Decortication of Inferior Alveolar Canal in Elderly Population: A Cone Beam Computed Tomography Study. -

Purpose: This study assessed the levels of cortication of the inferior alveolar canal (IAC) in different age groups on Cone Beam Computed Tomography (CBCT) scans. Materials and Methods: Retrospective study of 100 mandibular CBCT scans having second premolar, first molar and second molar, were assessed by 3 experienced oral radiologists. Fifty male and 50 female scans were divided into 3 age groups. Levels of decortication was studied in the region of second premolar, first molar and second molar. The cortication was scored as grades 1 for 0% to 25% cortication, 2 for 26% to 50% cortication, 3 for 51% to 75% cortication, and 4 for 76% to 100% cortication according to the extent of visibility of IAC. At the end of the session all observers arrived at a mutual consensus score which was then used for analysis. Results were analysed using chi-square and kappa test. Results: With increasing age especially after 50 years of age, the IAC gradually shifts from good cortication (scores 1 and 2) to poor cortication (scores 3 and 4). Gender analysis showed no statistical significance, however elderly females show more decortication compared to elderly males. Inter-observer reliability (Kappa: 0.72), indicated substantial agreement. Conclusion: Absence of cortication could lead to error in selecting the length of the implant or planning other surgeries in this region, subsequently injuring the mandibular nerve and affecting quality of life. Clinicians should therefore be judicious when planning surgeries in the mandibular second premolar to second molar region to avoid injuring the IAC contents.