title: Removal of impacted mandibular third molars using an inward fragmentation technique (IFT) - Method and first results.
abstract: OBJECTIVE
  Conventional surgical extraction of impacted mandibular third molars (M3M) requires a lateral flap reflection in conjunction with lateral bone removal for outward mobilization of the tooth. The aim of this report is to outline a novel inward fragmentation technique (IFT) in conjunction with an occlusal miniflap approach to reduce the amount of bone removal to a minimum.
  
  
  METHODS
  Seventeen consecutive patients (7 men and 10 women; mean age 24.4 years, range 18-36 years) required the extraction of 21-impacted M3M with a close relationship to the inferior alveolar nerve (IAN). Occlusal miniflaps were used and only occlusal bone removal was performed to expose the M3M under endoscopic vision. A central space-making cavity was created followed by inward fragmentation and mobilization of the crown and subsequent root removal through the space created.
  
  
  RESULTS
  20 of 21 sites healed uneventfully, one late infection was observed, no permanent neurosensory lesion occurred. The mean preoperative buccal bone height was 15.5 (11-18) mm and the postoperative buccal bone height 14.7 (11-17) mm. On the 2nd day, the mean swelling level was 1.38 (0-2) on a 4 point scale, the pain level was 2.30 (0-5) on a 10 cm VAS, mean pain duration was 2.04 days.
  
  
  CONCLUSIONS
  An inward fragmentation technique allows preservation of >90% of the buccal bone height adjacent to mandibular third molars and may reduce postoperative morbidity without raising the risk of IAN lesions.
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Henning Schliephake), School of Dentistry, Georg-August-University, School of Dentistry, Göttingen, Germany. Electronic address: wengelke@med.uni-goettingen.de.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Engelke
authors.affiliation: Department of Adult Integral Dentistry (Head: Prof. Dr. Ramón Fuentes), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.
authors.forename: Víctor
authors.initials: V
authors.lastname: Beltrán
authors.affiliation: Department of Adult Integral Dentistry (Head: Prof. Dr. Ramón Fuentes), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile; Doctoral Program in Morphological Sciences, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile.
authors.forename: Mario
authors.initials: M
authors.lastname: Cantín
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Henning Schliephake), School of Dentistry, Georg-August-University, School of Dentistry, Göttingen, Germany.
authors.forename: Eun-Jin
authors.initials: EJ
authors.lastname: Choi
authors.affiliation: Department of Mathematics and Statistics, Universidad de La Frontera, Temuco, Chile.
authors.forename: Pablo
authors.initials: P
authors.lastname: Navarro
authors.affiliation: Department of Adult Integral Dentistry (Head: Prof. Dr. Ramón Fuentes), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.
authors.forename: Ramón
authors.initials: R
authors.lastname: Fuentes
mesh_terms: D000293:Adolescent; D000328:Adult; D000539:Alveolar Process / Q000473:pathology; D004487:Edema / Q000209:etiology; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008334:Mandible / Q000473:pathology / Q000601:surgery*; D008340:Mandibular Nerve / Q000473:pathology; D019060:Minimally Invasive Surgical Procedures; D008964:Molar, Third / Q000294:innervation / Q000601:surgery*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications; D013524:Surgical Flaps / Q000601:surgery; D019228:Tooth Crown / Q000601:surgery; D014081:Tooth Extraction / Q000379:methods*; D014092:Tooth Root / Q000601:surgery; D014095:Tooth, Impacted / Q000601:surgery*; D016896:Treatment Outcome; D064232:Visual Analog Scale; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
keywords: Endoscopes; Mandibular third molars; Microsurgical removal; Occlusal approach