Coronectomia em terceirosmolares inferiores: relato de dois casos / Coronectomy in inferior third molars: two cases case reports

A parestesia do nervo alveolar inferior, uma complicação decorrente de cirurgias de terceiros molares inferiores, é passível de acontecer principalmente quando sinais radiográficos indicam um íntimo contato das raízes com o canal da mandíbula. A tomografia computadorizada cone beam é o exame que confirma esse contato. Para estes casos, a coronectomia é uma opção cirúrgica, na qual é realizada a remoção apenas da porção coronária, com a manutenção das raízes localmente, minimizando, desta forma, o risco de parestesia. Objetivo: Apresentar o relato de dois casos clínicos de coronectomia no manejo de terceiros molares inferiores cuja radiografia panorâmica evidenciava íntima relação das raízes com o canal da mandíbula. Relato do caso: A técnica cirúrgica utilizada foi a mesma em ambos os casos. Sob anestesia local, realizou-se uma incisão tipo envelope, e o descolamento do retalho mucoperiostal. A osteotomia vestibular e distal foi realizada, expondo o dente ao nível da junção cemento-esmalte. Em seguida, iniciou-se a odontosecção, sendo realizada com uma extensão de 2/3 no sentido vestíbulo-lingual e 2 mm abaixo da junção cemento-esmalte; uma alavanca foi utilizada para separar a coroa das raízes. Realizou-se, por fim, o acabamento da superfície, deixando a superfície radicular 3 mm abaixo da crista óssea. Não houveram intercorrências trans ou pós-operatórias. Os pacientes permanecem sob acompanhamento radiográfico anual. Conclusão: A coronectomia é uma técnica eficaz, que reduz o risco de parestesia alveolar inferior, após a cirurgia de terceiros molares inferiores, cujas raízes estão próximas ao canal da mandíbula...

Oroantral communication is a pathological communication that occurs between the oral cavity and the maxillary sinus. When this communication suffers epithelialization it is called oroantral fistula. It can occur mainly after extraction of posterior maxillary teeth, due to the close relationship between their roots and the maxillary sinus floor. Aim: To present the surgical options for the treatment of oroantral communication and report a case of a large oroantral fistula, explaining the technique step. Case Report: Female patient female, 37-year-old, presented bucossinusal fistula in the left upper molars area and was surgically treated for its closure. Under local anesthesia an incision was made around the fistula, cutting epithelial tissue to allow the union of the wound edges, and it was sutured by layers: initially sinus mucosa with 4-0 catgut and then the gums, with nylon. The suture was removed 10 days later and by this time the complete closure of the fistula was observed. Conclusion: The decision of which treatment modality to use for oroantral communication is influenced by many factors, such as its size, the tissue conditions and the surgeon’s skills. The surgical technique presented in this case proved effective and easy to perform, with a confortable postoperative period for the patient and with no recurrence of the communication...

Endoscopically assisted removal of a lingually displaced third molar adjacent to the inferior alveolar nerve.

BACKGROUND: Osteotomy of impacted lower third molars still represents a major trauma because of periosteal flap preparation and buccal bone loss. We present a new occlusal flapless approach for the removal of lingually impacted lower third molars adjacent to the inferior alveolar nerve without lateral or lingual osteotomy. METHOD: After occlusal exposure under local anesthesia, visualization of the third molar region is obtained from a posterior perspective using support endoscopy. Under magnifying endoscopic visualization, the crown is removed using an inward fragmentation technique. After exposure of the furcation area, the roots are separated and removed via the occlusal cavity. CONCLUSIONS: Endoscopically assisted removal of mandibular third molars allows the maintenance of the adjacent bone structures and the integrity of the mandibular canal. It is valuable in complex anatomic sites in particular.

Correlation between radiographic signs of third molar proximity with inferior alveolar nerve and postoperative occurrence of neurosensory disorders: a prospective, double-blind study.

PURPOSE: To evaluate the interference of radiographic factors in the appearance of sensory deficit related to inferior alveolar nerve (IAN) after third molars (3Ms) removal. METHODS: A prospective, double-blind, observational, unicentric study was performed with 126 patients submitted to a surgical procedure of lower 3Ms removal in the period from March to October/2011. Collected data included gender, age, eruption stage of 3Ms, position/angle of 3Ms (Pell-Gregory and Winter classifications, respectively), presence/absence of radiographic signs of 3Ms proximity with the inferior alveolar canal and surgical technique. Occurrence evaluation of the IAN injury was performed on the seventh postoperative day through pin-prick, two-point discrimination and brush directional stroke tests. RESULTS: Predominant radiographic signs were: narrowing of the inferior alveolar canal (68.25%), darkening of root (46.82%) and diversion of the canal (31%). None of the patients presented sensory loss. Sixty-one (48.41%) of the cases had at least one or two radiographic signs of proximity with NAI. Forty-seven (37.3%) had 3 or more signs, and 18 (14.29%) did not have any radiographic signs of proximity to mandibular canal. CONCLUSION: There was not a positive correlation between presence of radiographic signs of 3Ms with IAN proximity and postoperative neurosensory disorders occurrence.

Correlation between radiographic signs of third molar proximity with inferior alveolar nerve and postoperative occurrence of neurosensory disorders: A prospective, double-blind study

PURPOSE: To evaluate the interference of radiographic factors in the appearance of sensory deficit related to inferior alveolar nerve (IAN) after third molars (3Ms) removal. METHODS: A prospective, double-blind, observational, unicentric study was performed with 126 patients submitted to a surgical procedure of lower 3Ms removal in the period from March to October/2011. Collected data included gender, age, eruption stage of 3Ms, position/angle of 3Ms (Pell-Gregory and Winter classifications, respectively), presence/absence of radiographic signs of 3Ms proximity with the inferior alveolar canal and surgical technique. Occurrence evaluation of the IAN injury was performed on the seventh postoperative day through pin-prick, two-point discrimination and brush directional stroke tests. RESULTS: Predominant radiographic signs were: narrowing of the inferior alveolar canal (68.25%), darkening of root (46.82%) and diversion of the canal (31%). None of the patients presented sensory loss. Sixty-one (48.41%) of the cases had at least one or two radiographic signs of proximity with NAI. Forty-seven (37.3%) had 3 or more signs, and 18 (14.29%) did not have any radiographic signs of proximity to mandibular canal. CONCLUSION: There was not a positive correlation between presence of radiographic signs of 3Ms with IAN proximity and postoperative neurosensory disorders occurrence.

Lower third molar region / Región del tercer molar inferior

The lower third molar region is an important region for the odontostomatological practice, since it presents a great amount of pathological processes related to the development and eruption of the third molar; thus having a considerable number of surgical interventions. Despite its importance, this region is not accounted for in anatomical terminology nor is it described in topographic anatomy; and in spite of the great number of studies that analyze the surgical anatomy of the region, it is necessary to systematize the description of its boundaries, planes, content, risk elements, anatomical repairs, etc.; therefore, the purpose of the present article is to review the modern concepts related to the surgical anatomy of the lower third molar region and to establish a description based on these concepts...

La región del tercer molar inferior es una región importante para la práctica odontoestomatológica, en ella se presenta una gran cantidad de procesos patológicos relacionados con el desarrollo y erupción del tercer molar, por lo que se practican un gran número de intervenciones quirúrgicas. No obstante su importancia, esta región no se encuentra considerada en la terminología anatómica ni descrita en la anatomía topográfica y a pesar de la gran cantidad de estudios que analizan la anatomía quirúrgica de la región, es necesario sistematizar la descripción de sus límites, planos, contenidos, elementos de riesgo, puntos de reparo, etc., es por ello que el propósito de este artículo es revisar los conceptos modernos relacionados con la anatomía quirúrgica de la región del tercer molar inferior y proponer una descripción basada en estos conceptos...

Influence of the tooth section technique in alveolar nerve damage after surgery of impacted lower third molars.

This study is a randomized control split-mouth non-blinded prospective trial, the aim of which was to evaluate clinically the frequency and type of injury to the inferior alveolar nerve (IAN) following mandibular third molar surgery using or not using the tooth section technique. The sample consisted of 50 lower third molars in 25 patients, in the control group the tooth section technique was not used, and it was used in the experimental group. The outcomes have shown a frequency of 8% of IAN injury for both groups (in both genders), and there were no statistically significant associations between the use of the tooth section technique and a diminished incidence of IAN injury or the presence of radiographic signs of a direct relationship between the tooth/nerve/mandibular canal and IAN injury. There was no association between deformities of the tip of dental needles and nerve injury. Temporary hypoesthesia and paresthesia were the commonest nerve injuries. All patients recovered from these injuries within six months.

Comparison of orthopantomographs and conventional tomography images for assessing the relationship between impacted lower third molars and the mandibular canal.

PURPOSE: A comparative analysis was made of the relationship between impacted lower third molars and the mandibular canal by means of orthopantomography and conventional mandibular tomography. Consideration was given to the association between the existence or absence of a close relationship according to gender, age, and tooth involved, as well as the resolution of the mandibular canal tomograph of the mesial and distal roots. MATERIALS AND METHODS: The sample consisted of 19 patients of both genders with impacted third molars that exhibited a close relationship between impacted lower third molars and the mandibular canal on the orthopantomograph. Thirty-one relationships were assessed, for each of which a conventional mandibular tomograph was requested. Cases were verified for a true relationship. All cases were appraised by the same radiologist. RESULTS: A close relationship with the mandibular canal was found on the tomograph in 77.4% of cases. The reported data showed that the most common relationship criterion was darkening of the roots (14 cases; 45.2%). A true relationship was confirmed on the tomograph in 92.1% of these cases. CONCLUSION: The presence of the radiographic sign of a close relationship found on the orthopantomograph represents, in most cases, a true relationship, requiring the classification of the type of radiographic sign to prevent injury to the nerve.