Orthodontic extraction: the extraction of the third molars in close proximity to the mandibular canal by an orthodontic-surgical approach

The purpose of this study was to describe an orthodontic-surgical approach to performing riskless extractions of those third molars with congruity between the roots and the mandibular canal. The approach consists of different phases. First the surgical risks have to be assessed. A first topographic diagnosis is made using a panoramic radiograph and then, if there is a suspected contact between root and mandibular canal, a CT scan is done. When the proximity is confirmed, "the orthodontic extraction procedure" will start with the creation of an orthodontic anchorage. This phase is followed by a surgical exposure of the third molar crown in order to bond a bracket to the occlusal surface. A stainless steel sectional wire is anchored from the first molar to the third molar to produce the extrusive forces. After a positive clinical assessment of the extrusion level, a new radiological check is requested to evaluate the tooth movement. When the tooth is out of the mandibular canal, the surgeon can perform a safe and easy third molar extraction. With this therapeutic approach the extraction of an impacted lower third molar will be: easier and quicker, with less post-operative discomfort, without risk of paresthesia or mandibular fracture, with periodontal advantage. In conclusion the orthodontic-surgical approach to the high-risk extraction of impacted lower third molar has proved to be a quite simple technique for the dentist and minimally traumatizing for the patient.