Inferior alveolar nerve demage following removal of mandibular third molar teeth. A prospective study using panoramic radiography

Permanent alteration of sensation in the lip after the removal of mandibular third molar teeth is an unusual but important complication. Studies have been performed to assess the risk of nerve damage but most of these have been retrospective and poorly controlled. This prospective trial predicted the outcome of altered sensation prior to surgery based on assessment of a panoramic radiograph and correlated this with the result postoperatively in the consecutive removal of 479 third molar teeth. Results indicated that 5.2 per cent had transient alteration in sensation but only one patient (0.2 per cent) had prolonged anaesthesia. As 94.8 per cent of teeth extracted had no neurological sequelae the figures for prediction were skewed and a kappa statistical analysis of 0.27 illustrated a fair level of agreement between prediction and outcome. This study supports previously reported levels of neurological damage and confirms that panoramic radiography is the optimum method for radiological assessment for mandibular third molar teeth prior to their removal.