Análise dos fatores que influenciam o rompimento da cortical óssea lingual durante a extração de terceiros molares inferiores por meio da tomografia computadorizada de feixe cônico

Abstract

In surgeries for the extraction of lower third molars, several complications can occur, among them, the rupture of the lingual plate, whose occurrence can be influenced by local anatomical factors. This disruption can cause damage to the lingual nerve, with neurological consequences. The objective of the study was to determine the factors that influence lingual plate damage during the extraction of impacted mandibular third molars, through cone beam computed tomography (CBCT), taking into account the position of the third molars and the thickness of the lingual plate measured at different levels anatomical. 36 CBCT images of 35 mandibular third molars were used, obtained in two moments (Preoperative and 7 days later). In the preoperative images, 6 parameters were evaluated: lingual plate thickness, impaction depth, mesiodistal angulation, buccolingual angulation, lingual cortical morphology and topographic relationship between the root apex and the lingual cortical. In the postoperative images, the lingual plate was evaluated and classified as intact or ruptured. Statistical analysis to evaluate the influence of different variables on disruption of the lingual plate was performed using linear logistic regression. Of all the variables tested, only the thickness of the lingual plate measured at the level of the cementoenamel junction significantly influenced the occurrence of its disruption (p=0.007). It is concluded that the thickness of the lingual plate at the level of the cementoenamel junction should be taken into account during surgical planning, in order to avoid its rupture, and the importance of CBCT in surgical planning and diagnosis of complications has become clear.