“Which Types Of Wisdom Tooth Impaction Are Associated With The Most Risk?”

6.5.24 Quick Review #142 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental Over the past 50 years, several studies have analyzed the types of wisdom tooth (third molar) impactions, their proximity to the inferior alveolar nerve (IAN) and lingual nerve (LN), and the resulting complications. Consistently, the type of impaction that shows a higher frequency of complications, particularly nerve injuries, is the osseous (bony) impaction, especially when the roots are in close proximity to or encircle the IAN. Key Findings: 1. Nerve Injuries and Root Orientation: • Inferior alveolar nerve injury is more common when the roots of the impacted third molar are oriented buccally or lingually relative to the IAN. When the root encircles the IAN or is in close proximity (contact or oppression), the risk of nerve injury increases significantly. • Lingual nerve injuries are often associated with the reflection of the lingual flap during surgery. This injury risk is higher when a lingual retractor is not used correctly. 2. Depth and Type of Impaction: • Osseous impactions, where the crown is completely surrounded by bone, pose a higher risk for complications compared to mucosal impactions or partially erupted teeth. The complete encasement in bone requires more invasive surgical techniques, which increases the risk of nerve damage . • Studies have shown that the incidence of IAN injury varies depending on the root’s orientation and the depth of the impaction. For instance, osseous impactions with roots protruding into or flattening the IAN canal are at the highest risk. 3. Correlation with Mandibular Fractures: • Mandibular fractures are another significant complication associated with deeply impacted third molars. These fractures often occur postoperatively, particularly in the mandibular angle, and are more frequent in cases where the third molar is deeply embedded and requires substantial bone removal during extraction. Collective Data and Statistics: • Studies indicate that approximately 14% of mandibular fractures post-third molar surgery are related to the presence of deeply impacted third molars. • The proximity of the IAN to the roots of impacted third molars varies, with some studies reporting that up to 35% of roots are lingually positioned relative to the nerve, significantly increasing the risk of nerve injury during extraction. References: 1. Yang, X., Zhang, X., & Liu, H. (2022). The effect of root orientation on inferior alveolar nerve injury after extraction of impacted mandibular third molars based on propensity score-matched analysis: a retrospective cohort study. BMC Oral Health, 22, 56. 2. Gómez, P., Herráez, P., & Morillo, D. (2021). Risk factors associated with inferior alveolar nerve injury after extraction of impacted mandibular third molars. Applied Sciences, 11(8), 816. 3. ChatGPT. 2024. - #podcast #podcasts #dentalpodcast #dentalpodcasts #doctorgallagherpodcast #doctorgallagherspodcast