of Oral and Maxillofacial Surgeons

Purpose: Surgical removal of impacted third molars may be the most frequent procedure in oral surgery. Damage to the inferior alveolar nerve (IAN) is a typical complication of the procedure, with incidence rates reported at 1% to 22%. The aim of this study was to identify factors that lead to a higher risk of IAN impairment after surgery. Materials and Methods: In total 515 surgical third molar removals with 3-dimensional (3D) imaging before surgical removal were retrospectively evaluated for IAN impairment, in addition to 3D imaging signs that were supposed predictors for postoperative IAN disturbance. Influence of each predictor was evaluated in univariate and multivariate analyses and reported as odds ratio (OR) and 95% confidence interval (CI). Results: The overall IAN impairment rate in this study was 9.4%. Univariate analysis showed narrowing of the IAN canal (OR, 4.95; P Ͻ .0001), direct contact between the IAN and the root (OR, 5.05; P ϭ .0008), fully formed roots (OR, 4.36; P ϭ .045), an IAN lingual course with (OR, 6.64; P ϭ .0013) and without (OR, 2.72; P ϭ .007) perforation of the cortical plate, and an intraroot (OR, 9.96; P ϭ .003) position of the IAN as predictors of postoperative IAN impairment. Multivariate analysis showed narrowing of the IAN canal (adjusted OR, 3.69; 95% CI, 1.88 to 7.22; P ϭ .0001) and direct contact (adjusted OR, 3.10; 95% CI, 1.15 to 8.33; P ϭ .025) to be the strongest independent predictors. Conclusion: Three-dimensional imaging is useful for predicting the risk of postoperative IAN impairment before surgical removal of impacted lower third molars. The low IAN impairment rate seen in this study-compared with similar selected study groups in the literature of the era before 3D imagingindicates that the availability of 3D information is actually decreasing the risk for IAN impairment after lower third molar removal. © 2011 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 69:1867-1872, 2011 Surgical removal of impacted third molars is a regular, perhaps even the most frequent, procedure in oral and maxillofacial surgery. Damage to the inferior alveolar nerve (IAN) is a typical complication of the procedure. Susarla and Dodson 1 stated that nerve damage after third molar surgery occurs in 1% to 22% of surgeries. Different factors have been discussed in the literature as causes of nerve damage, eg, age of the patient, inexperience of the surgeon, or deep impaction