Remoción de terceros molares mandibulares con asistencia endoscópica. Nota técnica de un nuevo procedimiento quirúrgico para prevenir lesiones del NAI y formación de defectos óseos | Revista Clínica de Periodoncia, Implantología y Rehabilitación Oral

Información del artículo

Resumen

La variada posición anatómica de los terceros molares mandibulares presenta importantes desafíos asociados a su profundidad y grado de inclinación. Las complicaciones más habituales del procedimiento quirúrgico convencional de extracción se relacionan con la extensa osteotomía y poca visualización del sitio quirúrgico, que pueden generar consecuencias post-quirúrgicas como inflamación, dolor, trismus, lesiones reversibles e irreversibles del nervio alveolar inferior (NAI) o nervio lingual, riesgo de fractura y formación de defectos periodontales del segundo molar. La implementación de soportes rígidos en la óptica endoscópica ha permitido utilizar esta tecnología para realizar abordajes mínimamente invasivos para remover terceros molares mediante accesos flapless con una mínima osteotomía de la zona oclusal, conservando la pared bucal y lingual a través de la visualización directa y magnificada del sitio quirúrgico, adaptable a los movimientos del paciente durante la intervención. En este reporte se presenta un nuevo procedimiento quirúrgico mínimamente invasivo a través de asistencia endoscópica para la conservación ósea en la remoción de terceros molares mandibulares con riesgo de lesión del nervio alveolar inferior.

Palabras clave:

Endoscopio

terceros molares mandibulares

dientes impactados

osteotomía

daño al NAI

Abstract

Anatomic variability of the position of mandibular third molars represents significant challenges associated with its depth and angulation. The most common complications of conventional surgical procedure are related to extensive osteotomy and poor visualization, which can cause postsurgical effects such as inflammation, pain, trismus, reversible and irreversible lesions of the inferior alveolar nerve (IAN) or lingual nerve, fracture risk and formation of a deep periodontal defect on the distal aspect of the second molar. The implementation of rigid endoscopy in optics has allowed to use this technology via a minimally invasive approach to remove third molars by a minimally occlusal flapless ostectomy, preserving the buccal and lingual walls through direct and magnified visualization of the surgical site, adaptable to the patient's movements during the surgery. In this report, we present a new and minimally invasive procedure through endoscopic assistance for bone conservation in the removal of third molars at risk of inferior alveolar nerve injury

Key words:

Endoscope

mandibular third molars

impacted teeth

osteotomy

AIN injury

El Texto completo está disponible en PDF

Referencias Bibliográficas

[1.]

E. Scherstén, L. Lysell, M. Rohlin.

Prevalence of impacted third molars in dental students.

Swed Dent J, 13 (1989), pp. 7-13

Medline

[2.]

F.R. Fuentes, V.G. Oporto.

Tercer molar ectópico impactado en zona retromolar. Reporte de caso.

Int J Morphol, 27 (2009), pp. 35-38

[3.]

C.P. Ortiz, V.J. San Pedro.

Relationship between the mandibular canal and the roots of the mandibular third molars of young patients in Talca.

Int J Odontostomat, 3 (2009), pp. 131-135

[4.]

W. Tantanapornkul, K. Okouchi, Y. Fujiwara.

A comparative study of conebeam computed tomography and conventional panoramic radiography in assessing the topographic relationship between the mandibular canal and impacted third molars.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 103 (2007), pp. 253-259

http://dx.doi.org/10.1016/j.tripleo.2006.06.060 | Medline

[5.]

J.P. Shepherd, M. Brickley.

Surgical removal of third molars.

BMJ, 309 (1994), pp. 620-621

Medline

[6.]

T. Meisami, A. Sojat, G.K. Sàndor, H.P. Lawrence, C.M. Clokie.

Impacted third molars and risk of angle fracture.

Int J Oral Maxillofac Surg, 31 (2002), pp. 140-144

http://dx.doi.org/10.1054/ijom.2001.0215 | Medline

[7.]

P.R. Genú, B.C. Vasconcelos.

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

Int J Oral Maxillofac Surg, 37 (2008), pp. 923-928

http://dx.doi.org/10.1016/j.ijom.2008.05.016 | Medline

[8.]

G. Arakeri, V. Arali.

Tooth section technique and pain upon elevation in third molar removal.

Int J Oral Maxillofac Surg, 39 (2010), pp. 98-99

http://dx.doi.org/10.1016/j.ijom.2009.10.007 | Medline

[9.]

W.C. Ngeow.

Tooth section technique for wisdom teeth.

Int J Oral Maxillofac Surg, 38 (2009), pp. 908

http://dx.doi.org/10.1016/j.ijom.2009.02.027 | Medline

[10.]

L. Landi, P.F. Manicone, S. Piccinelli, A. Raia, R. Raia.

A novel surgical approach to impacted mandibular third molars to reduce the risk of paresthesia: A case series.

J Oral Maxillofac Surg, 68 (2010), pp. 969-974

http://dx.doi.org/10.1016/j.joms.2009.09.097 | Medline

[11.]

G.A. Bonetti, S.I. Parenti, L. Checchi.

Orthodontic extraction of mandibular third molar to avoid nerve injury and promote periodontal healing.

J Clin Periodontol, 35 (2008), pp. 719-723

http://dx.doi.org/10.1111/j.1600-051X.2008.01286.x | Medline

[12.]

H.R. Kim, B.H. Choi, W. Engelke, D. Serrano, F. Xuan, D.Y. Mo.

A comparative study on the extractions of partially impacted mandibular third molars with or without a buccal flap: A prospective study.

J Oral Maxillofac Surg, 69 (2011), pp. 966-970

http://dx.doi.org/10.1016/j.joms.2010.02.025 | Medline

[13.]

A. Kahairi, S. Ahmed Khan, A. Amirozi.

Endoscopic-assisted enucleation of radicular cysts - A case report.

Malays J Med Sci, 17 (2010), pp. 56-59

Medline

[14.]

R. Schön, R. Gutwald, A. Schramm, N.C. Gellrich, R. Schmelzeisen.

Endoscopyassisted open treatment of condylar fractures of the mandible: Extraoral vs. intraoral approach.

Int J Oral Maxillofac Surg, 31 (2002), pp. 237-243

http://dx.doi.org/10.1054/ijom.2001.0213 | Medline

[15.]

N. Nakamura, T. Mitsuyasu, M. Ohishi.

Endoscopic removal of a dental implant displaced into the maxillary sinus: Technical note.

Int J Oral Maxillofac Surg, 33 (2004), pp. 195-197

http://dx.doi.org/10.1054/ijom.2003.0470 | Medline

[16.]

M.M. Suarez-Cunqueiro, R. Schoen, A. Schramm, N.C. Gellrich, R. Schmelzeisen.

Endoscopic approach to removal of an ectopic mandibular third molar.

Br J Oral Maxillofac Surg, 41 (2003), pp. 340-342

Medline

[17.]

W. Engelke, C. Galle.

Endoscopic Interventions in oral implantology - A report of 5 years clinical experience.

Int J Odontostomat, 2 (2008), pp. 153-161

[18.]

T. Renton, M. Hankins, C. Sproate, M. McGurk.

A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars.

Br J Oral Maxillofac Surg, 43 (2005), pp. 7-12

http://dx.doi.org/10.1016/j.bjoms.2004.09.002 | Medline

[19.]

W. Engelke, J. Bierbaum, E.J. Choi.

Microsurgical removal of inferior third molars using an occlusal approach.

Dtsch Zahnärztl Z, 66 (2011), pp. 415-423

[20.]

T.A. Quee, D. Gosselin, E.P. Millar, J.W. Stamm.

Surgical removal of the fully impacted mandibular third molar. The influence of flap design and alveolar bone height on the periodontal status of the second molar.

J Periodontol, 56 (1985), pp. 625-630

http://dx.doi.org/10.1902/jop.1985.56.10.625 | Medline

[21.]

L. Szmyd, W.R. Hester.

Crevicular depth of the second molar in impacted third molar surgery.

J Oral Surg. Anaesth Hosp Dent Surv, 21 (1963), pp. 185-189

[22.]

R.E. LaBelle.

The influence of third molars on periodontal health.

Minneap Dist Dent J, 53 (1969), pp. 25-28

Medline

[23.]