Integrated Dental Clinic, Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Campinas, Brazil.
Dentomaxillofac Radiol. 2021 May 1;50(4):20200412. doi: 10.1259/dmfr.20200412. Epub 2020 Nov 25.
This study observed whether changes in diagnosis caused by analysis of three-dimensional images can lead to alterations in the treatment plans of impacted lower third molars (ILTMs).
Sets of panoramic (PAN) - cone beam computed tomography (CBCT) of 218 patients were assessed for ILTM classification, contact with mandibular canal, contact and resorption of the lower second molar (LSM), intraoperative planning and post-operative expectations.
Percentage agreement and McNemar test compared PAN CBCT assessments. Logistic regression analyzed the dependency of change in surgical planning considering the changes in diagnostic features; descriptive statistics was used to observe the expectation of post-operative complications and paresthesia. Differences were found between PAN CBCT for classification of impaction and positioning, LSM relationship, choice for crown and root sectioning and expectation of post-operative complications (all with < 0.001). Logistic regression indicated that the change in diagnosis caused by CBCT examination did not change the clinical decision to extract ILTM but altered the planning of intraoperative steps such as osteotomy, crown sectioning and relaxing incision. The expectation of post-operative complications decreased when professionals planned the ILTM removal using tri-dimensional images.
We concluded that changes in the diagnosis after CBCT examination can lead to alterations in the treatment plan of impacted lower third molar.
本研究观察分析三维图像引起的诊断变化是否会导致下颌阻生第三磨牙（ILTM）治疗计划的改变。
对 218 例 ILTM 分类、与下颌管接触、下颌第二磨牙（LSM）接触和吸收、术中计划和术后预期的 PAN-CBCT 进行评估。
百分比一致性和 McNemar 检验比较了 PAN 和 CBCT 的评估。逻辑回归分析了考虑诊断特征变化的手术计划变化的依赖性；描述性统计用于观察术后并发症和感觉异常的预期。在 PAN 和 CBCT 对阻生和定位分类、LSM 关系、冠和根部分选择以及术后并发症预期方面存在差异（均 < 0.001）。逻辑回归表明，CBCT 检查引起的诊断变化不会改变提取 ILTM 的临床决策，但改变了切开术、冠部分等术中步骤的规划。使用三维图像规划 ILTM 去除时，术后并发症的预期会降低。
我们得出结论，CBCT 检查后的诊断变化可能导致下颌阻生第三磨牙治疗计划的改变。
