The prognostic value of panoramic radiography of inferior alveolar nerve damage after mandibular third molar removal: retrospective study of 400 cases

Objective. The aim of the study was to estimate the accuracy of panoramic radiographic signs predicting inferior alveolar nerve (IAN) paresthesia after lower third molar removal. Study design. In a case-control study the sample was composed of 41 cases with postoperative IAN paresthesia and 359 control cases without it. The collected data included classic specific signs indicating a close spatial relationship between third molar root and inferior alveolar canal (IAC), root curvatures, and the extent of IAC-root tip overlap. Bivariate and multivariate logistic regression analyses were completed to estimate the association between radiographic findings and IAN paresthesia. Results. The multivariate logistic analysis identified 3 signs significantly associated with IAN paresthesia (P < .001): interruption of the superior cortex of the canal wall, diversion of the canal, and darkening of the root. The sensitivities and specificities ranged from 14.6% to 68.3% and from 85.5% to 96.9%, respectively. The positive predictive values, calculated to factor a 1.1% prevalence of paresthesia, ranged from 3.6% to 10.9%, whereas the negative predictive values >99%. Conclusion. Panoramic radiography is an inadequate screening method for predicting IAN paresthesia after mandibular third molar removal. ( Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 294-302)