Extraction of impacted mandibular third molars in close proximity to the inferior alveolar canal with coronectomy-miniscrew traction to avoid nerve injury

Abstract

Abstract Objectives Extraction of impacted mandibular third molars (IMTMs) is the most common surgery in the Department of Oral and Maxillofacial Surgery. Inferior alveolar nerve (IAN) injury is a rare but severe complication, and the risk is significantly higher for IMTM near the inferior alveolar canal (IAC). The existing surgical method to extract such IMTMs is either not safe enough or is time-consuming. A better surgical design is needed. Materials and Methods From August 2019 to June 2022, 23 patients received treatment by Dr Zhao at Nanjing Stomatological Hospital, Medical School of Nanjing University, to extract their IMTMs and were diagnosed with IMTMs connecting the IAC. Due to high IAN injury risk, these patients undertook coronectomy-miniscrew traction to extract their IMTMs. Results The time between the two surgeries (time of miniscrew traction) was 32.65 ± 2.110 days, which was significantly lower than that of traditional orthodontic traction. No IAJ injury was observed with two-point discrimination testing or reported by patients during follow-up. Other complications such as severe swelling, severe bleeding, dry socket, and limited mouth opening were not observed. Postoperative pain was not significantly higher in the coronectomy-miniscrew traction group than in the traditional IMTM extraction group. Clinical Relevance: For IMTMs connecting the IAC that must be extracted, coronectomy-miniscrew traction is a novel approach to minimize IAN injury risks in a less time-consuming way with a lower possibility of complications.