Surgery of mesio-inclined and horizontal lower third molars (from 25 to 100 degrees)

OBJECTIVES The aim of this module is to introduce clinicians to the correct approach for the surgical management of horizontal and mesio-inclined mandibular third molars (from 25 to 100 degrees of inclination), providing a standardized pre-surgical and surgical protocol. MATERIALS AND METHODS The most recent national and interna tional literature available through major databases (PubMed, Medline, Scopus, Google Scholar, and Cochrane Library) was analyzed. This review was comple mented with ministerial guidelines and clinical experience derived from several years of practice. RESULTS Scientific data and clinical cases relating to horizontal and mesio-angular mandibular third molars with an incli nation between 25 and 100 degrees were collected. Each clinical case was described from an anamnestic, radio graphic and clinical point of view. Each clinical case was also classified ac cording to a difficulty scale chosen by the authors (Casaburi at al.) which al lows to determine pre-operatively the complexity. The surgical approach of each clinical case was explained in de tail through clinical images illustrating the various phases of avulsion from an esthesia to sutures. Each surgical phase was described and motivated by analyzing the specific characteristics in order to give the clinician a series of standardized steps. DISCUSSION The treatment of horizontal and me sio-angular mandibular third molars must be undertaken after an accurate pre-sur gical evaluation of the case. It is essential to carry out an anamnestic, clinical and radiographic examination which allows to highlight the indications for extraction, es timate the extraction difficulty, the risk factors involved as well as the complications. In this way it is possible to plan the treat ment by choosing the most correct surgi cal approach. Before undertaking surgery, it is possible to use a scale suitable for classifying extraction difficulty which al lows to determinate pre-operatively the complexity of the clinical case. The surgi cal phases must be carried out following well-defined and planned steps based on the typical characteristics of the third mo lar in question. Mesio-angular or horizon tal third molars are more associated with problems such as caries of the second molar, development of periodontal pathol ogy affecting the second molar and root resorption of the second molar, therefore it is important to also inspect the state of health of the second molar and evaluate whether this requires therapy. CONCLUSIONS The notions provided in this module in clude a detailed explanation of all the pre-surgical and surgical phases that underlie a correct approach to horizontal or mesio-angular mandibular third mo lars. This module gives the clinician an adequate cultural background and a steps-by-steps guide in order to plan the correct surgical treatment of a specific clinical case. CLINICAL SIGNIFICANCE The extraction of the lower third mo lars represents a surgical treatment with difficulties and complications. This module represents a step-by-step guide that illustrates all the pre-surgical and surgical phases use ful for planning and performing the ex traction of horizontal and mesio-angu lar mandibular third molars in an ef fective and safe manner.