Clinical trial NCT05946317: Removal of Impacted Molars With Lingual Split Technique
Official title: Evaluation of Sir William Kelsey Fry Technique in Lingual Surgical Removal of Impacted Lower Third Molar With Retraction Lingual Nerve
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Lingual Nerve Injuries
Keywords: Impacted third molar
lingual nerve
lingual flap retractor
Lead sponsor: Tishreen University
Sponsor class: OTHER
First posted: 2023-07-14
Enrollment: 20
Sex: ALL
Minimum age (years): 19
Maximum age (years): 24
Standard ages: ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
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.
Primary purpose: TREATMENT

Brief 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.

Eligibility criteria: Inclusion Criteria:

* Patients who have impacted mandibular third molar indicated for removal.
* Patients are healthy and have no systemic diseases (ASA1 ASA2).
* Patient's age is less than 25 years where the bone grain is still present and the use of the chisel and hammer is permitted.
* Patient's consent to surgical work and inclusion in the research.

Exclusion Criteria:

* A deep impacted mandibular third molar which is close proximately to the neuro-vascular package, deep horizontal impaction, extreme disto-angular impaction.
* Patient's age is over 25 years.
* The lingual plate is thick.

Primary outcomes:
measure: Lingual nerve injury location
timeFrame: 6 hours after the surgical procedure of removal of impacted mandibular third molar.
measure: Nerve discrepancy
timeFrame: 6 hours after the surgical procedure of removal of impacted mandibular third molar.
measure: Taste function
timeFrame: 6 hours after the surgical procedure of removal of impacted mandibular third molar.
Secondary outcomes:
measure: Healing time
timeFrame: Two weeks after the surgical procedure.
measure: Healing time
timeFrame: Four weeks after the surgical procedure.
measure: Healing time
timeFrame: Six weeks after the surgical procedure.
measure: Healing time
timeFrame: Two months after the surgical procedure.
measure: Healing time
timeFrame: Four months after the surgical procedure.
measure: Healing time
timeFrame: Six months after the surgical procedure.
Other outcomes:
Locations:
city: Latakia
country: Syrian Arab Republic
facility: Alaa Alaji
Study officials:
affiliation: Tishreen University
name: Abdul Karim Khalil, PHD
role: STUDY_CHAIR
affiliation: Tishreen University
name: Alaa Alaji, Master
role: PRINCIPAL_INVESTIGATOR
References:
citation: Rud J. Reevaluation of the lingual split-bone technique for removal of impacted mandibular third molars. J Oral Maxillofac Surg. 1984 Feb;42(2):114-7. doi: 10.1016/0278-2391(84)90323-9. No abstract available.
citation: Farish SE, Bouloux GF. General technique of third molar removal. Oral Maxillofac Surg Clin North Am. 2007 Feb;19(1):23-43, v-vi. doi: 10.1016/j.coms.2006.11.012.
citation: Pippi R, Spota A, Santoro M. Prevention of Lingual Nerve Injury in Third Molar Surgery: Literature Review. J Oral Maxillofac Surg. 2017 May;75(5):890-900. doi: 10.1016/j.joms.2016.12.040. Epub 2017 Jan 4.
citation: Pogrel MA, Goldman KE. Lingual flap retraction for third molar removal. J Oral Maxillofac Surg. 2004 Sep;62(9):1125-30. doi: 10.1016/j.joms.2004.04.013.
citation: Steel B. Lingual split versus surgical bur technique in the extraction of impacted mandibular third molars: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Sep;114(3):294-302. doi: 10.1016/j.tripleo.2011.07.028. Epub 2012 Jan 27.
citation: Smith MH, Lung KE. Nerve injuries after dental injection: a review of the literature. J Can Dent Assoc. 2006 Jul-Aug;72(6):559-64.