FEATURES OF MINIMALLY INVASIVE SURGICAL INTERVENTIONS IN ATYPICAL REMOVAL OF LOWER THIRD MOLARS UNDER DIFFICULT ANATOMICAL CONDITIONS
DOI:
https://doi.org/10.32782/2786-7684/2025-3-1Keywords:
mandible, mandibular molars, lower third molar, retention, treatmentAbstract
Introduction. The problem of surgical treatment of impacted and dystopic lower third molars does not lose its relevance in both clinical and social aspects. One of the most unfavorable situations is their anatomical proximity to the mandibular canal, which causes the risk of iatrogenic damage to the inferior alveolar nerve. The situation is especially dangerous when the root apex covers the lumen of the canal, which is clearly determined by computed tomography. To reduce the risk of damage to nerve structures, methods of coronectomy and staged removal are proposed. The aim is to evaluate the clinical outcomes of coronectomy in patients with a high probability of inferior alveolar nerve involvement, using clinical and radiographic monitoring over a two-year period. Materials and Methods. The study included 36 patients with retention and dystopia of the mandibular third molars. Of these, 32 patients were determined to have a high risk of damage to the inferior alveolar nerve (IAN), aged 20 to 35 years. The Pederson complexity index using the Winter classification was taken into account. Further observation for 24 months demonstrated the absence of persistent neurological complications and a minimal number of intra- and postoperative complications (temporary paresthesia, bleeding, partial root mobilization). The results. After the coronectomy, no damage to the lingual nerve was recorded in the patients, and no need for reoperation was observed. However, in 4 patients, during the coronectomy, an unsuccessful attempt was made to mobilize the roots during the intervention, with their subsequent removal; 2 patients had severe bleeding during the intervention, and in 2 more: temporary paresthesia of the lingual nerve. Conclusion. The coronectomy technique is a safe and clinically justified approach in the treatment of impacted lower third molars under conditions of high risk of damage to nerve structures.
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