The presurgical workup before third molar surgery: How much is enough?

Purpose: We sought to assess the indications for patient referral for computed tomography (CT) scan before third molar extraction. The influence of the data obtained from the CT scans on the surgical outcome and morbidity was also evaluated. Patients and Methods: There were 189 patients in the study (120 females and 69 males). Sixty-five patients were referred to receive CT and formed the study group. The remaining patients were included in the control group. Results: There were no statistically significant differences between the groups with regard to demographic data and tooth and root angulations. Indications for tooth extraction such as pain, swelling, pericoronitis, caries, endodontic problems, pathology, and prosthetic considerations were similar. The proximity of the tooth root to the inferior alveolar canal was the only statistically significant difference between the 2 groups (P <.001). The treatment plan outcomes for extraction, surgical extraction, and follow-up were comparable. The surgeon changed the initial decision from "surgical extraction" to "follow-up" in only 1 case after CT scan. Conclusions: Within the limits of the present study, it can be concluded that the main reason for CT scan referral is the proximity of the third molar root to the inferior alveolar canal (<1 mm). The data obtained from the CT scan had minimal effect on the final surgical outcome. The routine use of CT scan in cases of third molar extractions cannot be recommended. (C) 2004 American Association of Oral and Maxillofacial Surgeons.