SHOULD WE GET CONE BEAM SCAN (CBS) IMAGES PRIOR TO THRID MOLAR REMOVAL?

Every once in awhile I read an article in a responsible medical or dental journal that just floors me in its stupidity. The article I reference here is one of these (JADA 148(8) 575-583). This article is nothing more than an analysis of other articles written on the subject which draws a completely stupid conclusion that “clinicians should not perform CT routinely before M3M surgery because using CT images does not seem to reduce incidence or affect the patient’s prognosis of IAN injuries in comparison with using PR images.”

First, panoramic imaging (PR images) has been and still is the standard of care for evaluation of impacted third molar teeth. Second, when we recommend the cone beam scan (CT) it is to evaluate someone who may be at a greater risk for complications such as nerve injury and the reason for that study is to better visualize impacted tooth position and the relative positioning of the adjacent vital structures. This is done in order to better prepare for the procedure and therefore reduce risks. Any experienced surgeon can tell you the surgical planning and risk reduction benefits of having better imaging. I have no question that having the pre-surgical information of the exact relationship of the impacted tooth roots to the relative vital structures such as the nerve reduces the risks to the patient of having resultant injuries to these structures.

I would trust your surgeon on this one. If they are suggesting that you get a cone beam scan prior to your third molar extractions do it. It is a minor study without a lot of radiation or cost and it can possibly be the difference between having a complication like a long term nerve injury or not.