Computer Guided Versus Conventional Surgical Removal of Deeply Impacted Mandibular Third Molar With Preservation of External Oblique Ridge

Study Overview
=================
Brief Summary
-----------------
in patent have deeply impacted lower third molar ,dose computer guided enhance surgical outcome versus conventional surgical remove of wisdom teeth

Detailed Description
-----------------
P- Patient with deeply impacted mandibular molar I- Computer guided surgical cutting stent C- Conventional extraction O- Clinical outcome sound radiographic outcomes primary outcome - pain : each patient well be asked to rate current and worst pain intensity on visual analogue scale (VAS ) of 0-10 with Zero being no pain and Ten corresponds to the worst pain. Secondary outcome evaluation of maximum inter incisal opening: assessment of MMO will be performed by measuring the distance in mm between the incisal edges of the upper and lower central incisor by using tape graduated method. evaluation of edema throw use nylon thread.

Official Title
-----------------
Computer Guided Versus Conventional Surgical Removal of Deeply Impacted Mandibular Third Molar With Preservation of External Oblique Ridge

Conditions
-----------------
Impacted Third Molar Tooth

Intervention / Treatment
-----------------
* Procedure: computer guided surgical
* Procedure: Conventional surgery
* Device: CBCT
* Device: CBCT


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: patient with deeply impacted mandibular third molar patients should be free from any systematic disease that affect normal healing Exclusion Criteria: -Patient with soft tissue impaction and impaction class A position 1 Medical problem that may interfere with the procedures such as bleeding disorder & pregnant. Uncooperative patient.

Ages Eligible for Study
-----------------
Minimum Age: 16 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Conventional surgery<br>comprised 9 patient undergoing surgical removal of deeply impacted mandibular third molar by regular manor. (Based on :Panorama and CBCT ) technique : 1- flap design 2- bone removal 3- tooth division 4- closure flap (suture) | Procedure: computer guided surgical<br>* has three cutting guided plane for identify the position of place of the third molar, it have beveled cut for stability after remove the teeth and placing the bony window<br>Device: CBCT<br>* For measuring the bone removeal<br>|
| Experimental: computer guided surgery<br>comprised 9 patient undergoing surgical removal of deeply impacted mandibular third molar using computer guided surgical cutting stent. Based on (panorama , CBCT and fabricating computer guided stent technique: 1- flap design 2- accurate setting stent in a predesign site 3- bony window removing according to the stent design 4- surgical separation of the teeth with extraction the remaning part . 5- identify the nerve 6- replace the bony window in to original place with stability 7- closure and depridment | Procedure: Conventional surgery<br>* Low speed motor with surgiacl round burs and surgical fissure for removal a covering bone with decapitation and guttering formation<br>Device: CBCT<br>* for identifed the nerve<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain | each patient well be asked to rate current and worst pain intensity on visual analogue scale (VAS ) of 0-10 with Zero being no pain and Ten corresponds to the worst pain(pain change during follow up period . | immediate post operative ,at three day pain change till fourteen day day . | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| evaluation of maximum inter incisal opening | assessment of MMO will be performed by measuring the distance in mm between the incisal edges of the upper and lower central incisor by using tape graduated method. | immediate post operative ,at three day inter incisal change till fourteen day . |