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• W2170935002 abstract "I read with great interest the paper by Szalma et al.1Szalma J. Lempel E. Jeges S. Szabó G. Olasz L. The prognostic value of panoramic radiography of inferioralveolar nerve damage after mandibular third molar removal: retrospective study of 400 cases.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109: 294-302Google Scholar addressing the prognostic value of panoramic radiography in predicting inferior alveolar nerve (IAN) paresthesia before mandibular third molar removal. They concluded that the absence of any of the significant signs indicates a minimal chance for IAN paresthesia, whereas the presence of ≥1 signs on panoramic radiographs is not a reliable indication of possible paresthesia. Cone-beam computerized tomography (CBCT) is a diagnostically more accurate imaging modality used to determine the relationship of the IAN canal with the mandibular third molar.2Kositbowornchai S. Densiriaksorn W. Piumthanaroj P. Ability of two radiographic methods to identify the closeness between the mandibular third molar root and the inferior alveolar canal: a pilot study.Dentomaxillofac Radiol. 2010; 39: 79-84Google Scholar, 3Tantanapornkul W. Okouchi K. Fujiwara Y. Yamashiro M. Maruoka Y. Ohbayashi N. Kurabayashi T. A comparative study of cone-beam computed tomography and conventional panoramic radiography in assessing the topographic relationship between the mandibular canal and impacted third molars.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103: 253-259Google Scholar Owing to the cost, limited availability, and radiation dose, CBCT is usually not the radiographic technique of choice for a preoperative radiographic evaluation of lower third molars.2Kositbowornchai S. Densiriaksorn W. Piumthanaroj P. Ability of two radiographic methods to identify the closeness between the mandibular third molar root and the inferior alveolar canal: a pilot study.Dentomaxillofac Radiol. 2010; 39: 79-84Google Scholar I wish to highlight the use of the vertical tube shift intraoral radiographic technique as a cost-effective alternative method to determine the relationship between mandibular third molars and the IAN canal. Richard and Arbor's vertical tube shift technique/buccal object rule has been described in the literature, with two periapical radiographs been taken with a change in vertical x-ray beam projection angulation.2Kositbowornchai S. Densiriaksorn W. Piumthanaroj P. Ability of two radiographic methods to identify the closeness between the mandibular third molar root and the inferior alveolar canal: a pilot study.Dentomaxillofac Radiol. 2010; 39: 79-84Google Scholar, 4Richards A.G. Arbor A. Roentgenographic localization of the mandibular canal.J Oral Surg. 1957; 10: 325-329Google Scholar Changing the vertical angulation so that the beam is directed 20 degrees upward projects the image of the buccal object above that of the lingual object. If the upward angulation causes the image of the mesiobuccal root apex to appear above the mesiolingual root, it suggests that the mandibular canal lies to the lingual side of the tooth. If the inferior border of the mandibular canal appears above the apexes of all the roots, the mandibular canal lies to the buccal side of the root apices. If the inferior border of the mandibular canal lies above the apices of the mesiolingual and distal roots, it suggests that the canal lies to the buccal side of the apexes of the mesiolingual and distal roots. In addition, dilacerated roots or multiple curved roots can be better observed because of the improved capacity for interpretation. Panoramic radiography is generally advised as a routine radiograph for the determination of the anatomic position of the roots of the third molars in relation to the IAN. However, as a clinical application of the findings of the paper, I would suggest that if ≥1 predictive radiographic markers (as defined by Szalma et al.1Szalma J. Lempel E. Jeges S. Szabó G. Olasz L. The prognostic value of panoramic radiography of inferioralveolar nerve damage after mandibular third molar removal: retrospective study of 400 cases.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109: 294-302Google Scholar) are identified on a panoramic radiograph, the vertical tube shift intraoral technique should be applied. This is a simple and cost-effective technique, easily performed in dental clinic practice, the results of which are straightforwardly interpreted and obtained with minimum radiation exposure to the patient. Cone-beam CT should be used when a panoramic radiograph and the tube shift image do not provide sufficient clarity for interpretation. The prognostic value of panoramic radiography of inferior alveolar nerve damage after mandibular third molar removal: retrospective study of 400 casesOral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and EndodonticsVol. 109Issue 2PreviewThe aim of the study was to estimate the accuracy of panoramic radiographic signs predicting inferior alveolar nerve (IAN) paresthesia after lower third molar removal. Full-Text PDF In replyOral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and EndodonticsVol. 109Issue 6PreviewThe vertical tube shift technique mentioned by Dr. Jaju is an interesting alternative diagnostic method in the evaluation of the lower third molar root tip and inferior alveolar canal relationship. As the method describes, two periapical films with a change in vertical x-ray beam projection angulation are necessary to differentiate the dental canal and the third molar's roots. Nevertheless an important limitation should be mentioned: the patient's possible discomfort and nausea during the placement of the film or (even more) the sensor of digital intraoral x-ray devices. Full-Text PDF" @default.
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• W2170935002 date "2010-06-01" @default.
• W2170935002 modified "2023-09-25" @default.
• W2170935002 title "Localization of mandibular canal by buccal object rule" @default.
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