title: Pericoronal ostectomy: an alternative surgical technique for management of mandibular third molars in close proximity to the inferior alveolar nerve.
abstract: OBJECTIVE
  Close proximity of the inferior alveolar nerve (IAN) to mandibular third molars (MTMs) may result in nerve injury during the extraction of third molars. Alternative surgical techniques, such as coronectomy, have been suggested to decrease this risk. This study examined a new alternative technique, the pericoronal ostectomy (PO), that is intended to decrease IAN injury in high-risk cases.
  
  
  METHODS
  This prospective clinical cohort study consisted of 14 patients with 17 MTMs in close relation to the IAN. All patients were subjected to 2- and 3-dimensional preoperative radiographic evaluations. Selected patients with mesioangular and vertical bone impactions were treated by the staged PO technique. An institutional review board approval from the University of the Pacific was given to this study.
  
  
  RESULTS
  Because of the PO procedure, all 17 high-risk MTMs in the study erupted to a more occlusal position away from the danger zone of the IAN and were eventually removed (mean distance of eruption, 2.0 mm). Three patients reported a transient neurosensory deficit, 2 with the IAN and 1 with a lingual nerve. All 3 had a full resolution of symptoms within 3 months of the postoperative period.
  
  
  CONCLUSIONS
  The PO technique appears to be an additional viable alternative technique to extraction of MTMs in intimate proximity to the IAN.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, USA. Tolstunov@yahoo.com
authors.forename: Len
authors.initials: L
authors.lastname: Tolstunov
authors.forename: Bahram
authors.initials: B
authors.lastname: Javid
authors.forename: Lance
authors.initials: L
authors.lastname: Keyes
authors.forename: Anders
authors.initials: A
authors.lastname: Nattestad
mesh_terms: D000328:Adult; D000541:Alveolectomy / Q000379:methods*; D015331:Cohort Studies; D054893:Cone-Beam Computed Tomography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007431:Intraoperative Complications / Q000517:prevention & control; D061222:Lingual Nerve Injuries; D008297:Male; D008334:Mandible / Q000294:innervation / Q000601:surgery*; D008340:Mandibular Nerve / Q000000981:diagnostic imaging*; D008875:Middle Aged; D008964:Molar, Third / Q000294:innervation / Q000601:surgery*; D010292:Paresthesia / Q000209:etiology; D010497:Pericoronitis / Q000601:surgery; D011446:Prospective Studies; D011862:Radiography, Panoramic; D013524:Surgical Flaps; D019228:Tooth Crown / Q000601:surgery; D014078:Tooth Eruption / Q000502:physiology; D014081:Tooth Extraction; D014095:Tooth, Impacted / Q000145:classification / Q000601:surgery*; D061221:Trigeminal Nerve Injuries; D055815:Young Adult