Escola Superior da Amazônia , Department of Oral Diagnosis , Belém , PA , Brazil .
Universidade Federal do Rio Grande do Sul - UFRS, Surgery and Orthopedics Department , Porto Alegre , RS , Brazil .
Braz Oral Res. 2022 Jun 10;36:e078. doi: 10.1590/1807-3107bor-2022.vol36.0078. eCollection 2022.
This study analyzed the impact of CBCT on the level of confidence in diagnostic and treatment thinking in mandibular lower molar (M3M) clinical management. Thirty cases for which panoramic radiographs and CBTC images were available were selected and classified according to radiologic signs indicating the proximity of the M3M to the mandibular canal (interruption of the radiopaque borders of the canal of the mandibular canal wall, darkening of the roots, and diversion or narrowing of the canal, n = 10 for each classification). Twelve oral and maxillofacial surgeons (OMS) contributed to this study by answering two questionnaires. The first questionnaire contained a clinical description of the case and a panoramic radiograph. After 30 days, a second questionnaire with the same clinical illustrations and tomographic multiplanar reconstruction images was administered. Both questionnaires asked specialists to rate diagnostic confidence, the surgical complexity, chosen treatment, and surgical confidence. In approximately 40% of answers, CBCT images had a positive impact on ratings of diagnostic confidence and treatment thinking confidence, and in 24.4%, they increased the surgical complexity score. There was no change in the treatment plan following the use of CBCT, but the CBCT examination was a determining factor for diagnosis and treatment planning in 72.8% of the answers CBCT improved the confidence level in diagnostic and treatment thinking of the M3M management while also increasing the perceived level of surgical complexity. The findings of this study support the need to consider using CBCT in diagnosis and treatment planning for M3Ms with radiographic signs such as darkening of the roots, interruption of the radiopaque borders of the mandibular canal, or deviation of the mandibular canal and narrowing of the roots.
本研究分析了锥形束 CT（CBCT）对下颌磨牙（M3M）临床管理中诊断和治疗思维信心水平的影响。选择了 30 例具有全景片和 CBTC 图像的病例，并根据影像学征象进行分类，这些征象表明 M3M 与下颌管的接近程度（下颌管管壁不透射线边界中断、牙根变暗、管移位或变窄，每种分类各有 10 例）。12 名口腔颌面外科医生（OMS）参与了这项研究，他们通过回答两个问卷来完成。第一个问卷包含病例的临床描述和全景片。30 天后，他们收到了第二个问卷，其中包含相同的临床插图和断层多平面重建图像。两个问卷都要求专家评估诊断信心、手术复杂性、选择的治疗方法和手术信心。在大约 40%的答案中，CBCT 图像对诊断信心和治疗思维信心的评分有积极影响，在 24.4%的答案中，它们增加了手术复杂性评分。使用 CBCT 后治疗计划没有改变，但在 72.8%的答案中，CBCT 检查是诊断和治疗计划的决定因素。CBCT 提高了 M3M 管理中诊断和治疗思维的信心水平，同时也增加了手术复杂性的感知程度。本研究的结果支持在具有牙根变暗、下颌管不透射线边界中断或下颌管移位和牙根变窄等影像学征象的 M3M 的诊断和治疗计划中考虑使用 CBCT。
