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Piezosurgery for the Lingual Split Technique in Lingual Positioned Impacted Mandibular Third Molar Removal

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this study was to evaluate the effect and safety of lingual split technique using piezosurgery for the extraction of lingual positioned impacted mandibular 3rd molars with the goal of proposing a more minimally invasive choice for this common surgery.

Eighty-nine consecutive patients with 110 lingual positioned impacted mandibular 3rd molars requiring extraction were performed the lingual split technique using piezosurgery. One sagittal osteotomy line and 2 transverse osteotomy line were designed for lingual and occlusal bone removal. The success rate, operative time, postoperative outcome, and major complications (including nerve injury, mandible fracture, severe hematoma or edema, and severe pyogenic infection) were documented and analyzed.

All impacted mandibular 3rd molars were successfully removed (110/110). The average time of operation was 14.6 minutes (ranged from 7 to 28 minutes). One hundred and seven extraction sites (97.3%) were primary healing. Pain, mouth opening, swelling, and PoSSe scores on postoperative 7-day were 0.34 ± 0.63, 3.88 ± 0.66(cm), 2.4 ± 0.2(cm), and 23.7 ± 5.9, respectively. There were 6 cases (5.5%) had lingual nerve disturbance and 3 cases (2.7%) developed inferior alveolar nerve impairment, and achieved full recovery within 2 months by neurotrophic drug treatment.

Our study suggested piezosurgery for lingual split technique provided an effective way for the extraction of lingual positioned and deeply impacted mandibular 3rd molar.

No MeSH data available.


Tooth was delivered in lingual direction after bone removal.
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Figure 3: Tooth was delivered in lingual direction after bone removal.

Mentions: All patients were operated by the same surgeon under local anesthesia with 2% lidocaine. A mouth prop was put into the patient's mouth on the other side to ensure the mandible was adequately supported. The flap involved a sulcular incision from the mesial aspect of the 2nd mandibular molar and a distal relieving incision along the external oblique ridge to the anterior border of the ramus.8 For fully impacted teeth, the incision was extended to the 1st molar for greater access. After a full thickness flap was elevated, a piezosurgical device (Silfradent, Italy) was used to cut a precisely defined bony window. Cutting of bone and tooth was continuously accompanied by copious irrigation with chilled saline solution. When cutting and loosening of the alveolar bone, a curved periosteal elevator was placed on the lingual bone to improve exposure of the surgical field, to protect the lingual nerve, and to prevent the 3rd molar slipping accidentally into the lingual soft tissue4 (Figure 2). After the alveolar bone was removed by a periosteal detacher, the tooth was exposed and delivered in distolingual direction by inserting a straight elevator (Figure 3). No drainage was adopted in any cases. The extraction socket was debrided and filled with colloidal silver (Gelatamp, Germany). All extraction sockets were closed by interrupted 4/0 absorbable silk (Covidien, US) sutures.


Piezosurgery for the Lingual Split Technique in Lingual Positioned Impacted Mandibular Third Molar Removal
Tooth was delivered in lingual direction after bone removal.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998409&req=5

Figure 3: Tooth was delivered in lingual direction after bone removal.
Mentions: All patients were operated by the same surgeon under local anesthesia with 2% lidocaine. A mouth prop was put into the patient's mouth on the other side to ensure the mandible was adequately supported. The flap involved a sulcular incision from the mesial aspect of the 2nd mandibular molar and a distal relieving incision along the external oblique ridge to the anterior border of the ramus.8 For fully impacted teeth, the incision was extended to the 1st molar for greater access. After a full thickness flap was elevated, a piezosurgical device (Silfradent, Italy) was used to cut a precisely defined bony window. Cutting of bone and tooth was continuously accompanied by copious irrigation with chilled saline solution. When cutting and loosening of the alveolar bone, a curved periosteal elevator was placed on the lingual bone to improve exposure of the surgical field, to protect the lingual nerve, and to prevent the 3rd molar slipping accidentally into the lingual soft tissue4 (Figure 2). After the alveolar bone was removed by a periosteal detacher, the tooth was exposed and delivered in distolingual direction by inserting a straight elevator (Figure 3). No drainage was adopted in any cases. The extraction socket was debrided and filled with colloidal silver (Gelatamp, Germany). All extraction sockets were closed by interrupted 4/0 absorbable silk (Covidien, US) sutures.

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this study was to evaluate the effect and safety of lingual split technique using piezosurgery for the extraction of lingual positioned impacted mandibular 3rd molars with the goal of proposing a more minimally invasive choice for this common surgery.

Eighty-nine consecutive patients with 110 lingual positioned impacted mandibular 3rd molars requiring extraction were performed the lingual split technique using piezosurgery. One sagittal osteotomy line and 2 transverse osteotomy line were designed for lingual and occlusal bone removal. The success rate, operative time, postoperative outcome, and major complications (including nerve injury, mandible fracture, severe hematoma or edema, and severe pyogenic infection) were documented and analyzed.

All impacted mandibular 3rd molars were successfully removed (110/110). The average time of operation was 14.6 minutes (ranged from 7 to 28 minutes). One hundred and seven extraction sites (97.3%) were primary healing. Pain, mouth opening, swelling, and PoSSe scores on postoperative 7-day were 0.34 ± 0.63, 3.88 ± 0.66(cm), 2.4 ± 0.2(cm), and 23.7 ± 5.9, respectively. There were 6 cases (5.5%) had lingual nerve disturbance and 3 cases (2.7%) developed inferior alveolar nerve impairment, and achieved full recovery within 2 months by neurotrophic drug treatment.

Our study suggested piezosurgery for lingual split technique provided an effective way for the extraction of lingual positioned and deeply impacted mandibular 3rd molar.

No MeSH data available.