Case of Two-stage Extraction of an Impacted Third Molar in Which the Mandibular Canal Passes through the Roots

Abstract

In cases where wisdom teeth approach the mandibular canal, attention must be paid to potential injury of the mandibular canal during extraction.
The present patient was a 61-year-old woman, in whom bony impaction of tooth 48 was causing pericoronitis. Computed tomography examination revealed that the inferior alveolar nerve was passing between the tooth roots.
We selected a two-stage tooth extraction method. As the first treatment step, we removed the crown of tooth 48. During the second treatment step, we confirmed slight movement of the root and an enlarged periodontal ligament cavity after a 6-month transition period. During extraction of the root, the periapical alveolar bone was first cut using an ultrasonic bone cutting instrument, and root partition was then performed. Surgical invasion into the inferior alveolar nerve and soft tissue was minimized through the use of an ultrasonic bone cutting instrument. In difficult extraction cases such as this, we believe that use of the two-stage extraction method and an ultrasonic bone cutting instrument is effective.