title: Predictive Value of Panoramic Radiography for Injury of Inferior Alveolar Nerve After Mandibular Third Molar Surgery.
abstract: OBJECTIVE
  The purpose of the present systematic review was to assess the added value of panoramic radiography in predicting postoperative injury of the inferior alveolar nerve (IAN) in the decision-making before mandibular third molar (MM3) surgery.
  
  
  METHODS
  MEDLINE and EMBASE were searched electronically to identify the diagnostic accuracy of studies that had assessed the predictive value of 7 panoramic radiographic signs, including root-related signs (darkening of the root, deflection of the root, narrowing of the root, and dark and bifid apex of the root) and canal-related signs (interruption of the white line of the canal, diversion of the canal, and narrowing of the canal) for IAN injury after MM3 surgery.
  
  
  RESULTS
  A total of 8 studies qualified for the meta-analysis. The pooled sensitivity and specificity of the 7 signs ranged from 0.06 to 0.49 and 0.81 to 0.97, respectively. The area under the summary area under the receiver operating characteristic curve ranged from 0.42 to 0.89. The pooled positive predictive value (PPV) and negative predictive value (NPV) ranged from 7.5 to 26.6% and 95.9 to 97.7%, respectively. The added value of a positive sign for ruling in an IAN injury (PPV minus the prior probability) ranged from 3.4 to 22.2%. The added value of a negative sign for ruling out an IAN injury (NPV minus [1 minus the prior probability]) ranged from 0.1 to 2.2%.
  
  
  CONCLUSIONS
  For all 7 signs, the added value of panoramic radiography is too low to consider it appropriate for ruling out postoperative IAN in the decision-making before MM3 surgery. The added value of panoramic radiography for determining the presence of diversion of the canal, interruption of the white line of the canal, and darkening of the root can be considered sufficient for ruling in the risk of postoperative IAN injury in the decision-making before MM3 surgery.
authors.affiliation: PhD candidate, State Key Laboratory of Oral Disease and Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China; and Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands. Electronic address: naichuansu@hotmail.com.
authors.forename: Naichuan
authors.initials: N
authors.lastname: Su
authors.affiliation: Associate Professor, Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: Arjen
authors.initials: A
authors.lastname: van Wijk
authors.affiliation: Assistant Professor, Department of Oral Radiology, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: Berkhout
authors.affiliation: Associate Professor, Department of Oral Radiology, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Sanderink
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: De Lange
authors.affiliation: Professor, State Key Laboratory of Oral Disease and Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
authors.forename: Hang
authors.initials: H
authors.lastname: Wang
authors.affiliation: Professor, Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: Geert J M G
authors.initials: GJMG
authors.lastname: van der Heijden
mesh_terms: D006801:Humans; D008334:Mandible; D008340:Mandibular Nerve; D008964:Molar, Third / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011862:Radiography, Panoramic; D014081:Tooth Extraction; D014095:Tooth, Impacted / Q000601:surgery*; D061221:Trigeminal Nerve Injuries / Q000000981:diagnostic imaging*