Section of Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Denmark.
Dentomaxillofac Radiol. 2019 Dec;48(8):20190209. doi: 10.1259/dmfr.20190209. Epub 2019 Aug 27.
To assess factors influencing treatment decision for maxillary third molars referred for cone beam CT (CBCT). Parameters influencing the decision to treat and to remove either the maxillary second molar or third molar were pursued.
111 impacted maxillary third molars, clinically examined including a panoramic image, in 86 patients (mean age 26 years, range 15-55) were referred for CBCT on suspicion of pathology/root resorption in the second molar, based on information in the panoramic image. The following parameters were assessed from the patient's file, including the radiographic images: (1) third molar angulation; (2) initial treatment plan based on clinical examination and the panoramic image; (3) diagnoses based on information from CBCT; (4) treatment decision after additional CBCT information was available; (5) pre-/post-operative complications; (6) treatment of the maxillary second molar.
70 cases (63.1%) underwent treatment, while 41 (36.9%) received no treatment. Change in treatment plan was registered in 65 cases (58.6%) after CBCT. In 12 cases (10.8%), treatment changed from removal of the third to removal of the second molar, while 25 (22.5%) were scheduled for removal in the initial treatment plan; but after CBCT, the decision was not to treat. If external root resorption involved the pulp of the second molar, there was an almost 17 times higher risk that this tooth was removed instead of the third molar (logistic regression analysis: odds ratio 16.8; < 0.001).
Findings in CBCT often changed the treatment plan. Severe external root resorption observed in CBCT was the main decisive factor for removing the second instead of the third molar.
评估影响上颌第三磨牙锥形束 CT（CBCT）转诊治疗决策的因素。探讨影响治疗决策以及拔除上颌第二磨牙或第三磨牙的因素。
86 名患者（平均年龄 26 岁，范围 15-55 岁）的 111 颗临床检查的埋伏上颌第三磨牙（包括全景片），因怀疑第二磨牙有病变/牙根吸收，根据全景片信息转诊行 CBCT 检查。从患者病历中评估以下参数，包括影像学图像：（1）第三磨牙倾斜角度；（2）基于临床检查和全景片的初始治疗计划；（3）根据 CBCT 信息得出的诊断；（4）获得更多 CBCT 信息后做出的治疗决策；（5）术前/术后并发症；（6）上颌第二磨牙的处理。
70 例（63.1%）进行了治疗，41 例（36.9%）未接受治疗。CBCT 后，65 例（58.6%）治疗计划发生改变。12 例（10.8%）从拔除第三磨牙改为拔除第二磨牙，25 例（22.5%）在初始治疗计划中被安排拔除，但 CBCT 后决定不治疗。如果第二磨牙的外部牙根吸收累及牙髓，则该牙被拔除的风险几乎增加 17 倍（而不是第三磨牙）（逻辑回归分析：优势比 16.8；<0.001）。
CBCT 的发现常常改变治疗计划。CBCT 中观察到的严重外部牙根吸收是拔除第二磨牙而不是第三磨牙的主要决定性因素。
