Do I need a CBCT / Cone Beam 3D Xray for Impacted Wisdom Teeth Extractions?
by Gary Adams DDS Wisdom Teeth Removal Dentist
The incidence of impacted third molars has been quite high ranging up to 16%-72%. Wisdom teeth become impacted due to retarded development of jaw bones, little space for eruption, physical obstruction and abnormal development pattern. Impacted and abnormally erupted wisdom molars can cause serious functional consequences and complications such as pain, swelling, inability to open mouth, restricted mouth opening and even, spread of infection within the facial spaces. Your dental health care provider will decide to remove impacted wisdom tooth if it is causing oral infections or hindrance with normal oral functions. Special care must be taken whenever third molar surgery is planned especially in the lower jaw due to presence of vital structures such as nerves and major blood vessels in close neighborhood.
Severe bleeding episodes and loss of nerve sensations have been associated with wisdom tooth surgeries in high proportion of patients visiting oral clinics. Complete evaluation and comprehensive visual and radiographic examination is extremely necessary for prevention of complications and uneventful removal of wisdom teeth. Simple periapical and full view radiographs only show two dimensional details and are often insufficient for planning of wisdom tooth removal procedures. Three dimensional CT scan and CBCT scan are considered to be the modern modalities of choice for the assessment of proximity of vital structures in relation to wisdom tooth roots. CT scan and CBCT scans should be utilized in complex cases with severely impacted wisdom teeth with dilacerated roots or where significant abnormalities are encountered.
Following conditions necessitate the use of specialized 3-dimensional Cone Beam or CBCT scans for performing wisdom teeth removal:
- Wisdom teeth which lie deep either superimposing on the mandibular nerve canal or seem to be crossing it on regular radiographs,
- Disrupted nerve canal outline depicted in regular x rays,
- Nerve canal having a step or curve in its course where wisdom tooth roots join,
- Where associated cyst or other pathology is evident.
In conclusion, CT and CBCT scans not only prevent serious consequences such as permanent nerve paresthesia, numbness and discomfort following wisdom tooth removal but these also help guide and assist the clinician in removal of exact amount of bone removal around roots where needed.
A treatment that is very helpful in better wisdom teeth and implant surgery healing is PRF dental platelet rich fibrin.