The assesment of relationship between the angulation of impacted mandibular third molar teeth and the thickness of lingual bone: A prospective clinical study

Background: Our purpose was to investigate the relationship between the angulation of mandibular third molars and the thickness of the lingual bone, which can affect the risk of lingual nerve damage during lower third molars surgical extraction. Material and Methods: This study consisted of 104 patients (42 males and 62 females), aged between 18-42 years (24.67 ± 6.11 years). Cone Beam Computed Tomography (CBCT) images were taken for preoperative assessment. The teeth were divided into four groups according to their positions: mesioangular, distoangular, vertical and horizontal. Lingual bone thickness around impacted teeth were measured at three points: cementoenamel junction (CEJ) of the mandibular second molar, mid-root of the impacted third molar, and apex of the impacted third molar root. Two predisposing factors of lingual nerve damage were recorded: lingual bone perforated by the impacted tooth and lingual bone thinner than 1 mm. Additionally, buccolingual angulations of the teeth in each group were measured. Impacted mandibular third molars were removed in usual way. One week after surgery, the patients were evaluated regarding lingual nerve paresthesia. Results: None of the 104 patients experienced paresthesia, including the ones who had teeth with close proximity with lingual nerve. The mean thickness of bone was 1.21±0.63 mm at CEJ of the second molar; 1.25±1.02 mm at the mid-root; and 1.06±1.31 mm at the apex. Horizontally impacted teeth had thinner lingual bone at mid-root level (p=0.016). Buccolingual angulated teeth were more often associated with perforated lingual bone (p=0.002). Buccolingual and mesial/distal angulation had negative correlation with lingual bone thickness (p<0.05). Conclusions: As the buccolingual and mesiodistal angulations increase, lingual bone thickness decreases. Horizontally impacted teeth seemed to compromise the integrity of the lingual bone more than impacted teeth in other positions. During the surgery, thin or perforated lingual bone may result in displacement of the impacted tooth lingually

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Local vs general anaesthesia in the development of neurosensory disturbances after mandibular third molars extraction: A retrospective study of 534 cases

BACKGROUND: The choice of the anaesthetic modality is one of the primary steps during planning of third molar surgery. The aim of the present study was to compare the risk of developing neurological injures of the inferior alveolar nerve (IAN) and lingual nerve (LN) in patients treated for wisdom teeth removal under general anaesthesia (GA) with a group treated under local anaesthesia (LA). MATERIAL AND METHODS: This is an observational retrospective, unicentric study; between September 2013 and September 2014, 534 patients underwent third molar surgery, 194 (36,3%) under GA and 340 (63,7%) under LA by the same oral surgeon. Difference in the incidence of IAN and LN injures between groups have been statistically analyzed with Fisher exact test and estimated odd ratio for development of such complications has been calculated. RESULTS: In GA patients the incidence of IAN and LN injures was 4.6% and 2.1%, respectively while in the LA group it was and 0.3% and 0%, respectively. A significant difference in IAN and LN involvement between groups was observed (IAN lesion: Fisher exact test, p < 0.001; LN lesions: Fisher exact test, p < 0.05). The estimated odd ratio for development of IAN injures after GA was 16.49 (95% CI: 2.07-131.19) and was not calculable for LN injures because no cases were observed in the LA group. CONCLUSIONS: Since GA is a perioperative variable that seems to significantly increase the risk of developing IAN and LN lesions, when treating patients that request GA, they must be adequately informed that an higher incidence of post-surgical sensory disturbances is expected

Lesión del nervio lingual tras exodoncias de terceros molares inferiores. Revisión sistemática / Damage to lingual nerve following extraction of third lower molars: Systematic review

Introducción: La lesión del nervio lingual en la cirugía del tercer molar inferior es una complicación relativamente frecuente. Por ello, el odontólogo debe conocer qué situaciones pueden influir sobre un aumento en la frecuencia de damnificación de dicho nervio. Objetivos: Establecer la frecuencia de lesión del nervio lingual tras exodoncias de terceros molares e identificar los principales factores de riesgo, así como su evolución y el periodo de tiempo donde se producen un mayor número de recuperaciones nerviosas. Material y método: Se ha realizado una revisión bibliográfica realizando una búsqueda en la base de datos de PubMed, obteniéndose un total de 24 artículos comprendidos entre los años 1988 y 2011. Las variables analizadas fueron la edad, sexo, posición del tercer molar, retracción del colgajo lingual, realización de ostectomía y odontosección, la técnica lingual split y el número de reparaciones nerviosas en función del tiempo transcurrido desde el inicio de la lesión. Resultados: La frecuencia obtenida de la lesión fue de un 3,54 % encontrándose relación estadísticamente significativa para las variables: posición, retracción del colgajo lingual, realización de ostectomías, la técnica lingual split. Por el contrario no se encontró relación para el sexo y la realización de odontosección. El 83,5% de los pacientes presentaban recuperación nerviosa a los tres meses del inicio de la lesión. Conclusión: La posición distoangular, la retracción del colgajo lingual, la realización de ostectomías y la técnica lingual split conllevan un aumento del riesgo de lesión del nervio lingual en la cirugía del tercer molar inferior. El mayor número de recuperaciones se presentan durante los tres primeros meses (AU)

Introduction: Damage to the lingual nerve during surgery on the third lower molar is a relatively frequent complication. The dentist should therefore be aware of what situations may influence an increase in the frequency of damage to that nerve. Aims: Establish the frequency of damage to the lingual nerve during extraction of third molars and identify the principal risk factors, as well as the evolution and the period of time within which most nervous recovery takes place. Material and Method: A bibliographic review was conducted with a PubMed search, obtaining a total of 24 articles published between 1988 and 2011. The variables analysed were age, sex, position of the third molar, lingual flap retraction, the carrying out of ostectomies and tooth sectioning, the lingual split technique and the number of recoveries of the nerve according to the time passed from when the damage occurred. Results: The frequency obtained for the damage was 3.54 %, with a statistically significant relationship being found for the following variables: position, retraction of the lingual flap, conducting ostectomies, the lingual split technique. On the contrary, no relationship was found for sex nor for tooth sectioning. 83.5% of the patients showed nervous recovery three months after the damage occurred. Conclusion: Distoangular position, retraction of the lingual flap, ostectomies and the lingual split technique carry an increased risk of damage to the lingual nerve in surgery on the third lower molar. The majority of cases presented recovery present within the first three months (AU)

Sensibility and taste alterations after impacted lower thirdmolar extractions. A prospective cohort study

Objectives: To determine the incidence, severity and duration of lingual tactile and gustatory function impairments after lower third molar removal.Study Design: Prospective cohort study with intra-subject measures of 16 patients undergoing lower third molar extractions. Sensibility and gustatory functions were evaluated in each subject preoperatively, one week and one month after the extraction, using Semmes-Weinstein monofilaments and 5 different concentrations of NaCl, respectively. Additionally, all patients filled a questionnaire to assess subjective perceptions.Results: Although patients did not perceive any sensibility impairments, a statistically significant decrease was detected when Semmes-Weinstein monofilaments. This alteration was present at one week after the surgical procedure and fully recovered one month after the extraction. There were no variations regarding the gustatory function. Conclusions: Lower third molar removal under local anesthesia may cause light lingual sensibility impairment. Most of these alterations remain undetected to patients. These lingual nerve injuries are present one week after the extraction and recover one month after surgery. The taste seems to remain unaffected after these procedures (AU)