Observation of positional relation between mandibular third molars and the mandibular canal on limited cone beam computed tomography

We describe the preoperative use of limited cone beam computed tomography (CT) with a dental CT scanner for the assessment of mandibular third molars before extraction. Cone beam CT provides 42.7-mm-high and 30-mm-wide rectangular solid images, with a resolution of less than 0.2mm.The positional relationship between the mandibular third molars and the mandibular canal was examined by dental CT. Sixty-eight lower third molars of 62 patients whose teeth were superimposed on the mandibular canal on periapical or panoramic radiographs were studied. Dental CT scans clearly demonstrated the positional relationship between the mandibular canal and the teeth. The mandibular canal was located buccally to the roots of 16 teeth, lingually to the roots of 27 teeth, inferiorly to the roots of 23 teeth, and between the roots of 2 teeth. The presence of bone between the mandibular canal and the teeth was not noted in 7 of 16 buccal cases, 24 of 27 lingual cases, and 10 of 23 inferior cases on dental CT scans, suggesting that the cana was in contact with the teeth.Fifty-nine of the 68 mandibular third molars were surgically removed, and postoperative transient hypoesthesia occurred in 4 patients. Dental CT scans showed no bone between the mandibular canal and the teeth in all 4 patients. Hypoesthesia was not related to the bucco-lingual location of the mandibular canal or to the extent of bone loss between the canal and the teeth. However, hypoesthesia did not occur in patients with bone between the mandibular canal and the teeth. Thus, information on the distance between the canal and teeth on dental CT scans was useful for predicting the risk of inferior alveolar nerve damage.Because of its high resolution and low radiation dose, cone beam CT was useful for examination before mandibular third molar surgery.