Traditional vs Orthodontic Extraction of Impacted Teeth Related to the Inferior Alveolar Nerve

Marmara University46 enrolled

Overview

The aim of this clinical study was to compare the effects of traditional and orthodontic extraction methods on postoperative nerve damage in impacted third molars associated with the inferior alveolar nerve. The main question it aims to answer is: -Does the orthodontic extraction method reduce the risk of nerve injury compared to traditional extraction? Participants will: * undergo either traditional or orthodontic extraction * be monitored for postoperative paresthesia. Researchers will compare traditional and orthodontic extraction methods to see if extraction methods affect postoperative nerve damage.

The extraction of an impacted mandibular third molar is one of the most frequently performed procedures by oral and maxillofacial surgeons. The close anatomical relationship between the root of an impacted mandibular third molar and the inferior alveolar nerve may result in inferior alveolar nerve damage. The incidence of inferior alveolar nerve injury during the removal of an impacted mandibular third molar ranges from 0.35% to 8.4%. In addition to radiographic analysis, various surgical techniques, such as coronectomy, have been proposed to reduce the incidence of inferior alveolar nerve injury. The orthodontic extraction technique is an orthodontically supported surgical approach that reduces the risk of neurological complications that may occur in inferior alveolar nerve and facilitates the surgical removal of impacted mandibular third molars close to the mandibular canal, even if they are associated with cystic lesions. The purpose of this study is to examine the effect of orthodontic extraction applied to minimize inferior alveolar nerve damage during the extraction of deeply impacted mandibular third molar teeth on postoperative nerve injury. For this purpose, the postoperative paresthesia findings of patients who underwent orthodontic extraction will be compared with those of those who underwent traditional extraction.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Interventions

Traditional ExtractionPROCEDURE

Participants in this group will undergo traditional extraction method. This method involves uncovering the impacted tooth and extracting the tooth with or without dividing it.

Orthodontic ExtractionPROCEDURE

Participants in this group will undergo orthodontic extraction method. In this method, a two-stage surgical procedure will be performed. In the first operation, the impacted tooth will be uncovered, and then a button will be placed on the tooth. For anchorage purposes, orthodontic mini screws will be placed in the mandibular ramus or zygomaticomaxillary buttress area. Elastics and/or ligature wires fixed to the button will be attached to the mini screw to provide force for the traction of the tooth. Patients will be called for check-up appointments every two weeks, and the movement of the impacted tooth will be monitored with panoramic x-rays. The second operation will be planned when the tooth moves away from the inferior alveolar nerve. In the second operation, the tooth will be extracted in a similar way to the traditional extraction group.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 60 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Presence of indication for wisdom tooth extraction for reasons such as pericoronitis, pathological formation, orthodontic reasons, caries, etc. * Mandibular impacted wisdom teeth close to the inferior alveolar nerve Exclusion Criteria: * Mandibular impacted wisdom tooth not close to inferior alveolar nerve * Wisdom tooth whose apexification has not yet been completed * Suspicion of a malignant pathological lesion * Pathological lesion associated with inferior alveolar nerve * Presence of an acute infection

Outcomes

Primary Outcomes

2-point discrimination test on the 7th day after surgery

The primary outcome measure of the study was the assessment of nerve injury. For this purpose, postoperative nerve injury will be recorded by a 2-point discrimination test with the help of a caliper with a 1mm gap.

Time frame: A 2-point discrimination test will be performed before the extraction and 7 days after extraction in both groups.

Secondary Outcomes

Visual Analog Score(VAS)

To measure the degree of nerve injury, the patient will be asked to choose a score based on the degree of numbness, where 0 indicates complete numbness and 10 indicates complete normal sensation.

Time frame: VAS will be evaluated on the 7th and 14th postoperative days and the 1st, 3rd, and 6th months after tooth extraction.

2-point discrimination test on the 14th days and the 1st, 3rd, and 6th months after extraction.

Nerve injury will be recorded by a 2-point discrimination test with the help of a caliper with a 1mm gap.

Time frame: A 2-point discrimation test will be performed on the 14th days and the 1st, 3rd, and 6th months after extraction.

Inferior alveolar nerve recovery

The effect of demographic data such as age, gender, and tooth position on IAN recovery will be evaluated. At postoperative time points, 2-point discrimation test values that are 2 mm more than the preoperative result will be considered to indicate nerve injury.

Time frame: Inferior alveolar nerve recovery will be assessed on the 7th and 14th postoperative days and the 1st, 3rd, and 6th months after tooth extraction.