Removal of third molars with sagittal split osteotomies: The case for

Abstract

r n general, with few exceptions, impacted third moars should be removed concomitant with sagittal split steotomies (SSOs) for patients undergoing mandibuar orthognathic surgery, because to do so limits risk, s cost efficient, minimizes unwanted postsurgical onsequences, and provides a reliable, deft means by hich planned surgery can be accomplished. Some authors have recommended that removal of mpacted mandibular third molars be completed at east 6 months before SSO because it is purported that he presence of the impacted third molar tooth comromises the bony architecture of the mandible such hat there is increased incidence of intraoperative andibular fractures.1-5 Currently, there are no data hat support this practice, as we shall see later. Ineed, at least 2 publications suggest that, regardless of he need for orthognathic correction, SSO is a good ethod for removal of very deeply located impacted andibular teeth.6,7 Surgical technique is important when performing emoval of impacted third molars concomitant with SO. Our preferred SSO technique has been previusly described,8 and more recently reiterated by alagoni and Stella.9 When impacted third molars are resent, cuts are performed through the greater sagttal length of the impacted third molar tooth during he sagittal osteotomy (Fig 1). The sagittal split is initiated with a flat blade spatula ollowed by the use of Smith and Tessier spreaders, espectively. No malleting of a chisel is used in any ase. Completion of the split is accomplished superonferiorly, not anteroposteriorly, because the last oint of osseous resistance is usually encountered on he lingual cortex below the entrance of the inferior lveolar nerve (IAN). Fixation is accomplished using late and unicortical screw fixation of the osteotomy