Comparison of Dental Panoramic Tomography (DPT) and CBCT for Assessment of Anatomic Relationship Between Mandibular Impacted Third Molars and Inferior Alveolar Nerve

Momina  Ghani; Zubair  Durrani

doi:10.54112/bcsrj.v6i5.1775

Authors

Momina Ghani Department of Oral and Maxillofacial Surgery, Rehman College of Dentistry (RCD), Rehman Medical Institute (RMI), Peshawar, Pakistan
Zubair Durrani Department of Oral and Maxillofacial Surgery, Rehman College of Dentistry (RCD), Rehman Medical Institute (RMI), Peshawar, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i5.1775

Keywords:

Impacted third molar, inferior alveolar nerve, panoramic radiography, CBCT, diagnostic accuracy

Abstract

The inferior alveolar nerve (IAN) injury is one of the common complications of surgical extraction of impacted mandibular third molars. The third molar and IAN are very important to be evaluated on proper imaging to evaluate their relation with anatomical distribution. Objective: To determine the diagnostic accuracy of Dental Panoramic Tomography (DPT) in assessing proximity between impacted mandibular third molars and the IAN, using Cone Beam Computed Tomography (CBCT) as the gold standard. Methods: The cross-sectional study was carried out between November 2024 and April 2025 at Rehman College of Dentistry. The 107 patients aged between 20 and 35 years old had both DPT and CBCT imaging. Radiographic findings on DPT were compared to CBCT to obtain the sensitivity, specificity, and overall accuracy. Results: DPT ranged from 75.3 percent sensitivity, 64.7 percent specificity, and 71.9 percent diagnostic accuracy. CBCT was better at detecting the location of nerves, in particular lingual canal positioning. Conclusion: CBCT provides remarkably better visualization of anatomy as compared to DPT and must be considered in high-risk scenarios.

Downloads

References

Apaydın BK, Icoz D, Uzun E, Orhan K. Investigation of the relationship between the mandibular third molar teeth and the inferior alveolar nerve using posteroanterior radiographs: a pilot study. BMC Oral Health. 2024 Mar 22;24(1):371.

Issrani R, Prabhu N, Sghaireen M, Alshubrmi HR, Alanazi AM, Alkhalaf ZA, Alnusayri MO, Aljohani FM, Khan ZA. Comparison of digital OPG and CBCT in assessment of risk factors associated with inferior nerve injury during mandibular third molar surgery. Diagnostics. 2021 Dec 6;11(12):2282.

Joshi J, Dudhia B, Mehta D, Thaker N, Patel H. Comparative Analysis of Impacted Mandibular Third Molar Root Proximity to the Mandibular Canal using Orthopantomography and Cone-beam Computed Tomography Imaging Modalities: A Pilot Study. Advances in Human Biology. 2025 Jan 1;15(1):113-7.

Verma A, Verma S, Dhankhar A, Moral NK, Nagar N, Bhadoria AS. Predicting the Risk of Inferior Alveolar Nerve Injury in Impacted Lower Third Molars Using Panoramic Radiography and Cone Beam Computed Tomography. Journal of Evolution of Medical and Dental Sciences. 2021 Aug 23;10(34):2910-5.

Öztürk HP, Özgedik HS, Avsever İH, Özarslantürk S, Allaberdiyev M, Aslan Balcı A. Evaluation of Relationship Between Mandibular Third Molars and Mandibular Canal: Comparison of Findings Obtained by Panoramic Radiography and Cone-Beam Computed Tomography.

Vasegh Z, Bakhshaei P, Jahanbani M, Mahmoudi Anzabi R. Evaluation of anatomical relationships in the mandibular third molar region based on its angulation and depth of impaction: a CBCT-based study. Oral and Maxillofacial Surgery. 2024 Jun;28(2):613-22.

Yang Y, Bao DY, Ni C, Li Z. Three-dimensional positional relationship between impacted mandibular third molars and the mandibular canal. BMC Oral Health. 2023 Nov 4;23(1):831.

Jesudas PC, Seelam M, Santhosh Kumar MP. Assessment of relation and course of inferior alveolar nerve using CBCT-a retrospective study of 120 cases. Int J Dent Oral Sci. 2021 Sep 5;8:4320-5.

Vranckx M, Geerinckx H, Gaêta-Araujo H, Leite AF, Politis C, Jacobs R. Do anatomical variations of the mandibular canal pose an increased risk of inferior alveolar nerve injury after third molar removal?. Clinical Oral Investigations. 2022 Jan;26(1):931-7.

Mousa AA, Ali HE, Ibrahim IH. Assessment of the Relationship Between the Impacted Mandibular Third Molar and Inferior Alveolar Canal Using Cone Beam Computed Tomograph. Al-Azhar Assiut Dental Journal. 2023 Oct 1;6(2):167-78.

Rai S, Misra D, Misra A, Dhawan A, Gupta P, Solanki S. Diagnostic accuracy of position of impacted mandibular third molar on CBCT with panoramic radiography. Journal of Dr. YSR University of Health Sciences. 2024 Oct 1;13(4):392-400.

Naeem I, Khalid MU, Usama MM, Ashraf MS. Diagnostic Accuracy of Orthopantogram in Identifying the Proximity of Inferior Alveolar Nerve Canal to the Roots of Mandibular Third Molar as Compared to Cone Beam Computed Tomography. National Journal. 2025;10(1):47.

Mehanny M, Alhazmi A, Alharbi A. Assessment of anatomical proximity of impacted mandibular third molars to the mandibular canal using panoramic radiographic markers and Cone beam Computed Tomography. Egyptian Dental Journal. 2025 Apr 1;71(2):1347-56.

Sehgal A, Saxena V, Rangarajan H, Gopalakrishnan V, Dewan K. A Clinico-Radiological Study to Evaluate the Risk of Inferior Alveolar Nerve Damage in Impacted Mandibular Third Molar Removal. Journal of Maxillofacial and Oral Surgery. 2025 Mar 14:1-0.

Kim HJ, Jo YJ, Choi JS, Kim HJ, Kim J, Moon SY. Anatomical risk factors of inferior alveolar nerve injury association with surgical extraction of mandibular third molar in Korean population. Applied Sciences. 2021 Jan 16;11(2):816.

Mohammadpour Z, Foroughi R, Abesi F, Bijani A, Haghanifar S. Radiographic comparison of the relation between mandibular third molar root and inferior alveolar canal in panoramic radiography and cone-beam computed tomography. Journal of Babol University of Medical Sciences. 2021 Mar 10;23(1):289-96.

Ogbozor BE, Abubakar MK, Yahaya A, Iya S, Ewansiha GO, Bashir K, Bamgbose BO. Radiographic Assessment of Features of Impacted Mandibular Third Molars With Post-Operative Injury to the Inferior Alveolar Nerves: A Record-Based Cross Sectional Study. Nigerian Dental Journal. 2025 Jun 14;33(2).

Remulla SD, Koneru J, Reddy S, Tatapudi R, Darna G, Prathipati NM. Prediction of nerve damage by comparing periapical radiographic signs of impacted mandibular third molars in close proximity to inferior alveolar nerve with their true tomographic relationship–An observational study. IP Int J Maxillofac Imaging. 2021;7(3).

Beck F, Austermann S, Bertl K, Ulm C, Lettner S, Toelly A, Gahleitner A. Is MRI a viable alternative to CT/CBCT to identify the course of the inferior alveolar nerve in relation to the roots of the third molars?. Clinical Oral Investigations. 2021 Jun;25:3861-71.

Choi E, Lee S, Jeong E, Shin S, Park H, Youm S, Son Y, Pang K. Artificial intelligence in positioning between mandibular third molar and inferior alveolar nerve on panoramic radiography. Scientific Reports. 2022 Feb 14;12(1):2456.