Keywords
How to Cite
Abstract
Objective: To evaluate anatomical risk factors associated with impacted mandibular third molars using orthopantomogram (OPG) and cone beam computed tomography (CBCT), and to determine the correlation between panoramic radiographic signs and CBCT-defined high-risk anatomical relationships.Materials and Methods: This cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery, MTI–Khyber College of Dentistry, Peshawar, over 12 months. A total of 180 impacted mandibular third molars from patients aged ≥18 years who underwent both OPG and CBCT were included. Panoramic radiographs were assessed for classical radiographic signs indicating proximity to the inferior alveolar canal, while CBCT scans evaluated canal position, cortical integrity, and root–canal relationship. Statistical analysis was performed using SPSS version 25.Results:The mean age of patients was 27.99 ± 6.33 years, with slight male predominance. Mesioangular impaction was the most common pattern. Darkening of roots was the most frequent panoramic sign. CBCT demonstrated a high-risk anatomical relationship in 45% of cases. Among panoramic findings, narrowing of the inferior alveolar canal showed a significant association with high-risk CBCT findings and was identified as an independent predictor on logistic regression analysis. However, its diagnostic accuracy remained low.Conclusion: Panoramic radiographic findings alone are insufficient for reliable prediction of high-risk anatomical relationships between impacted mandibular third molars and the inferior alveolar canal. CBCT provides superior anatomical assessment and should be selectively used in cases with suspicious panoramic findings to improve surgical planning and reduce the risk of inferior alveolar nerve injury.