Alt gömülü yirmi yaş dişlerinin inferior alveolar sinir ile ilişkisinin panoramik radyografi ve konik ışınlı bilgisayarlı tomografi ile operasyon öncesi muayenesi: Panoramik radyografiler alt gömülü yirmi yaş dişler için hala standart tanı araçları mıdır?

Yıl 2023, Cilt: 9 Sayı: 3, 11 - 20, 01.12.2023

Merve Çakır , Meltem Karaman

Öz

Amaç: Bu çalışmanın amacı, konik ışınlı bilgisayarlı tomografi (KIBT) görüntüleri ile panoramik radyografilerde (PR) alt gömülü yirmi yaş dişlerinin (AGY) inferior alveolar sinir (IAN) ile ilişkisinin radyolojik belirteçlerinin uyumluluğunu değerlendirmektir.
Gereç ve Yöntemler: Eylül-Aralık 2021 tarihleri arasında AGY çıkarılması için sevk edilen hastaların PR ve KIBT görüntüleri kullanılmıştır. AGY’ler, PR'de Pederson Zorluk İndeksi'ne göre sınıflandırılmış. Dişler ile IAN arasındaki ilişki tespit edilirse, ilişkiyi doğrulamak için KIBT görüntüleri incelenmiştir.
Bulgular: 52 AGY'li 45 hasta, PR yanında KIBT görüntüleri olduğu için çalışmaya dahil edilmiştir. Pederson İndeksine göre 14 diş çok zor, kalan 38 diş ise orta derecede zor olarak sınıflandırılmıştır. Dişlerin PR görüntüleri incelendiğinde 44 dişte IAN ile ilişki saptanmıştır. IAN ile ilişkili 44 dişin KIBT görüntüleri incelendiğinde bu dişlerden 7'sinde IAN ile ilişki saptanmamıştır. Öte yandan ilişki yok olarak sınıflandırılan 8 dişin KIBT görüntüleri incelendiğinde 4 tanesinin IAN ile ilişkisi olduğu belirlenmiştir. Böylece 52 dişin 41'i IAN ile ilişkili bulunmuştur. 52 dişin 41'inin KIBT görüntüleri IAN'ın yakınlığını doğrulamış, 14'ü çok zor, 27'si orta derecede zor olarak sınıflandırılmıştır.
Sonuç: Bu bulgular, PR'ye göre IAN-AGY ilişkisi şüpheli ise ve Pederson indeksine göre orta derecede zor veya çok zor olarak sınıflandırılan dişler varsa, ameliyattan önce KIBT çekilmesi gerektiğini göstermektedir.

Anahtar Kelimeler

alt gömülü yirmi yaş, inferior alveolar sinir, KIBT, panoramik radyografi

Pre-operative examination of inferior alveolar nerve and impacted lower third molars relation by panoramic radiography and cone beam computerized tomography: Are panoramic radiographies still standard diagnostic tools for impacted lower third molars?

Öz

Objectives: The aim of this study was to evaluate the compatibility of radiological markers of the impacted lower third molar (LTM) relationship to inferior alveolar nerve (IAN) in panoramic radiographs (PR) with cone beam computerized tomography (CBCT) images.
Materials and Methods: PR and CBCT images of the patients who were referred for LTM removal between September-December 2021 were used. LTM were classified according to the Pederson Difficulty Index in PR. If relation between the teeth and IAN was detected, then CBCT images were investigated to verify the relation.
Results: 52 LTM were included to the study because of having CBCT images. According to Pederson Index 14 teeth were classified as very difficult, 38 as moderately difficult. In PR examination a relationship with the IAN was observed in 44 teeth. When the CBCT images of 44 teeth were examined, 7 of these showed no relationship. On the other hand, when the CBCT images of the 8 teeth, which were classified as ‘no relationship’ in PR images, were examined, it was determined that 4 of them had relationship. Thus, 41 of the 52 teeth were related to the IAN. The CBCT images of 41 of the 52 teeth confirmed for the proximity of the IAN, 14 of them were classified as very difficult, 27 of them were classified as moderately difficult.
Conclusion: These findings indicate that if IAN-LTM relation is suspicious according to PR and teeth classified as difficult or very difficult according to Pederson’s Index, CBCT is necessary before the surgery.

Anahtar Kelimeler

CBCT, IAN, impacted lower third molar, panoramic radiograph

Kaynakça

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