Malmö University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Radiographic imaging in relation to the mandibular third molar: a survey among oral surgeons in Sweden
Malmö University, Faculty of Odontology (OD).ORCID iD: 0000-0003-4611-3708
Malmö University, Faculty of Odontology (OD).
Malmö University, Faculty of Odontology (OD).ORCID iD: 0000-0002-8539-7742
Malmö University, Faculty of Odontology (OD). University of Bergen, Norway.
Show others and affiliations
2022 (English)In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 26, p. 2073-2083Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To query the experience of oral surgeons concerning referral routines and preferences for radiographic imaging modality before surgical removal of mandibular third molars and investigate factors that influence imaging modality preferences.

MATERIALS AND METHODS: Members of the Swedish Association of Oral and Maxillofacial Surgeons (n = 280) were invited to participate in a web-based digital survey concerning their experiences and use of three imaging modalities in pre-surgical assessment of mandibular third molar removal. The survey comprised multiple-choice questions and four cases depicted in images; respondents reported whether they would supplement the cases with other images and, if so, from which modality.

RESULTS: The response rate was 64%. Panoramic radiographs were most commonly used in pre-surgical planning (response options: always or often), significant difference between professions (p = 0.039), and considered to facilitate treatment planning (87%), as was CBCT (82%); for 51%, CBCT reduced post-operative complications. Preferred modality for localizing the mandibular canal was fairly evenly distributed and for non-complex case, significant difference between subgroups of OMFS surgeons was found (p = 0.003) as to preference for intraoral radiographs.

CONCLUSIONS: A majority of respondents received a report within 2 weeks of their referral for CBCT and would read the report and view the images before surgery. Image modality preference differed depending on case complexity, with a greater perceived need for CBCT. Profession and practical experience affected choice.

CLINICAL RELEVANCE: Choice of imaging modality in mandibular third molar assessment is also important from dose delivery and social economy standpoints.

Place, publisher, year, edition, pages
Springer, 2022. Vol. 26, p. 2073-2083
Keywords [en]
Clinical decision-making, Dental radiography, Oral surgical procedures, Third molar, Tooth extraction
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-46362DOI: 10.1007/s00784-021-04189-9ISI: 000702617400003PubMedID: 34596771Scopus ID: 2-s2.0-85116101158OAI: oai:DiVA.org:mau-46362DiVA, id: diva2:1603552
Available from: 2021-10-15 Created: 2021-10-15 Last updated: 2024-02-26Bibliographically approved
In thesis
1. Radiographic imaging in relation to the mandibular third molar: tooth characteristics, modality choice, optimization, and absorbed dose
Open this publication in new window or tab >>Radiographic imaging in relation to the mandibular third molar: tooth characteristics, modality choice, optimization, and absorbed dose
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Radiographic imaging of the mandibular third molar (M3) is a valuable diagnostic tool. It provides information on tooth position, root morphology, and relations to surrounding anatomical structures that facilitates diagnosis and treatment planning. Three modalities are commonly used in dentistry: intraoral and panoramic radiography, and cone beam computed tomography (CBCT). Over time, panoramic radiography became a justified choice in most cases of M3 removal. In the last decade, a three-dimensional (3D) alternative, CBCT, has seen increasing use. The advantages of 3D come at the cost of higher radiation doses and societal expense. The four studies in this thesis originated from current knowledge gaps and clinical needs.

The use of panoramic radiography for evaluating the M3 and its relation to the inferior alveolar nerve (IAN) is well-established practice; however, its application has declined over time, possibly due to the rising popularity of CBCT imaging. Thus, it is of interest to investigate the suitability of panoramic imaging of the M3. Choice of imaging modality is important from dose delivery and socioeconomic standpoints. A survey of clinician experiences and preferences in imaging modalities for pre-surgical analysis was needed.

In diagnostic imaging, the common goal is to reduce radiation exposure to the lowest threshold that still delivers reliable diagnostic information. Due to the growing use of CBCT, there is a need to optimize exposure settings and use reliable measurement methods in dosimetric analysis. Nevertheless, for the M3, the present literature has neither evaluated a low-dose protocol in a clinical setting nor compared the standard method of measuring absorbed dose in dental CBCT with an alternative method.

This thesis is based on the following papers:

Paper I, an observational study, evaluated M3 characteristics and IAN relation, incidental findings, and image quality regarding patient positioning on 442 panoramic radiographs. 

Key findings: A majority of M3s were erupted and vertically positioned, regardless of age. The IAN was located inferior to the roots in just over half of the cases; an overlapping position was most common if the tooth was retained or semi-retained, or patient age less than 30 years. Frequent incidental findings were apical radiolucencies, idiopathic osteosclerosis, and tooth fragments. Patient positioning was suboptimal in one-third of the radiographs; common errors included patient placement posterior to the image layer and an upward-tilted head. 

Paper II was a web-based questionnaire sent to general dentists and to residents and specialists in oral and maxillofacial surgery. The survey comprised multiple-choice questions with four M3 cases depicted in images. 

Key findings: A majority of respondents received a report within 2 weeks of their CBCT referral and would read it and view the images before surgery; one-third did not. Panoramic radiographs were the preferred modality in pre-surgical planning; differences between professions were significant. Panoramic radiographs and CBCT were seen as facilitating treatment planning, and CBCT as also reducing post-operative complications. CBCT tended to be preferred in more complex M3 cases. 

Paper III was a clinical trial investigating an alternative, low-dose CBCT protocol with lower tube current than the default protocol. After justification for CBCT, 48 patients (62 M3s) referred for a pre-surgical investigation were recruited. Two scans of each site were made using the two protocols

Key findings: No significant differences occurred in visibility of root and mandibular canal relationship and proximity, root morphology, and possible root resorption of the second molar. Visibility of the periodontal ligament was significantly better in default images. Subjective image quality in low-dose images (60% less radiation) was acceptable in most cases. 

Paper IV was a laboratory study comparing two dosimeters in a CBCT scan of the M3 region. Five slices of an anthropomorphic phantom were prepared with thermoluminescent dosimeters (TLD-100) at 75 sites and covered with Gafchromic film LD-V1. 

Key findings: Point dose measurements at all TLD sites correlated well with doses measured on film; agreement was better at lower doses. Minimum and maximum doses on film versus at TLD sites deviated greatly on all slices and for several organs. 

To conclude, panoramic radiography is useful in evaluating M3 and IAN relationships. Clinicians consider pre-surgical information to differ depending on imaging modality; modality preference seems to depend on case complexity. Optimized CBCT protocols can be used for the M3. Gafchromic film is a favorable alternative in dental CBCT dosimetry

Place, publisher, year, edition, pages
Malmö: Malmö University Press, 2023. p. 89
Series
Malmö University Odontological Dissertations, ISSN 1650-6065
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-62211 (URN)10.24834/isbn.9789178773534 (DOI)978-91-7877-352-7 (ISBN)978-91-7877-353-4 (ISBN)
Public defence
2023-09-29, Aulan, Tandvårdshögskolan Malmö universitet, Smedjegatan 16, Malmö, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2023-08-31 Created: 2023-08-31 Last updated: 2024-02-26Bibliographically approved

Open Access in DiVA

fulltext(1002 kB)312 downloads
File information
File name FULLTEXT01.pdfFile size 1002 kBChecksum SHA-512
47b5a7a6b86c61ba0ba24f496b0fc80c4782ad02dfc8f1f858c336dbe5541c3b97575c05392605a831679f7fef5deeb040c3c25f32c736747009c98e969948e6
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMedScopus

Authority records

Cederhag, JosefineTruedsson, AnnaAlstergren, PerShi, Xie-QiHellén-Halme, Kristina

Search in DiVA

By author/editor
Cederhag, JosefineTruedsson, AnnaAlstergren, PerShi, Xie-QiHellén-Halme, Kristina
By organisation
Faculty of Odontology (OD)
In the same journal
Clinical Oral Investigations
Dentistry

Search outside of DiVA

GoogleGoogle Scholar
Total: 312 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 164 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf