journal presentation 2 agt 2012
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7/29/2019 Journal Presentation 2 Agt 2012
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Cortical integrity of the inferior alveolarcanal as a predictor of paresthesia after
third-molar extractionWonse Park, DDS, MSD; Ji-Wook Choi, DDS; Jae-Young
Kim, DDS; Bong-Chul Kim, DDS; Hyung Jun Kim, DDS,
MSD, PhD; Sang-Hwy Lee, DDS, MSD, PhD
JADA, Vol. 141 http://jada.ada.org March 2010 271
Presented by Andhika Priyatama
7/29/2019 Journal Presentation 2 Agt 2012
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Background
Extraction of mandibularthird molar
Damage of the inferioralveolar nerve
Direct Damage=
Paresthesia
Panoramic RadiographyUsed for evaluating nerve
damage
position
angulation
Proximity of IAN
Disanvantage: limited 3-D visualization
relatively poor diagnostic accuracy when used
to examine anatomical forms and structures.
(Bell and colleagues)
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Background
CT (Computed Tomography)
Provide 3D info of IAN and MTM
Bucolingualconfiguration
Corticalloss of IAC
DistanceIAN & MTM
Curvature andnumber of roots
Most consistent finding that visible on CT image
Purposes
evaluate the relationship between the paresthesia that occur as complication of MTM extraction and the cortical integrity of the IAC as viewed via CT
help predict potential damage to theIAN during MTM extraction
evaluated the usefulness of cortical interruption as a possible
risk factor in, or predictor of, IAN injury and resulting pares-thesia after MTM extraction.
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Preoperative CTImaging
Participants, Methods and Material
• Participants: patients At Department of Oral andMaxillofacial Surgery or the Department of General Dentistry at the Yonsei University DentalHospital (2004 and 2007) for the evaluation and
management of impacted MTMs.
Panoramic Radiography revealed any evidence of
increased risk of nerve damage
Excluded: patients with pathological lession
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Participants, Methods and Material
Tooth Assignment
group 1,
no contact between
the root or crown of
the MTM and the IAC
(Figure, A and B);.
primary:the cortical integrity of theIAC
secondary:
the number of CT imageslices containing evidenceof loss of cortical integrity
primary:
the presence or absenceof paresthesia after MTM
extraction.
• Variables:
group 2,
contact between the root of
the MTM and the intact IAC
cortex (Figure, C and D);
group 3,
contact with the interrupted
cortex, the IAC contacted
the root of the MTM with
interruption of the cortex
(Figure, E and F).
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follow-up evaluation everyweek for three weeks andthen monthly evaluationsthere- after.
Participants, Methods and Material
•
Methods:
Oral surgeons checkedpatients for signs of paresthesia on the firstday and the seventh dayafter surgery
paresthesia,
comparing thesensitivities ofthe affected andunaffected sidesusingneurologicalperception testsfor the IAN
cold
pin- prick
brush stroke
two-pointdiscrimination
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Participants, Methods and Material
• Result
179 participants
MTM extraction(259 MTMsextracted).
mean age 23.6years47.5 percentmale
Most impaction horizontal.
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Participants, Methods and Material
•
Result
Groups 1 and 2together includedonly one case of
paresthesia,
group 3 had 10cases (11.8percent).
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Participants, Methods and Material
• Result
reclassifed the predictorvariable cortical integrity
intact disrupted
Table 3 summarizes therelationship between corticalintegrity and paresthesia
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Participants, Methods and Material
• Result
incidence of paresthesiadiffered
significantlywith theposition of theIAC relative tothe MTM
Table 4 details theprevalence ofparesthesiaaccording to theposition of the MTM
incidence of post- operative paresthesia wasgreater for the lingually positioned IAC relative tothe crown and root of the MTM compared with theapical or buccal positions (seven of 66 cases).
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Participants, Methods and Material
• Result
the incidence ofparesthesiaincreased
markedly
the number of CT images observedcortical disruption exceeded three slices
group 3 (interrupted cortex),
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Discussion
occurrence of paresthesia afterMTM extraction
raredistressing experience forthe patient and the clinician
relationship
paresthesia afterMTM extraction
cortical integrity of the IAC as viewedon CT imaging
cortical integrity is a viableprognostic marker forparesthesia after MTM extraction
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Discussion
group 3(participants whohad an interruptedcortical lining)
higher(11.8percent)
the other two groups,
the frequency of nerve damage
the number of CTimage slices
showing loss of cortical integrity.
prevalence of paresthesia
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Discussion
absence of corticalcontinuity in the IAC-As viewed on CT-
direct contactbetween theIAN and theMTM,
injury or exposureof the nerveduring MTMextraction
Integrity of canal isimportant to IAN Damage
valuable prognosticindicator of IAN injury.
Pathway
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Discussion
cortical integrity, the predictorvariable, is an important factorin predicting postoperativeparesthesia.
When the cortical interruption as viewed on CTimaging exceeded approximately 3 mm, the risk of IAN damage increased to more than 20 percent.
First Predictorvariable
secondarypredictor variable
prevalence of paresthesiaincreased significantly whenmore than three consecutive CTimage slices exhibited evidenceof cortical interruption.
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Recommendation
Rood and Shehab(1990) summarizeradiological predictorsof IAN injury threecritical radiographicsigns:
use of CT only when the oral and maxillofacialclinicians observed a definite radiographic sign of paresthesia on prior panoramic radiography.
diversion of the IAC,
darkening of the root
interruption of theradiopaque lines of the IAC.
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Conclusion
cortical interruption of the IAC(as viewed on CT imaging)
direct contact betweenthe IAN and the MTM
higher risk of experiencingparesthesia after MTM extraction
than if thecortex was intact.
clinician can estimate degree of contact betweenthe nerve and the tooth
number of CT images thatshow cortical interruption
effective predictor of possible injury
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MATUR NUWUN
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