Abstract
Background: The surgical removal of impacted mandibular molars represents one of the most prevalent procedures carried out by the oral and maxillofacial surgeon. Despite its prevalence, unusual impaction location of mandibular molars necessitates alternative extraction approaches. One of the methods described for extraction of deeply impacted molars is the bony lid approach which was first presented for surgical endodontic treatment of mandibular molars. The aim of this study was to evaluate the outcome of the bony lid approach in extracting mandibular molars. In addition, critical clinical key points, new aspects while performing this procedure, indications and contraindications are discussed. Materials and Methods: 9 patients were treated with the bony lid technique. A retrospective analysis of medical charts was conducted to evaluate the results of surgery. Results: The operative technique described in the article was successfully carried out in 12 cases of impacted mandibular molars. No incidence of permanent sensory deficit was recorded. In one patient, an infection mandated the removal of the bony lids. In all other cases the healing process was uneventful. Conclusion: The bony lid technique has many advantages over alternative extraction methods and should be considered as a treatment option in cases of critical proximity between an impacted tooth and the inferior alveolar nerve.
Highlights
IntroductionManagement of deeply impacted molars, unusual impaction locations and intimate proximity to the inferior alveolar nerve (IAN) mandates the surgeon to neglect the conventional approach
All patients presented with mandibular molars that were classified as type II with the inferior alveolar nerve (IAN) located on the lingual surface of the tooth (Figure 1(b), Figure 4)
In cases of deeply impacted mandibular molars, the surgeon is obligated to consider the variety of treatment options and select the most suitable technique which will enable a fast and effective treatment with the lowest morbidity
Summary
Management of deeply impacted molars, unusual impaction locations and intimate proximity to the inferior alveolar nerve (IAN) mandates the surgeon to neglect the conventional approach. In such cases, alternative techniques have been described, and include: coronectomy [5], sagittal split osteotomy (SSO) and extraoral approaches, each with its own advantages and complications [6]. One of the methods described for extraction of deeply impacted molars is the bony lid approach which was first presented for surgical endodontic treatment of mandibular molars. Conclusion: The bony lid technique has many advantages over alternative extraction methods and should be considered as a treatment option in cases of critical proximity between an impacted tooth and the inferior alveolar nerve
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