography is an inadequate screening method for predicting IAN paresthesia after mandibular third molar removal.
aOral Surgeon, Assistant Lecturer, Department of Oral and Maxillofacial Surgery, University of Pécs, Pécs, Hungary
bAssistant Lecturer, Department of Conservative Dentistry and Endodontics, University of Pécs, Pécs, Hungary
cSenior Research Professor and Head, Department of Biostatistics and Medical Informatics, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
dProfessor and Head, Department of Oral and Maxillofacial Surgery, University of Pécs, Pécs, Hungary
eProfessor, President of Hungarian Association of Oral and Maxillofacial Surgeons, Department of Oral and Maxillofacial Surgery, University of Pécs, Pécs, Hungary
Reprint requests: József Szalma, DMD, Oral Surgeon, Assistant Lecturer, Department of Oral and Maxillofacial Surgery, University of Pécs, 5 Dischka Gy Street, Pécs, Hungary, H-7621
ABSTRACT