The CBCT before removing a wisdom tooth is not a routine examination: it is needed when the root of the tooth approaches the nerve of the jaw or the maxillary sinuses. Without these signals, a well-read panoramic radiograph remains sufficient to plan the extraction.
For whom CBCT on wisdom teeth may be useful
Three-dimensional diagnosis with CBCT is indicated for adult patients with wisdom teeth (third molars) that are impacted or have difficulty erupting, especially lower wisdom teeth, when the root may be close to the nerve of the mandible, called the inferior alveolar canal. These patients have generally already undergone a panoramic radiograph, but the two-dimensional image leaves a specific question unanswered: where exactly does the nerve run, and how close is it to the root of the tooth to be removed?
The examination is also particularly useful when the lower wisdom tooth shows signs of resorption of the adjacent second molar, distal bone loss, or when the planning includes the option of coronectomy, i.e. the removal of only the crown with preservation of the roots to protect the nerve. In these cases an evaluation with advanced technology is an integral part of the route.
When the panoramic radiograph is already enough
Not all wisdom teeth require a three-dimensional examination. On the panoramic view, if the roots appear clearly separated from the mandibular canal and no critical overlaps are observed, the basic examination is already adequate to set up the extraction. The same applies to upper wisdom teeth without complex relationships with the maxillary sinus visible in two dimensions, and to cases of partial eruption without deep bone inclusion.
The operating principle is clear: CBCT is justified when it can change the clinical decision. If the panoramic radiograph already provides useful information, adding a three-dimensional examination is not beneficial and only increases the radiation dose. This is why in the practice we prescribe CBCT only after reading the signals on the panoramic radiograph and relating them to the overall clinical picture.
Radiographic signals that raise the priority of CBCT
The literature has identified some signals on the panoramic radiograph that are significantly associated with the absence of corticalization between the root of the wisdom tooth and the inferior alveolar canal on CBCT. These signs, described by Rood and Shehab, are six:
- interruption of the cortical white line of the canal;
- darkening of the root at the canal;
- darkening of the channel itself;
- root deviation;
- channel narrowing;
- channel deviation.
The presence of one or more of these signs makes further investigation with CBCT clinically justified. Their absence suggests that the root and canal are separate and supports proceeding with the panoramic radiograph alone. This helps avoid overprescribing three-dimensional examinations while identifying cases in which an in-depth view genuinely changes the surgical plan.
How we decide at Studio Buniato
The sequence at the practice is always the same. First comes the initial specialist consultation, with a medical history and assessment of an existing or newly taken panoramic radiograph. We then evaluate the radiographic signs described above. Only when it is actually indicated do we acquire a CBCT with our Planmeca equipment, using a volume focused on the area of interest to limit the radiation dose.
The report is read together with the patient, showing where the jaw nerve runs and how it relates to the roots of the tooth to be removed. When proximity risk is high, we openly discuss surgical alternatives, including coronectomy, and postoperative management scenarios. The decision takes into account the clinical risk, age and symptoms: CBCT does not automate the choice, it makes it more transparent and shared.
What changes in the surgical plan after the 3D exam
CBCT does not amplify risk: it stratifies it. A 2025 study of 115 lower wisdom teeth observed that, in the presence of a cortical defect of the lower alveolar canal visible on CBCT, intraoperative exposure of the nerve occurred in 73.9% of cases. The data does not mean that the injury is certain: it means that CBCT precisely identifies high-risk situations and allows you to prepare technically in a different way. The length of the cortical defect visible in 3D was correlated with nerve exposure, with a odds ratio of 1.38 for every additional 0.1 mm.
In practice, after an informative CBCT the plan can change in three directions: standard extraction with specific surgical precautions, targeted fragmentation of the root during surgery, or coronectomy with preservation of the roots when complete extraction would expose the nerve. The same logic applies when the 3D data is used to set a implant rehabilitation in the same region.
What risks does three-dimensional planning reduce
The main risks of lower wisdom tooth surgery are injury to the lower alveolar nerve, with alteration of sensitivity of the lip and chin, oro-antral communication for the upper wisdom teeth in close relationship with the maxillary sinuses, and post-extraction complications resulting from approximate planning.
A planning that integrates well-interpreted panoramic and targeted CBCT, when indicated, concretely reduces these risks: the surgeon knows in advance the precise point of proximity between the root and the nerve, chooses the least invasive technique possible and prepares instruments and operating times in a coherent manner. When the relationship is critical, he may propose a coronectomy instead of complete extraction. The approach does not guarantee zero risk, but takes the decision out of improvisation.
What to expect during the exam and afterwards
CBCT acquisition with Planmeca equipment requires a few seconds of scanning, standing, without contrast medium and with a field of view limited to the affected region, to keep the radiation dose proportionate to the clinical question. The exam is outpatient and immediately reportable: the patient does not add days of waiting to the procedure and can review the 3D image together with the clinician in the same session. The report enters directly into the surgical plan discussed in the office, with the same logic of precision applied in the treatments carried out at operating microscope.
In the course of time, a well-established three-dimensional planning reduces intraoperative variability, limits surgical times and makes post-extraction management more predictable. An extraction decided today on the basis of solid data limits neurological sequelae and surgical revisions, and protects the health of the adjacent teeth, in particular the second molar.
Frequently asked questions
I’ve already had a panoramic radiograph. Why add a CBCT scan?
The panoramic radiograph remains the starting point. CBCT is added only when the panoramic radiograph shows precise signals of proximity to the nerve or when other clinical elements require it. If there is no indication, it is not performed: the objective is to prescribe the test when it can change the surgical plan, not as an automatic step.
From the start, the doctor was very helpful and courteous and clearly explained the work he would need to do.
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I did not know Dr Buniato and found him through an internet search. My old bite splint had broken, and I was looking for a practice that used cutting-edge techniques to make a new one. From the start, the doctor was very helpful and courteous and clearly explained the work he would need to do. Once the splint had been made, we had to meet several times so that he could adjust it to fit my teeth as well as possible. Now I have a splint that does its job perfectly. Above all, I greatly appreciated his human warmth, helpfulness, courtesy, calm manner and ability to explain the various steps that would follow. The reception staff are excellent too. The practice is clean, modern and well cared for. What can I say: these days, a doctor like this is almost a rarity. So I recommend him and thank him sincerely.
Does CBCT expose you to more radiation than panoramic?
CBCT involves a higher dose than panoramic, but is performed with a field of view limited to the area to be investigated. For this reason it is prescribed only when the diagnostic benefit is clear and proportionate. The selection of volume and acquisition parameters is an integral part of the clinical decision.
He explains what he is doing and what you may feel before each step
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I’m writing a little more than I usually would because I know how difficult it can be to find a dentist you genuinely feel comfortable with — especially when you are looking for treatment abroad. I came to Turin for dental treatment and honestly could not be happier that I found Dr. Buniato.
What impressed me from the beginning was how thorough and transparent everything was. He takes the time to do a proper assessment, with detailed images and analysis, and then explains clearly what is going on, what the different options are, which one he recommends and what each option would cost. You are never left in the dark or simply expected to trust that someone knows what is best for you. You understand what is being done, why it is being done and what to expect.
That same care continues throughout the treatment. He explains what he is doing and what you may feel before each step, so you are never caught by surprise. You can tell that he is incredibly precise and genuinely cares about getting every detail right.
And the result exceeded my expectations. I had virtually no pain afterwards, despite expecting quite the opposite. The work looks excellent, but even more importantly, it feels completely natural. After dental work, there is usually some adjustment period — you notice that something has changed, or your bite may feel different. With Dr. Buniato, I had none of that. Everything felt completely natural from the moment I left the chair.
I was also genuinely impressed by the technical standard of the practice. The equipment and technology are on a level I have rarely seen, and it is clear that they are used with real expertise rather than simply being there for show.
The whole team is warm, attentive and professional, and you get the feeling that they are willing to take the time needed to do things properly.
I would genuinely recommend Dr. Buniato to anyone looking for excellent dental care in Turin. I’m very happy I found him and will definitely be back for my future treatment.
What is a coronectomy and when is it offered?
Coronectomy consists in removing only the crown of the wisdom tooth, leaving the roots in place, when these are too close to the nerve of the jaw. It is offered in selected cases, after a CBCT that documents the risk and after explicit informed consent that clarifies limits and follow-up.
attentive and always willing to explain every stage of treatment.
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I began treatment with Dr Gianluca Buniato to straighten my teeth as an adult — I am 40 — and I can say it was one of the best decisions I could have made. Thanks to a carefully planned course of orthodontic treatment lasting less than two years, I achieved results I would never have thought possible: my smile has changed completely and I finally feel confident showing it!
Dr Buniato is extremely precise, attentive and always willing to explain every stage of treatment. The entire team is also kind, welcoming and very well organised. The practice, on Corso Francia in Turin, is carefully designed down to the smallest detail and immediately gives you a sense of trust and calm.
Although I live quite far from the practice, the excellent reviews persuaded me to put my trust in the doctor, and I can confirm that it was the right choice.
I absolutely recommend this practice to anyone who wants to improve their smile with professionalism, technology and plenty of personal attention.
Are the exam and the extraction done on the same day?
The CBCT is a short, outpatient examination, which can also be performed before the operating session. The extraction is scheduled in a dedicated session. When the risk is high it is important not to compress the two phases into a single step and to provide a moment for shared reading of the report.
the reception team is well organised when it comes to information, appointments and email reminders for them.
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The practice has a very welcoming waiting room, and all the rooms are bright and clean. The staff are professional, and the reception team is well organised when it comes to information, appointments and email reminders for them. The dentists are professional and attentive to each patient’s particular sensitivities. In conclusion, I am fully satisfied with the treatment and the result achieved.
Can the risk to the jaw nerve be completely avoided?
No technique eliminates risk absolutely. However, a plan integrating a panoramic radiograph, clinical assessment and targeted CBCT allows the clinician to manage risk in an informed way and choose the most conservative surgical strategy for the individual case, reducing the probability of permanent sequelae.
although I am quite afraid of the dentist, I feel calm with him.
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I have known the Buniato dental practice for several years, after various experiences at other practices! I have always had a good experience: the doctor and his colleagues are knowledgeable, kind and precise. He has always advised me tactfully but professionally, and I must say that, although I am quite afraid of the dentist, I feel calm with him. He works with great attention to patients’ needs. Thank you again. Elisabetta
For a personalized assessment of your case, Dr. Buniato is available for an initial specialist visit with complete diagnostic analysis.
Sources
- Patel PS, Shah JS, Dudhia BB, Butala PB, Jani YV, Macwan RS. Comparison of panoramic radiograph and cone beam computed tomography findings for impacted mandibular third molar root and inferior alveolar nerve canal relation. Indian J Dent Res. 2020. DOI: 10.4103/ijdr.IJDR_540_18. PMID: 32246689.
- Barraclough J, Power A, Pattni A. Treatment Planning for Mandibular Third Molars. Dent Update. 2017;44(3):221. DOI: 10.12968/denu.2017.44.3.221. PMID: 29172329.
- Chen K, Chen Y, Chen P, Jiang J, Wang E, Guo C. Is cone beam computed tomography accurate in predicting inferior alveolar nerve exposure during mandibular third molar extraction? BMC Oral Health. 2025. DOI: 10.1186/s12903-025-05716-w. PMID: 40055692.
- Leung YY, Hung KF, Li DTS, Yeung AWK. Application of Cone Beam Computed Tomography in Risk Assessment of Lower Third Molar Surgery. Diagnostics (Basel). 2023;13(5):919. DOI: 10.3390/diagnostics13050919. PMID: 36900063.
- Weckx A, Agbaje JO, Sun Y, Jacobs R, Politis C. Visualization techniques of the inferior alveolar nerve (IAN): a narrative review. Surg Radiol Anat. 2016;38(1). DOI: 10.1007/s00276-015-1538-0. PMID: 26163825.
