AI in Surgical Extractions of Impacted Teeth

Nobody likes a surprise mid-surgery, especially when it comes to impacted teeth. Just when an oral surgeon thinks he has his way around, a minor apical curvature of a distal tooth root or a missed approximation of a nerve canal can become a roadblock to surgical extractions.

For years, 2D X-rays and later 3D-CBCT (Cone Beam Computed Tomography) scans have been the thumb rule for planning surgical extractions of impacted third molars and canines. With dental AI in place, routine 3D imaging offers precise, intricate and fast visualisation of dental structures. Planning extractions of complex extractions and impacted teeth with dental AI ensures optimized procedures and better patient outcomes.

Risks and Challenges in the Extraction of Impacted Teeth

Impacted teeth are those that have not fully erupted due to limited space, incorrect alignment, or obstruction by adjacent teeth.

Extraction of impacted teeth, or disimpaction, is a regular procedure that can become complex if unplanned. Multiple challenges develop, complicating the process and affecting patient recovery. Here are some of the most prevalent issues linked to the surgical extraction of impacted teeth:

• A complex, lengthy and traumatic procedure

Incomplete analysis of the exact tooth location, angulation and depth of impaction may lead to larger wounds, over-drilling of bone, and repeated tooth sectioning. With an approximate idea of the tooth, the dental surgeon may try several positions of the dental elevators and forceps. This increases the duration of the procedure, resulting in more stress on the tissues and bones. As a result, patients may endure substantial swelling, bruising, and discomfort during surgery, as well as a longer recovery time.

• Ulcers, blood loss, numbness or other postoperative complications

Ulcers from irritation, significant blood loss, temporary or permanent numbness caused by nerve injury, infection, swelling, and delayed recovery times are all possible postoperative effects of a lengthy, complex surgical tooth extraction.

• Nerve damage

Mandibular third molars are often located near the mandibular nerve, which controls sensation in the lower lip, chin, and tongue. Inaccurate surgeries can damage the nerve during the extraction, causing temporary or permanent numbness or tingling in these areas, known as paresthesia.

• Damage to the nearby teeth

Impacted teeth close to the adjacent tooth make positioning of dental instruments difficult. Without planning and mock surgeries, inadvertent loosening of neighbouring teeth, chipping or even fractures can happen during extraction [1].

Dental AI can Minimize Risks and Optimize Surgical Extraction of Impacted Teeth

Traditionally, treatment planning for impacted teeth was a manual process that relied heavily on the dentist’s experience and interpretation of available imaging. While experienced dentists can anticipate and manage potential complications, there is always some level of uncertainty. AI in dentistry helps mitigate them.

● Dental AI in Image Analysis

AI tools consolidate the information from 2D panoramic X-rays—OPGs (Orthopantomograph) and IOPARs (Intraoral periapical radiograph (IOPA)—and 3D CBCT scans to produce a detailed report. Two tools that are key to the process are:

• 3D reconstruction of the CBCT and panoramic views
• CBCT segmentation tool

Reconstruction tools use AI for the precise spatial arrangement of all anatomical structures, teeth, tooth roots, nerves, sinus cavities, blood vessels, etc. This helps the dentist to get an objective idea of the mutual arrangement of the impacted tooth and its related structures.

Additionally, the segmentation tool can delineate every different 3D component—bones, teeth, etc. Every segment can be individually exported via the AI tool by directly generating STL files from the DICOM data. They can be fed into Exocad software for surgical planning and more [2].

● Visualization Tools

Online 3D viewers in dental AI tools can create a multiplanar reconstruction of the impacted tooth, allowing the physician to rotate and position the viewing axes of the tooth as needed.

This is crucial to pre-surgical planning, intra-operative checks and patient education. Such visualisation tools are often accompanied by interactive tools like colourful marking and tracing of nerve canals, sinus linings, bone anatomy, etc. [3].

● Treatment Planning

AI can create highly tailored treatment regimens based on a variety of patient characteristics, including age, bone density, and overall dental health. For example, in teenagers, the alveolar bone of an impacted tooth may be more pliable, making extraction easier. AI can evaluate these aspects and recommend the best course of action [3].

● Predictive Risk Assessment

The complication rate after wisdom tooth extractions varies and can be as high as 30%, causing multiple postoperative follow-ups [4]. One of the most dreaded risks in the surgical removal of impacted teeth is inferior alveolar nerve damage in the mandible. This occurs in approximately 2% of all third molar extractions but can vary widely depending on the placement of the wisdom teeth and age [5].

The accuracy of dental AI in analysis and visualization offers a surgical roadmap with a better forecast of probable difficulties and risks. This enables dentists to perform extractions with more confidence and fewer surprises.

● Patient Education, Retention and Satisfaction

As mentioned, visualisation tools with detailed reports, tooth charts and 3D reconstructions can be mutually used for surgical understanding and patient orientation. Patients are genuinely impressed with the details of the treatment plan. Inquisitive and anxious patients feel comfortable knowing the nuances of the procedure and are not left to imagine the surgical possibilities surrounding impacted teeth. Together, they help in better patient conversions, retention, satisfaction and referrals.

Diagnocat AI—A Popular Tool for Extraction of Impacted Teeth

AI in dentistry allows in-depth analysis of simple yet technique-sensitive procedures like surgical extractions of impacted teeth. It contributes to all the three legs of surgical procedures—accurate diagnoses, streamlined treatment planning, and enhanced patient outcomes.

Diagnocat AI offers 4 tools that are popular in all oral and maxillofacial surgical procedures—from disimpactions to jaw surgeries. These include radiology reports, CBCT segmentation, cloud storage and viewer, and superimposition tools. Together with supporting case studies, the Diagnocat AI tools can transform surgical planning, reduce risks, speed procedures and reduce patient recovery time. Moreover, these tools are instrumental to predictive analysis and risk assessment can help dentists decide when it’s best to intervene. They help analyse the progression of the impacted tooth over time, the surgical risks involved and recommend whether monitoring or preemptive extraction is the best option for the patient.

References:

1. Choi JF, Chang P. Oral Surgery, Extraction of Unerupted Teeth. [Updated 2023 May 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK592391/
2. Swaity A, Elgarba BM, Morgan N, Ali S, Shujaat S, Borsci E, Chilvarquer I, Jacobs R. Deep learning driven segmentation of maxillary impacted canine on cone beam computed tomography images. Sci Rep. 2024 Jan 3;14(1):369. doi: 10.1038/s41598-023-49613-0. PMID: 38172136; PMCID: PMC10764895.
3. Orhan K, Bilgir E, Bayrakdar IS, Ezhov M, Gusarev M, Shumilov E. Evaluation of artificial intelligence for detecting impacted third molars on cone-beam computed tomography scans. Journal of Stomatology, Oral and Maxillofacial Surgery. 2021 Sep 1;122(4):333-7.
4. Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am. 2007 Feb;19(1):117-28, vii. doi: 10.1016/j.coms.2006.11.013. PMID: 18088870.
5. Vranckx M, Fieuws S, Jacobs R, Politis C. PROPHYLACTIC VS. SYMPTOMATIC THIRD MOLAR REMOVAL: EFFECTS ON PATIENT POSTOPERATIVE MORBIDITY. J Evid Based Dent Pract. 2021 Sep;21(3):101582. doi: 10.1016/j.jebdp.2021.101582. Epub 2021 Apr 28. PMID: 34479679.