DOES THE CONE BEAM SCAN (CONE BEAM COMPUTED TOMOGRAPHY) CHANGE THE TREATMENT DECISION TO REMOVE IMPACTED THIRD MOLAR TEETH?

The main reasons why I recommend a cone beam scan (CBCT) for third molar extractions is when there is significant risk to the nerve in the lower jaw (inferior alveolar nerve) or when there are significant lesions (typically cysts or tumors) associated with the jaw and/or teeth. For me, the cone beam scan has never affected my decision as to whether or not to remove the tooth. (J Oral Maxillofac Surg 78: 1061-1066, 2020). Rather, it has acted as an aid – again to assess the position, anatomy, and risks.

The noted article comes from Hungary. Europeans have often embraced the idea of coronectomy for treatment of third molar teeth. I strongly disagree with this technique as being an appropriate alternative to careful removal. I have yet to see the case that would change my mind.

As it relates to that thought process though, I can see how the view from a panoramic x-ray may cause a great deal of fear and the CBCT can completely relieve that fear by showing the tooth and risks in 3D and helping to guide the surgery and reduce those risks. For me, having the CBCT reduces the risks by empowering me with the information of actual anatomy – such as whether the nerve is on one side or the other of the tooth root, separated or intimate with the root, free of the tooth or surrounded by the tooth. Again, in our hands we rarely have problems with the nerves because of thorough diagnosis, x-ray examination, and a careful surgical technique.