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Preoperative risk assessment of neurosensory disturbances before third molar surgery is essential. Panoramic radiography is
widely accepted and used because of its
advantages (cost effectiveness and low
radiation levels).13 The values of different
high risk markers and specific signs have
been evaluated and discussed to some
extent. Darkening of third molar roots on
0901-5027/000001+06 $36.00/0
Key words: third molar; panoramic radiography; inferior alveolar nerve; darkening of the
root.
Accepted for publication 22 June 2012
# 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Szalma J, et al. Darkening of third molar roots on panoramic radiographs: is it really predominantly
thickening of the lingual cortex? Int J Oral Maxillofac Surg (2012), http://dx.doi.org/10.1016/j.ijom.2012.06.018
YIJOM-2463; No of Pages 6
Szalma et al.
Fig. 1. The occurrence of different aetiological factors resulting in darkening on panoramic radiographs, according to the authors observations.
Please cite this article in press as: Szalma J, et al. Darkening of third molar roots on panoramic radiographs: is it really predominantly
thickening of the lingual cortex? Int J Oral Maxillofac Surg (2012), http://dx.doi.org/10.1016/j.ijom.2012.06.018
YIJOM-2463; No of Pages 6
Statistical analysis
Both the intra- and inter-observer reliabilities were excellent in this study. There
were no statistical differences between the
Fig. 2. (a and b) 25-Year-old female patient with left lower impacted third molar. Darkening of the root (single darkening) developed because the
mesiobuccal root was curved and shorter than the mesiolingual root.
Fig. 3. (a) 36-Year-old female patient with left mandibular impacted third molar, with single darkening of the root. (b) The buccal and lingual
roots were superimposed. (c) Mesiodistal view of the tooth shows that the shorter buccal root explained the development of the darkening.
Please cite this article in press as: Szalma J, et al. Darkening of third molar roots on panoramic radiographs: is it really predominantly
thickening of the lingual cortex? Int J Oral Maxillofac Surg (2012), http://dx.doi.org/10.1016/j.ijom.2012.06.018
YIJOM-2463; No of Pages 6
Szalma et al.
Fig. 4. (a and b) Despite the notable groove on the lingual surface of the root (arrow), no darkening was seen at the expected height of the root in
the panoramic radiograph, supporting the hypothesis that grooves might be present without radiological consequences.
Fig. 5. (ac) Different appearances of intra- and inter-radicular grooves with the impression of the dental canal. In (c), the arrow indicates the
prepared cavity for improved retention for the Barry elevator. (d) The crop of the panoramic radiograph represents multiple darkening (darkening
with slight narrowing of the canal) of the root. (e) The exposed IAN was seen lingually (arrow). (f) A marked groove (almost a hook) was seen on
the lingual surface of the root.
Please cite this article in press as: Szalma J, et al. Darkening of third molar roots on panoramic radiographs: is it really predominantly
thickening of the lingual cortex? Int J Oral Maxillofac Surg (2012), http://dx.doi.org/10.1016/j.ijom.2012.06.018
YIJOM-2463; No of Pages 6
exposures (38.8%) representing IAC cortical wall deficiency in their study correlates with the present results, but Susarla
et al. did not publish any information on the
concurrent panoramic signs in that study.17
The present results indicate that grooving
of the root occurred more frequently
(37.4%) among darkening cases than indicated in the study by Tantanapornkul
et al.11 (20%), whereas it did not reach
hman
the frequency stated in the study by O
13
et al. (63%). In another 8.4% of the
darkening cases in the present study, IAN
exposure was present with IAC wall deficiency but without grooving of the root.
Additionally, special root conformation,
which imitated darkening of the root on
radiographs, had a notable 9.6% rate of
occurrence. Neither Mahasantipiya et al.
nor Tantanapornkul et al. had described
this as an possible alternative.11,14 Clinically proven lingual cortical thickening or
fenestration appeared in 26.5% of the present cases, which is approximately onethird of that concluded by Tantanapornkul
et al.11 according to their CT observations.
Fig. 6. (a) 27-Year-old female patient with impacted lower third molar with single darkening. (b) Note the exposed IAN on the lingual surface
(arrow). (c) A groove was observed on the lingual surface of the root tip (arrow). (d) The lingual cortical thickening is remarkable (arrow). The
combination of a missing canal wall, a groove on the root and a thicker lingual cortical wall resulted in the increased radiolucency.
Please cite this article in press as: Szalma J, et al. Darkening of third molar roots on panoramic radiographs: is it really predominantly
thickening of the lingual cortex? Int J Oral Maxillofac Surg (2012), http://dx.doi.org/10.1016/j.ijom.2012.06.018
YIJOM-2463; No of Pages 6
Szalma et al.
Funding
None.
Competing interests
None declared.
Ethical approval
Not required.
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Address:
Jozsef Szalma
Department of Oral and Maxillofacial
Surgery
University of Pecs
5 Dischka Gy Street
Pecs H-7621
Hungary
Tel: +36 72 535924;
Fax: +36 72 535905
E-mail: jozsef.szalma@aok.pte.hu
Please cite this article in press as: Szalma J, et al. Darkening of third molar roots on panoramic radiographs: is it really predominantly
thickening of the lingual cortex? Int J Oral Maxillofac Surg (2012), http://dx.doi.org/10.1016/j.ijom.2012.06.018