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ePaper created 2014-12-05, 15:38:45 | version 1.33.01
I 13 case report _ CBCT in diagnostics I cone beam4_2014 The panoramic radiograph revealed that the right lower third molar was deeply impacted and close to the lower cortical margin of the mandible, showing a potential risk for a mandibular fracture.1 In addition, the analyses of the panoramic radi- ograph presumed a close contact between the impacted molar and the mandibular canal, because the roots of the impacted molar showed bright intervals in the lower third (Fig.1). In order to better visualise these anatomic re- lations a CBCT (SCANORA 3Dx, SOREDEX) was ac- quired. The CBCT images were edited and viewed in OnDemand3Dsoftware(Cybermed)andcouldclear- lyvisualisethattherewasnotthatcloseanatomical proximity of the deeply impacted right lower third molar and the mandibular canal. The mandibular canal runs on the buccal side (blue arrow, Fig. 2). The mandibular canal is most frequently located and runs lingually5, and the surgical approach is most commonly made from the buccal side. Without a CBCT radiograph, there is a great risk of damaging the inferior alveolar nerve, when follow- ingthecommonsurgicalprotocolforwisdomteeth removal. The CBCT scan also revealed that the lower cor- tical margin of the mandible had been fully intact (Fig. 3), which decreased the risk of an intraopera- tive mandibular fracture. On the other hand, the CBCT image showed that the roots of the deeply impacted right lower third molar were penetrating the lingual cortex in the middle and lower third of the mandible body (Figs. 3 & 4). Thus, there was a substantial risk for an accidental root displacement into the sublingual space3, excessive bleeding and incalculable complications, e.g. infections of the upper respiratory tract. _Conclusion In cases of deep impaction or close proximity of impacted teeth to important anatomical struc- tures9, CBCT imaging is essential to support the surgeons in scheduling a precise treatment plan, avoiding complications and increasing the post- operative outcome._ Editorial note: A complete list of references is available fromthepublisher. Prof.Snježana Čolić & Dr Jelena Stepić Clinic for Oral Surgery School of Dentistry,University of Belgrade Dr Subotića 4 11000 Belgrade,Serbia cone beam_contact Fig. 2_CBCT cross-sectional view, buccal position of the mandibular canal (blue arrow). Fig. 3_CBCT VR reconstruction. Fig. 4_Axial view, roots perforating the lingual cortex of the mandible body. Fig. 4 Fig. 3Fig. 2 CBE0414_12-13_Soredex 28.11.14 11:33 Seite 2 CBE0414_12-13_Soredex 28.11.1411:33 Seite 2