Wilfried Engelke1, Víctor Beltrán2, Mario Cantín3, Eun-Jin Choi4, Pablo Navarro5, Ramón Fuentes2. 1. 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. 2. Department of Adult Integral Dentistry (Head: Prof. Dr. Ramón Fuentes), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile. 3. 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. 4. Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Henning Schliephake), School of Dentistry, Georg-August-University, School of Dentistry, Göttingen, Germany. 5. Department of Mathematics and Statistics, Universidad de La Frontera, Temuco, Chile.
Abstract
PURPOSE: 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. PATIENTS AND 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. CONCLUSION: 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.
PURPOSE: 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. PATIENTS AND 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. CONCLUSION: 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.