An Illustrative Guide to Incidental Findings on Small Volume Cone Beam CT in The Mandibular Third Molar Region: Is There More Than What Meets The Eye?

Abstract

Background: Cone Beam CT (CBCT) is widely used to plan mandibular third molar (M3M) surgery. Primarily, it establishes the position and dimensions of the inferior dental canal, tooth/root morphology and associated pathology. Imaging often reveals incidental findings (IFs) which refer to occult features discovered when evaluating radiographs taken for another purpose. Aim(s): To establish the frequency and nature of IFs on small volume CBCTs in the M3M region and their effect on patient management. Method(s): 125 small volume (5x5) CBCTs of the M3M region, formally reported by consultant dental and maxillofacial radiologists, were retrospectively analysed. The following was recorded: type and frequency of IF, and recommended interventions. Result(s): Examples of IFs including periapical pathology, hypercementosis, bone pathology, resorption, caries and anatomical variants not apparent on plain film imaging were found on over 75% of the 125 CBCTs analysed. 60% required further management, including modification of treatment plan, recommendations to the original referrer (e.g. caries management) and onward referral to allied specialties. Discussion/Conclusions: IFs are readily visible on CBCTs and may be innocuous and some may require additional intervention. Exposure of anatomical areas beyond the dentoalveolar region, such as the airway and cervical spine, can be beyond the expertise of dentists. The correct field of view, patient positioning and access to specialised report networks should be available. Communicating IFs and their subsequent recommendations forms an important aspect of a patient's care plan. The increased use of CBCT imaging may correlate with the increased number of IFs.Copyright © 2025