journal presentation 2 agt 2012

7/29/2019 Journal Presentation 2 Agt 2012

http://slidepdf.com/reader/full/journal-presentation-2-agt-2012 1/18

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

http://jada.ada.org/

http://jada.ada.org/



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)



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.



Free Powerpoint Templates

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

http://www.powerpointstyles.com/







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).


http://localhost/var/www/apps/conversion/tmp/scratch_2/Pic.pptx











follow-up evaluation everyweek for three weeks andthen monthly evaluationsthere- after.


•

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







• Result

179 participants

MTM extraction(259 MTMsextracted).

mean age 23.6years47.5 percentmale

Most impaction horizontal.







•

Result

Groups 1 and 2together includedonly one case of

paresthesia,

group 3 had 10cases (11.8percent).







• Result

reclassifed the predictorvariable cortical integrity

intact disrupted

Table 3 summarizes therelationship between corticalintegrity and paresthesia







• 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).







• Result

the incidence ofparesthesiaincreased

markedly

the number of CT images observedcortical disruption exceeded three slices

group 3 (interrupted cortex),






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






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






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






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.







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.






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






MATUR NUWUN

journal presentation 2 agt 2012

Documents