Removal of Impacted Molars With Lingual Split Technique
Condition: Lingual Nerve Injuries
MeSH terms: Tooth, Impacted; Lingual Nerve Injuries
Study type: Interventional

Summary: 
      This research assesses removal of mandibular third molars by the lingual split technique with
      using Walter's lingual retractor for retracting lingual flap, and evaluates the lingual nerve
      injury that may result after applying this technique. The research sample included 20
      patients and their age under 25 years where the grain is clear. The lingual nerve is assessed
      by sensory neurological tests on a graphic map that divides the tongue into sextants.
    

Detailed description: 
      Although the scope of oral and maxillofacial surgery has expanded in many directions
      recently, the common or recurrent practice remains dentoalveolar surgery including impaction
      surgery. The main indication to extract is whether the third molar has involved in a disease
      process.

      Permanent injury of lingual and chorda tympani nerve (influenced by taste sensations)
      following removal mandibular third molar remains a clinical problem in oral and maxillofacial
      surgery. To reduce the risk of lingual nerve injury, the current protocols in North America
      accentuate raising a buccal flap and following a buccal approach during removal impacted
      mandibular third molar. However, there was no uniform success as a clinical reality showed.
      Many patients are still being referred to specialist centers for the management of lingual
      nerve injury. In most cases, the surgeon was not discerned of any incident that could cause
      the neurological injury. The alternative technique is Lingual split technique.

      Lingual split technique for removal impacted mandibular third molars introduced by Kelsey Fry
      and described by Ward in 1956 by removing a thin piece of disto-lingual bone and removing the
      tooth lingually. This technique is initially designed to remove distal and lingually inclined
      impacted mandibular third molar. This technique has not received much appreciation because of
      potential associated morbidity. Complications with this technique are potential damage to the
      lingual nerve, increasing hemorrhage from the lingual cohesive soft tissue, infection
      expansion to the sublingual or sublingual spaces and edema close to the airway. Several
      modifications have been made on the lingual split technique which they have reduced trauma
      and prevent complications. The advantages of this technique are easy, safety, less
      time-consuming and minimal tissue trauma and complications with good outcomes. Also, it
      allows obtaining the impacted third molar in one piece, and may be used as a donor tooth for
      non-restorable molar replacement. It has the advantage of reducing the volume of residual
      thrombosis when using sauzerization means. Few studies look specifically at the lingual split
      technique, which has been criticized for causing a high rate of lingual nerve injury and
      excluded for centuries.

      The independent basis in lingual spilt technique is that the lingual plate is much thinner
      than the buccal, especially in cases where the tooth is fully bone impacting. It is suitable
      for use in young patients only with a flexible bone where the grain is clear.6 The direction
      of the grain and the presence of the lingual prominence of the alveolar process allow the
      desired part of the bone plate to easily detach by chiseling and this makes the technique
      more rapid.
    

Intervention name(s): Lingual nerve function assessed after removal of mandibular third molar with lingual split technique
Intervention type(s): Procedure
Intervention description(s): The lingual split technique is based on using chisel and hammer in bone removing. After the buccal and lingual flaps are raised and retracted. Two buccal bone cutting with horizontal cutting up between them are performed, The disto-lingual bone fragment is fractured inward by placing the cutting edge of the chisel at 45 degrees with the surface of the bone and directed towards the lower second premolar of the opposite side. By maintaining the cutting edge of the chisel parallel to the external oblique ridge, a few light taps with the mallet will separate the lingual plate from the rest of the alveolar bone. And it released from soft tissues, buccally force is applied to roll the whole tooth lingually. The neurological function of the lingual nerve was assessed after the demise of local anesthesia, then the location of the disorder and taste function and healing time are determined by sensory neurological tests on a graphic map that divides the tongue into sextants.
Intervention model: Single Group Assignment
Intervention model description: The research sample included 20 patients from the Faculty of Dentistry in Tishreen University and maxillofacial surgery department in Tishreen Hospital who had have an impacted mandibular third molar indicated for extraction and their age under 25 years.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Impacted third molar; lingual nerve; lingual flap retractor