I. Are the results valid?
Qn 1. The participating patients did not present a diagnostic dilemma since the study successfully diagnosed patients based on the two stated criteria. The first was the presence or absence of one or more five panoramic radio signs that indicate an increased risk of injury, and the second was the surgeon’s interpretation of the results.
Qn 2. The investigators did compare the test to an appropriate reference standard. The aim of the research did not need the authors to compare with the reference standard. The aims were to estimate IAN exposure/injury after surgery, the association between the two predictor variables and sensitivities and specificities of the test (Sedaghatfar et al., 2005). Moreover, their hypothesis was to test the association between positive panoramic radiographic signs and increased risks for IAN nerve exposure after M3 extraction.
Qn 3. The two surgeons interpreting the test and reference standard were blinded to each other’s results regarding IAN exposure. For the maintenance of blindmess, each surgeon evaluated the patients of the other surgeons for the risk of IAN exposure based on the findings and number of panoramic radiographs signs.
Qn 4. The investigators performed the same reference standard for all patients regardless of the results of the test under investigation. The application of the reference standard to all the patients was to ensure accurate findings in the detection of either the five panoramic signs and the surgeon’s interpretation of the results.
II. What are the Results?
Qn 1. The likelihood ratios associated with the range of possible test results were the relative risk ratio. The ratio was calculated for each of the five panoramic predicts signs to predict their likelihood. Risk ratios were also calculated for the presence of 1 to 5 of the number of radiographic signs present for IAN exposure and IAN non-exposure.
III. How can I apply the results to my patient care?
Qn 1. The findings of the study could be reproduced and interpreted in my setting. However, it is rare to rely on only a (one) isolated findings to make a clinical decision. In the assessment of the risk of IAN injury after M2 extraction, the clinicians usually incorporated multiple radiographic findings when deicing whether the risk of exposure is higher or lower.
Qn 2. The results are applicable to the patients in my practice my practice. The results of the study confirm the clinical impression that the number of radiographic panoramic signs correlate with the likelihood of a nerve exposure occurring during extraction. Thus, the higher the number of radiographic signs, the higher the risk of nerve exposure during M3 extraction.
Qn 3. The results will not change my management strategy. Although the results confirm that the more the presence of radiographic signs, the higher the likelihood of IAN exposure, it is also important to consider both the presence and the absence of radiographic signs. The absence of radiographic signs is also important in deciding about the risk of IAN exposure. Thus, together with the presence of the signs might improve prediction.
Qn 4. The results of the study does not mean that patients will be better off conmpared to before the study. The test is not an original finding but a confirmation of t previous findings of the predictive value of the presence or absence of panoramic signs as a predictor of IAN exposure after M3 extraction (Monaco et al., 2004). Moreover, the interpretation of the findings is challenging in a clinical setting, because negative radiographic findings, the risk of IAN exposure and associated IAN injury are very low.
Monaco, G., Montevecchi, M., Bonetti, G. A., Gatto, M. R. A., & Checchi, L. (2004). Reliability of panoramic radiography in evaluating the topographic relationship between the mandibular canal and impacted third molars. The Journal of the American Dental Association, 135(3), 312-318.
Sedaghatfar, M., August, M. A., & Dodson, T. B. (2005). Panoramic radiographic findings as predictors of inferior alveolar nerve exposure following third molar extraction. Journal of oral and maxillofacial surgery, 63(1), 3-7.