## 1 Introduction  
Surgical removal of impacted lower third molars is frequently indicated, and it is the most common surgical procedure in dentistry. The traditional approach for surgically extracting lower third molars typically involves raising a buccal flap, removing buccal bone, which can be performed with (LF+) or without (LF) lingual retraction, and tooth sectioning. The proximity of the lower third molar to several vital structures, including the lingual nerve, poses potential complications. The lingual nerve is particularly susceptible to injury during lower third molar surgery, which can significantly impact a patient's quality of life, leading to both physiological and psychological disturbances [1]. Lingual nerve injury (LNI) can result in complications such as altered touch and taste sensations, neuralgia, and impaired swallowing and speech [2].  
The lingual nerve (LN) is a branch of the mandibular division of the trigeminal nerve [3]. It provides somatosensory innervation, such as sensations of pain, temperature, and pressure, to the mucous membrane. The LN innervates the anterior two-thirds of the tongue, the lingual gingiva of the mandibular teeth, and the mucosa of the floor of the mouth [3]. Approximately 1 cm below the point where the inferior alveolar nerve and LN diverge, the LN is joined by the chorda tympani nerve [4]. The path of the LN varies between individuals. A study by [PERSON] et al. found that, in twenty cadaveric heads, the LN was situated between 1 and 7 mm from the lingual plate of the lower third molar [5].  
This highlights the potential risk of lingual nerve injury when a lingual flap is retracted due to the varying locations of the LN.  
Lingual nerve injury (LNI) following the removal of third molars is typically transient, with studies indicating that spontaneous recovery occurs in about 60% of cases within three months and 35% of cases within six months [2]. If LNI persists beyond six months, the likelihood of spontaneous recovery diminishes significantly, and the injury may be considered permanent [6].  
In the literature, the incidence of third molar removal ranges from about 0 to 23%, depending on the technique and instruments used [7]. The most commonly reported statistically significant risk factor in the literature is the reflection of a lingual flap, the removal of bone, the sectioning of the tooth, and the experience of the operator, as well as the anatomic variations in the lingual nerve, but authors are not always in agreement with each other about its etiology, risk factors, and incidence [7,8]. The association between lingual nerve injury (LNI) and the extraction of third molars depends significantly on the anatomical relationship between these structures. Many studies highlight the closeness between the lingual nerve and the third molar surgery site [9, 10, 11, 12, 13].  
A relevant controversial topic linked to LNI is the application of surgical techniques of elevation and lingual flap protection to prevent LNI [14, 15, 16, 17]; according to the results obtained with surgical protocols developed in the United States, surgery with the elevation of only one buccal flap has spread further [14]. The debate regarding whether or not and how lingual flap protection could impact the incidence of lingual nerve injury (LNI) remains unresolved [18, 19, 20, 21, 22, 23].  
The aim of this study was to evaluate the efficacy of the methodical protection of the lingual nerve via the use of a standardized step-by step procedure during third molar surgical extraction by last year's students of the oral surgery specialty program.