A Prospective Observational Study on the Variables Affecting the Risk of Inferior Alveolar Nerve Damage During Lower Third Molar Surgery With Nerve/Root Proximity

Background. Maintenance of hard tissue in the case of impacted third molars (M3M) with close relationship to the mandibular canal is still a surgical challenge which may be overcome using the inward fragmentation technique. Methods. A consecutive case series of 12 patients required the extraction of 13 impacted M3M with a close relationship to the inferior alveolar nerve (IAN). Via occlusal miniflaps, M3M were exposed occlusal under endoscopic vision and removed by inward fragmentation. All patients received socket preservation with resorbable in situ hardening TCP particles to reduce the risk of pocket formation at the second molar. Results. All 13 sites healed uneventfully. Bone height was assessed using CBCT cross-sectional reformats pre- and 3 months postoperatively. The bone height was reduced by 1.54 mm lingual (SD 0.88), 2.91 mm central (SD 0.93), and 2.08 mm buccal (SD 1.09). Differences were significant at a 0.05% level. No tissue invagination at the extraction sites was observed. Conclusions. Major bone defects can be avoided safely using inward fragmentation surgery. The self-hardening bone filler appears to enhance the mineralization of the intrabony defect.

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Lingual flap retraction and prevention of lingual nerve damage associated with third molar surgery: A systematic review of the literature

Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology ◽

10.1067/moe.2001.114154 ◽

2001 ◽

Vol 91 (4) ◽

pp. 395-401 ◽

Cited By ~ 59

Author(s):

Jennifer W. Pichler ◽

O.Ross Beirne

Keyword(s):

Systematic Review ◽

Third Molar ◽

Nerve Damage ◽

Lingual Nerve ◽

Third Molar Surgery ◽

Review Of The Literature

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Panoramic versus CBCT used to reduce inferior alveolar nerve paresthesia after third molar extractions: a systematic review and meta-analysis

Dentomaxillofacial Radiology ◽

10.1259/dmfr.20190265 ◽

2020 ◽

Vol 49 (4) ◽

pp. 20190265

Author(s):

Nathalia Calzavara Del Lhano ◽

Rosangela Almeida Ribeiro ◽

Carolina Castro Martins ◽

Neuza Maria Souza Picorelli Assis ◽

Karina Lopes Devito

Keyword(s):

Systematic Review ◽

Panoramic Radiography ◽

Meta Analysis ◽

Inferior Alveolar Nerve ◽

Third Molar ◽

Risk Of Bias ◽

Third Molar Surgery ◽

Reference List ◽

Significant Heterogeneity ◽

Eligibility Criteria

Objectives: The aim of this systematic review was to verify whether CBCT in comparison with panoramic radiography reduced the cases of temporary paresthesias of the inferior alveolar nerve (IAN) associated with third molar extractions. Methods: The literature search included five databases (PubMed, Scopus, Web of Science, Cochrane, SciELO), in addition to gray literature and hand search of reference list of included studies. Two reviewers independently screened titles/abstracts, and full texts according to eligibility criteria, extracted data and evaluated risk of bias through Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB 2.0). Data were meta-analyzed by comparing CBCT versus panoramic radiographs for number of events (temporary paresthesia after third molar surgery). Fixed effect model was used for non-significant heterogeneity; relative risk (RR) and 95% CI were calculated. The certainty of evidence was evaluated by Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: Four randomized controlled trials (RCTs) were included in meta-analysis, and for the majority of domains they presented low risk of bias. RR was 1.23 (95% IC: 0.75–2.02; I2: 0%; p = 0.43) favouring panoramic radiography, but without significant effect, and with moderate certainty of evidence. Conclusions: We concluded that both interventions had a similar ability to reduce temporary paresthesia of the IAN after third molar surgery with moderate certainty of evidence.

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