Removal of impacted mandibular third molars using an inward fragmentation technique (IFT) – Method and first results

• Published in: Journal of cranio-maxillo-facial surgery Vol. 42; no. 3; pp. 213 - 219
• Main Authors: Engelke, Wilfried, Beltrán, Víctor, Cantín, Mario, Choi, Eun-Jin, Navarro, Pablo, Fuentes, Ramón
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01-04-2014
• Subjects: Adolescent; Adult; Alveolar Process - pathology; Dentistry; Edema - etiology; Endoscopes; Endoscopy - methods; Female; Follow-Up Studies; Humans; Male; Mandible - pathology; Mandible - surgery; Mandibular Nerve - pathology; Mandibular third molars; Microsurgical removal; Minimally Invasive Surgical Procedures; Molar, Third - innervation; Molar, Third - surgery; Occlusal approach; Pain Measurement - methods; Pain, Postoperative - etiology; Postoperative Complications; Surgery; Surgical Flaps - surgery; Tooth Crown - surgery; Tooth Extraction - methods; Tooth Root - surgery; Tooth, Impacted - surgery; Treatment Outcome; Visual Analog Scale; Wound Healing - physiology; Young Adult; Endoscopes; Mandibular third molars; Microsurgical removal; Occlusal approach
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2013.05.003

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.