• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.5
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• pp.341-350
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• 2024

Background: Achieving successful pain control and adequate anesthesia through an inferior alveolar nerve block for endodontic treatment in cases with symptomatic irreversible pulpitis (SIP) is difficult, especially in mandibular molars. This study was designed to compare the effect of oral medication with ibuprofen and soft laser therapy on inferior alveolar nerve block during endodontic treatment. Methods: The trial comprised 180 patients (45 each group) with SIP. Four groups of patients were created: group 1 received 400 mg of ibuprofen; group 2 received soft laser irradiation; group 3 received a combination of soft laser and ibuprofen 400 mg; and group 4 received a placebo 1 h prior to local anesthesia. Patients recorded their pain scores on the Heft-Parker visual analog scale (VAS) before the start of intervention, 15 min after anesthesia, during access cavity preparation, and ultimately during root canal instrumentation. Each patient also rated their level of discomfort on a VAS. Every stage with no or minimal discomfort was deemed successful. The chi-square, Kruskal-Wallis, and one-way analysis of variance tests were used to evaluate the data. Results: The best success rate was achieved for soft laser ibuprofen combination, ibuprofen and soft laser groups reported similar success results, and control group recorded the least pain scores. The mean pain scores were lowest for group 3 and highest for group 4 (P < 0.001). Ibuprofen and soft laser combination was significantly better than control group (P < 0.001). There was no significant difference between ibuprofen and laser groups (P = 0.24). Conclusions: For teeth with irreversible pulpitis, preoperative ibuprofen treatment combined with soft laser irradiation greatly improved the success rates of inferior alveolar nerve block anesthesia.

• Imaging Science in Dentistry
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• v.37 no.4
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• pp.217-220
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• 2007

Purpose: The purpose of this study was to compare the location of the mandibular canal in Class III malocclusion to its location in normal occlusion for adults. Materials and Methods: For this study 32 skeletal Class III patients and 26 normal patients were observed. Four measurements were taken on cross sectional tomography between the first and second molars: the distance from the mandibular canal to the inner surface of both the buccal and lingual cortices, the distance from the mandibular canal to the inferior border of the mandible, and the buccolingual width of the mandible. The buccolingual location of the canals was classified as lingual, central, or buccal. Each measurement was analyzed with an independent t test to compare Class III malocclusion to normal occlusion. Results: Compared to the control group, the prognathic group had a shorter distance from the canal to the inner surface of the lingual cortex and to the base of the mandible. A higher percentage of the canals were located lingually in the prognathic group. Conclusion: This study showed that the mandibular canal was located more lingually and inferiorly in prognathic patients than in patients with normal occlusion. These results could help surgeons to reduce injuries to the inferior alveolar nerve.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.1
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• pp.26-30
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• 2009

Background and Objectives: To determine the anatomic position of the inferior alveolar nerve (IAN) canal in patients with mandibular prognathism using the cone-beam CT (CBCT). Materials and Methods: Fifty rami from 25 patients were evaluated. The images were taken by i-CAT and reconstructed 3-dimensionally using the Simplant 11 program. The linear distances between the IAN canal to the buccal cortex (a, $a^{\dag}$ and $a^{\ddag}$), from the IAN canal to the alveolar crest (b and $b^{\dag}$) and the anterior margin ($b^{\ddag}$) and finally the buccal cortical thickness (c, $c^{\dag}$ and $c^{\ddag}$) were measured at three reference planes (VP, OP and HP). Results: On the left side, the average distance of a, b and c were 7.12, 15.96 and 3.60 mm on the VP plane, respectively. On the OP, the distance of $a^{\dag}$, $b^{\dag}$ and $c^{\dag}$ was 6.11, 8.83 and 2.63 mm. For the HP, the distance of $a^{\ddag}$, $b^{\ddag}$ and $c^{\ddag}$ was 4.84, 10.11 and 2.30 mm. On the right side, the distance of a, b and c, on the VP, was 7.10, 16.13 and 3.42 mm, respectively. On the OP, the distance of $a^{\dag}$, $b^{\dag}$ and $c^{\dag}$ was 4.77, 8.75 and 2.68 mm. On the HP, the distance of $a^{\dag}$, $b^{\dag}$ and $c^{\ddag}$ was 4.55, 9.84 and 2.38 mm. Regarding the difference between genders, the distance in male's was longer than female's on the VP (p=0.019), and was thicker in males than females on the HP (p=0.002). Conclusion: The CBCT data provided accurate information about the location and course of the IAN.

• Imaging Science in Dentistry
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• v.43 no.2
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• pp.105-109
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• 2013

Purpose: Preoperative radiographic assessment of the mandibular third molars is essential to prevent inferior alveolar nerve damage during extraction. The purpose of this study was to assess the reliability of panoramic signs of association between the roots of teeth and the canal, and to compare the panoramic signs with cone beam computed tomography (CBCT) findings. Materials and Methods: CBCT images of 132 impacted mandibular third molars were evaluated to determine the association of the root to the canal. The CBCT findings were compared with the corresponding panoramic images. Logistic regression analysis was used to define the diagnostic criteria of the panoramic images. Results: Among the panoramic signs, loss of the cortical line was the most frequent radiographic sign predicting association (sensitivity: 79.31). Contact of the tooth with the canal was observed in all cases in which the loss of cortical line of the canal or darkening of the roots was found on the panoramic radiographs. Conclusion: Darkening of the roots and loss of the cortical line on panoramic radiographs might be highly suggestive of the risk of nerve injury.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.30.1-30.7
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• 2015

Background: The inferior alveolar nerve (IAN) may be injured during extraction of the mandibular third molar, causing severe postoperative complications. Many methods have been described for evaluating the relative position between the mandibular third molar and the inferior alveolar canal (IAC) on panoramic radiography and computed tomography, but conventional radiography provides limited information on the proximity of these two structures. The present study assessed the benefits of three-dimensional computed tomography (3D-CT) prior to surgical extraction of the mandibular third molar, to prevent IAN damage. Methods: This retrospective study included 4917 extractions in 3555 patients who presented for extraction of the mandibular third molars. The cases were classified into three groups, according to anatomical relationship between the mandibular third molars and the IAC on panoramic radiography and whether 3D-CT was performed. Symptoms of IAN damage were assessed using the touch-recognition test. Data were compared using the chi-square test and Fisher's exact test. Results: Among the 32 cases of IAN damage, 6 cases were included in group I (0.35 %, n = 1735 cases), 23 cases in group II (1.1 %, n = 2063 cases), and 3 cases in group III (0.27 %, n = 1119 cases). The chi-square test showed a significant difference in the incidence of IAN damage between groups I and II. No significant difference was observed between groups I and III using Fisher's exact test. In the 6 cases of IAN damage in group I, the mandibular third molar roots were located lingual relative to the IAC in 3 cases and middle relative to the IAC in 3 cases. The overlap was ${\geq}2mm$ in 3 of 6 cases and 0-2 mm in the remaining 3 cases. The mean distance between the mandibular third molar and IAC was 2.2 mm, the maximum distance 12 mm, and the minimum distance 0.5 mm. Greater than 80 % recovery was observed in 15 of 32 (46.8 %) cases of IAN damage. Conclusions: 3D-CT may be a useful tool for assessing the three-dimensional anatomical relationship and proximity between the mandibular third molar and IAC in order to prevent IAN damage during extraction of mandibular third molars.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.13 no.1
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• pp.97-105
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• 1983

For the assessment of changes in the bone architecture of the maxilla and mandible in renal osteodystrophy, 31 chronic renal failure patients who were undergoing hemodialysis therapy were selected. They were evaluated through clinical oral examination, radiographic and biochemical examination. The results were as follows: 1. In 17 cases (54.8%), there were evidences of bony change in jawbone. 2. The most common dental radiographic finding was decreased bone density (14 cases, 45.2%). 3. The second most common dental radiographic finding was total or partial loss of lamina alveolar dura (11 cases, 35.5%). 4. The third most common dental radiographic finding was total or partial loss of inferior canal wall (8 cases, 25.8%). 5 cases showed evidences of bony change only in jawbone, and 5 cases only in hand, and 12 cases in both. 6. Serum creatinine, urea nitrogen and alkaline phosphatase values in hemodialysis group were much higher than in control group. 7. There were statistically significant correlation between bone density and lamina dura, and inferior alveolar canal wall.

• Imaging Science in Dentistry
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• v.49 no.3
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• pp.213-218
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• 2019

Purpose: The aim of this study was to evaluate the relationship between the mandibular canal and impacted mandibular third molars using cone-beam computed tomography (CBCT) and to compare the CBCT findings with signs on panoramic radiographs(PRs). Materials and Methods: This retrospective study consisted of 200 mandibular third molars from 200 patients who showed a close relationship between the mandibular canal and impacted third molars on PRs and were referred for a CBCT examination of the position of the mandibular canal. The sample consisted of 124 females and 76 males, with ages ranging from 18 to 47 years (mean, $25.75{\pm}6.15$ years). PRs were evaluated for interruption of the mandibular canal wall, darkening of the roots, diversion of the mandibular canal, and narrowing of the mandibular canal. Correlations between the PR and CBCT findings were statistically analyzed. Results: In total, 146 cases(73%) showed an absence of canal cortication between the mandibular canal and impacted third molar on CBCT images. A statistically significant relationship was found between CBCT and PR findings (P<0.05). The absence of canal cortication on CBCT images was most frequently accompanied by the PR sign of diversion of the mandibular canal(96%) and least frequently by interruption of the mandibular canal wall(65%). Conclusion: CBCT examinations are highly recommended when diversion of the mandibular canal is observed on PR images to reduce the risk of mandibular nerve injury, and this sign appears to be more relevant than other PR signs.

• Imaging Science in Dentistry
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• v.44 no.2
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• pp.171-175
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• 2014

One of the most common oral surgical procedures is the extraction of the lower third molar (LTM). Postoperative complications such as paresthesia due to inferior alveolar nerve (IAN) injury are commonly observed in cases of horizontal and vertical impaction. The present report discusses a case of a vertically impacted LTM associated with a dentigerous cyst. An intimate contact between the LTM roots and the mandibular canal was observed on a panoramic radiograph and confirmed with cone-beam computed tomographic (CBCT) cross-sectional cuts. An orthodontic miniscrew was then used to extrude the LTM prior to its surgical removal in order to avoid the risk of inferior alveolar nerve injury. CBCT imaging follow-up confirmed the success of the LTM orthodontic extrusion.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.22 no.1
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• pp.149-160
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• 1992

The purpose of this study was to localize the inferior alveolar canals in relation to the root apices of the mandibular third molars, according to their positions and degrees of impaction using vertical tube shift technique. One hundred three mandibular third molars, from 95 persons consisted of 57 males and 38 females, were clinically and radiographically investigated. The mandibular third molars had no pericoronitis and periapical lesions, and showed an evidence of complete root formation. The obtained results were as follows: 1. In localiztion of the inferior alveolar canals in relation to the root apices of the mandibular third molars, the inferior alveolar canal was located at the buccal side of the root apices of mandibular third molar in 77.7%, below the root apices in 16.5%, and the lingual side of root apices in 5.8%. 2. The positions of the mandibular third molars according to the Winter's Classification were as follows; 36.9% in Class Ⅰ, 21.3% in Class Ⅱ, 14.7% in Class Ⅲ, 4.8% in Class Ⅳ, 1.9% in Class Ⅴ, 17.5% in Class Ⅵ, 2.9% in Class Ⅶ. In localization of the inferior alveolar canals in relation to the root apices of the mandibular third molars according to the Winter's Classification, 92.1 % of Class Ⅰ, 86.4% of Class Ⅱ, 80.0% of Class Ⅲ, and 100.0% of Class Ⅳ and Ⅴ were located at the buccal side. In Class Ⅵ, however, 33.3% was located at the buccal side, 44.5% below the root apices, and 22.2% at the lingual side. 3. The degree of impaction was revealed to be 53.4% in Degree Ⅰ, 36.9% in Degree Ⅱ, and 9.7% in Degree Ⅲ. In localization of the inferior alveolar canals in relation to the root apices of mandibular third molars according to degree of impaction, 98.2% of Degree Ⅰ was located at the buccal side. In Degree Ⅱ, 60.5% was located at the bucal side, 31.6% below the root apices, and 7.9% at the lingual side. In Degree Ⅲ, 30.0% was located at the buccal side, 40.0% below the root apices, and 30.0% at the lingual side.

• Imaging Science in Dentistry
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• v.52 no.2
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• pp.231-238
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• 2022

Intraosseous xanthoma of the mandible is a rare benign disorder. A 17-year-old male patient presented with a suspected abscess in the right mandibular third molar, detected on a panoramic radiograph. The patient had no history of systemic or lipid-related metabolic diseases and complained of no specific symptoms or pain. A radiographic examination revealed a heterogeneous radiolucency extending from the apical to the distal aspect of the right mandibular third molar tooth germ. The lesion measured 9 × 16 × 24 mm (antero-posterior × mediolateral × supero-inferior) and showed a relatively well-defined, multilocular, foamy appearance with hyperostotic borders spreading to the inferior alveolar nerve canal. After excisional biopsy, a diagnosis of central xanthoma was made. The lesion recurred, and intraoral vertical ramus osteotomy was done near the lesion. For the treatment of xanthoma of the mandible, extensive and delicate surgical treatment under general anesthesia should be considered.