Comparative Evaluation of Cone Beam CT vs. Panoramic Radiography in Preoperative Assessment of Mandibular Third Molar Extraction Complications

Abstract

The extraction of mandibular third molars represents one of the most frequently performed surgical procedures in oral and maxillofacial surgery, yet it carries substantial risks of postoperative complications that can significantly impact patient outcomes and quality of life. The preoperative radiographic assessment plays a pivotal role in identifying anatomical risk factors and anticipating potential complications, thereby enabling surgeons to modify their surgical approach and provide informed consent to patients. This comprehensive study critically evaluates the diagnostic efficacy of Cone Beam Computed Tomography (CBCT) compared to conventional panoramic radiography in the preoperative assessment of mandibular third molar extractions, with particular emphasis on their ability to predict complications such as inferior alveolar nerve injury, lingual nerve damage, and root-mandibular canal relationships. Through an extensive review of contemporary literature and clinical evidence, this research demonstrates that while panoramic radiography remains a valuable screening tool with advantages in cost-effectiveness and reduced radiation exposure, CBCT provides superior three-dimensional visualization of anatomical structures, offering enhanced accuracy in identifying high-risk cases where the proximity between tooth roots and the inferior alveolar canal necessitates modified surgical techniques. The findings suggest that a stratified approach, utilizing panoramic radiography for initial screening followed by selective CBCT imaging for high-risk cases, represents the most clinically and economically rational strategy for optimizing patient safety while maintaining cost-effectiveness in contemporary dental practice.