Influence of 2D vs 3D images and professional experience on the treatment plan for impacted lower third molar

• Ano de defesa: 2020
• Autor(a) principal: Mendonça, Lucas Moreira
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: eng
• Instituição de defesa: Biblioteca Digitais de Teses e Dissertações da USP
• Palavras-chave em Português: Clinical decision; Clinical study; Cone beam computed tomography; Oral surgery; Planejamento; Terceiro molar; Third molar; Tomografia
• Link de acesso: https://www.teses.usp.br/teses/disponiveis/58/58131/tde-03102022-103836/

The objective of this study was to evaluate the influence of imaging exams (panoramic [PAN] or cone-beam computed tomography [CBCT]) and professional experience in the diagnosis and treatment planning of impacted lower third molars (ILTMs). This study involved a set of 218 image records containing both PAN and CBCT images of patients with ILTMs. Six professionals were selected and divided into 2 groups: seniors (Srs), who are more experienced professionals, and juniors (Jrs), who are less experienced professionals in ILTM treatment. Both groups evaluated the 436 images concerning (1) ILTM positioning, (2) mandibular canal contact, (3) lower second molar (LSM) contact, (4) intraoperative planning, and (5) postoperative expectations. The data were analyzed by observing the interexaminer (Srs vs Jrs) and intraexaminer (PAN vs CBCT) agreement in the ILTM treatment planning. There was a difference in the classification of the spatial and horizontal positioning depending on the image type and professional experience (P < 0.05). The agreement between Srs and Jrs on the relation of ILTM to mandibular canal was higher on CBCTs than PANs; the 7 signs in PANs associating ILTM proximity with inferior alveolar nerve (IAN) were identified with lower absolute frequency in 2D compared to 3D examinations about proximity to the canal, cortical interruption, and canal narrowing. Regarding LSM/ILTM, the absolute frequency of agreement between Srs and Jrs for resorption changed from 140 in PANs to 294 in CBCTs. A higher frequency of clinical decision to follow up was observed in the planning among Jrs when using CBCTs, and a higher frequency of coronectomy (170) was observed compared to PANs (94). Srs and Jrs expected almost the same pain, swelling, and trismus by CBCTs; this trend was not the same on PANs, where Jrs expected less. For paresthesia, Srs and Jrs expected similar frequencies comparing the image exam; however, Jrs expect up to 5 times more paresthesia than Srs on both exams types. It was possible to conclude that 3D imaging and professional experience can influence the ILTM diagnosis and treatment plan.