Removing High-Risk Impacted Mandibular Third Molars: A Surgical-Orthodontic Approach (original) (raw)
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Journal of Oral and Maxillofacial Surgery, 2007
Extraction of a lower third molar is among the most common oral surgical procedures. It can entail various complications; among these, the neurologic ones (paresthesias) are the most feared, because they are more likely to lead to legal disputes between surgeons and patients. Nerve damage resulting from the surgical procedure may be caused by either direct trauma of the lower alveolar nerve (more rarely of the lingual nerve) or indirect trauma due to nerve compression after edema or postextraction hematoma. This results in temporary or permanent paresthesias. The onset of such complications is affected by various factors, including the following: • Patient age. The older the patient, generally the greater the postextractive complications. 5 • Medical history. A positive medical history is associated with an increased risk of complications. • Level of tooth impaction. The risk of neurologic damage increases as the impaction becomes deeper. 1 • Tooth inclination. Neurologic complications are more frequent in vertical impactions. 1,6 • Root morphology. Roots with hooked apices are dangerous; most dangerous of all are roots fused together. 1 • Competency of the clinician. 1,7
Journal of Lumbini Medical College, 2020
Introduction: Third molar extractions are one of the most common reasons of injury to mandibular nerve and postoperative complications. Pre-operative assessment of pending doom is a must. In order to study the relations between change in Inferior Alveolar Canal (IAC) and Type, Class, and Level of impaction with radiographic root change of impacted third mandibular molar, we designed a study to assess the relationship of the mandibular canal to the roots of impacted third molar in reference to changes in roots and factors affecting it. Methods: This was a retrospective cross-sectional study wherein the panoramic radiographic records of subjects with impacted third molar were assessed for change in root and its correlation with change in IAC, Type, Class and Level of impacted mandibular third molar. Results: Roots of impacted third molar when in contact with IAC presented most often in our study subjects with the Darkening of roots in both sides {right side (16.79%) and left side (11....
BMC oral health, 2014
Preoperative radiographic examination of impacted mandibular third molars (IMTM) is essential to prevent inferior alveolar nerve injury during extraction. The purpose of this study was to evaluate the correlation between cone-beam computed tomography (CBCT) and digital panoramic radiography (DPR) findings in preoperative examination of IMTM. This retrospective study included 298 teeth in 191 individuals. The relationship between the inferior alveolar canal (IAC) and the IMTM (buccal, lingual, interradicular or inferior), the position of the IMTM with respect to the IAC (contact, no contact), the morphologic shape of the mandible in the IMTM region (round, lingual extended, lingual concave), the type of IMTM (vertical, horizontal or angular) and the number of roots of the IMTM were evaluated on CBCT images. DPR images were evaluated for the number of roots of the IMTM and for the most common radiographic findings indicating a relationship between the IAC and the IMTM (darkening of th...
Complication of mandibular third molars extraction: a case report
Médecine Buccale Chirurgie Buccale, 2012
Objective: the objective of this paper is to show through a clinical case that an adequate clinical and radiographic examination should be performed before third molar removal to avoid complications especially the displaced tooth. Methods: the authors present a case report of a submandibular displacement of a mandibular third molar during extraction. Results: after standard radiological examination and a computed tomography (CT-scan) surgery for retrieving the displaced tooth was performed under general anesthesia without difficulty. Conclusion: localization with CT-scan and proper surgical methods are the keys to retrieving the displaced tooth but we must to remind dentists on ways to prevent and manage this complication.
Journal of Babol University of Medical Sciences, 2016
BACKGROUND AND OBJECTIVE: Injury to the inferior alveolar nerve during extraction of mandibular third molars is one of the serious complications after surgery. Therefore, the precise localization of IAN in relation to the third molar is one of the critical issues before extraction of this tooth. The aim of this study was to evaluate the position of mandibular canal in the mandible and its relation to the roots of the third molar using cone-beam computed tomography (CBCT) in a selected Iranian population. METHODS: In this cross-sectional study, the CBCT images of 168 patients (214 mandibular third molars) were evaluated. The position of the mandibular canal in the mandible (lingual, central, buccal) and the position of the mandibular canal with respect to the root apex (lingually, centrally and buccally), were recorded. FINDINGS: Mandibular canals were located lingually in 68.5% of cases, centrally in 27.3% of cases, and buccally in 4.2% of cases(p<0.001). Also, of 355 third molar...
Dentomaxillofacial Radiology, 2017
Objectives: To find the differences between treatment decisions of lower impacted third molars among experts of oral and maxillofacial surgery according to panoramic radiographic and CBCT findings. Methods: A retrospective analysis of 62 panoramic radiographs and CBCT of lower third molars evaluated for treatment decisions by 9 independent experts of oral and maxillofacial surgery. Results: Differences in interpretation of the panoramic radiography were found between surgeons. The absence of radiological signs suspected for risk to the inferior alveolar nerve lead to the decision of extraction according to panoramic radiography without CBCT (p , 0.01). The presence of those signs lead to referral to CBCT by surgeons before treatment but did not change their decision. Conclusions: Treatment decision for surgical treatment of the lower third molar can be accepted without CBCT findings. The use of CBCT is popular before extraction of lower third molars. We found that it has a little effect on the treatment decision of the surgical intervention in comparison to panoramic radiography.
International Journal of Oral and Maxillofacial Surgery, 2009
This study investigated the diagnostic accuracy of cone beam computed tomography (CBCT) compared to panoramic radiography in determining the anatomical position of the impacted third molar in relation with the mandibular canal. The study sample comprised 53 third molars from 40 patients with an increased risk of inferior alveolar nerve (IAN) injury. The panoramic and CBCT features (predictive variables) were correlated with IAN exposure and injury (outcome variables). Sensitivity and specificity of modalities in predicting IAN exposure were compared. The IAN was exposed in 23 cases during third molar removal and injury occurred in 5 patients. No significant difference in sensitivity and specificity was found between both modalities in predicting IAN exposure. To date, lingual position of the mandibular canal was significantly associated with IAN injury. CBCT was not more accurate at predicting IAN exposure during third molar removal, however, did elucidate the 3D relationship of the third molar root to the mandibular canal; the coronal sections allowed a bucco-lingual appreciation of the mandibular canal to identify cases in which a lingually placed IAN is at risk during surgery. This observation dictates the surgical approach how to remove the third molar, so the IAN will not be subjected to pressure.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2003
We sought to evaluate the relationship between the mandibular third molar and the mandibular canal by using axial computed tomography with coronal and sagittal reconstruction for third molar surgery. Forty-seven impacted third molars in 41 patients were found in close association with the mandibular canal during a panoramic radiographic assessment. The relationship between the mandibular third molar and the mandibular canal was evaluated by using computed tomography and compared in terms of operative exposure of the inferior alveolar nerve and postoperative labial dysesthesia. Twenty-four (51%) mandibular canals were buccal relative to the third molar, 12 were lingual, 9 were inferior, and 2 were between roots. At the time of the surgical procedure, the inferior alveolar nerve was visible in 7 patients. Postoperative lower lip dysesthesia occurred in 1 patient whose mandibular canal was in the lingual position. Axial computed tomography with coronal and sagittal reconstruction provides useful information to surgeons regarding the relationship between the mandibular third molar and the mandibular canal.