Automatic detection and proximity quantification of inferior alveolar nerve and mandibular third molar on cone-beam computed tomography

Objectives During mandibular third molar (MTM) extraction surgery, preoperative analysis to quantify the proximity of the MTM to the surrounding inferior alveolar nerve (IAN) is essential to minimize the risk of IAN injury. This study aims to propose an automated tool to quantitatively measure the proximity of IAN and MTM in cone-beam computed tomography (CBCT) images. Materials and methods Using the dataset including 302 CBCT scans with 546 MTMs, a deep-learning-based network was developed to support the automatic detection of the IAN, MTM, and intersection region IR. To ensure accurate proximity detection, a distance detection algorithm and a volume measurement algorithm were also developed. Results The deep learning-based model showed encouraging segmentation accuracy of the target structures (Dice similarity coefficient: 0.9531 +/- 0.0145, IAN; 0.9832 +/- 0.0055, MTM; 0.8336 +/- 0.0746, IR). In addition, with the application of the developed algorithms, the distance between the IAN and MTM and the volume of the IR could be equivalently detected (90% confidence interval (CI): - 0.0345-0.0014 mm, distance; - 0.0155-0.0759 mm3, volume). The total time for the IAN, MTM, and IR segmentation was 2.96 +/- 0.11 s, while the accurate manual segmentation required 39.01 +/- 5.89 min. Conclusions This study presented a novel, fast, and accurate model for the detection and proximity quantification of the IAN and MTM on CBCT. Clinical relevance. This model illustrates that a deep learning network may assist surgeons in evaluating the risk of MTM extraction surgery by detecting the proximity of the IAN and MTM at a quantitative level that was previously unparalleled.