A novel surgical approach to impacted mandibular third molars to reduce the risk of paresthesia: a case series.
OBJECTIVE
Extraction of impacted mandibular third molars (M3s) may cause temporary or permanent neurosensorial disturbances of the inferior alveolar nerve (IAN). Although the incidence of this complication is low, a great range of variability has been reported in the literature. Several methods to reduce or eliminate this complication have been proposed, such as orthodontic-assisted extraction, extraction of the second molar, or intentional odontoectomy. The purpose of this series of cases is to present a novel approach for a riskless extraction of impacted mandibular M3s in contact with the IAN.


METHODS
Nine consecutive patients (4 male and 5 female; mean age 24.9 years, range 18-43 years) required the extraction of 10 horizontally or mesioangular impacted mandibular M3s. In all cases the M3 was in contact with the IAN with a high risk of nerve injury. A staged approached was proposed and accepted by the patients. This approach consisted in the surgical removal of the mesial portion of the anatomic crown to create adequate space for mesial M3 migration. After the migration of the M3 had taken place, the extraction could then be accomplished in a second surgical session minimizing neurological risks.


RESULTS
All M3s moved mesially within 6 months (mean 174.1 days, range 92-354 days) and could be successfully removed without any neurological consequences.


CONCLUSIONS
This technique may be considered as an alternative approach to the extraction of horizontally or mesioangular impacted M3s in proximity to the IAN.
Landi
Luca
L
Department of Prosthodontics, Catholic University of Sacred Heart, Rome, Italy. studio.ric@tin.it
Manicone
Paolo Francesco
PF
Piccinelli
Stefano
S
Raia
Alessandro
A
Raia
Roberto
R
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery*; D008340:Mandibular Nerve / Q000000981:diagnostic imaging; D008964:Molar, Third / Q000601:surgery*; D009407:Nerve Block; D010027:Osteotomy / Q000379:methods; D010292:Paresthesia / Q000517:prevention & control*; D010347:Patient Care Planning; D011183:Postoperative Complications / Q000517:prevention & control; D016300:Radiography, Bitewing; D012307:Risk Factors; D019227:Tooth Apex / Q000000981:diagnostic imaging; D019228:Tooth Crown / Q000601:surgery; D014081:Tooth Extraction / Q000379:methods*; D014085:Tooth Migration / Q000000981:diagnostic imaging; D014095:Tooth, Impacted / Q000601:surgery*; D061221:Trigeminal Nerve Injuries; D055815:Young Adult