Orthodontic extraction: riskless extraction of impacted lower third molars close to the mandibular canal

Purpose The study purpose was to describe an orthodontic approach to move the third molar’s roots, which are radiografically demonstrated to be close to the mandibular canal, away from the neuro-vascular unit in order to perform riskless extractions. Materials and Methods The authors described the different phases of this approach: Phase 0: Assessment of surgical risks. A topographic diagnosis is made first through a panoramic radiograph and then, if there is a suspected contact between root and mandibular canal, through a CT scan. If the proximity is confirmed, the orthodontic extraction will be started by: Phase 1: Creation of the orthodontic anchorage. Phase 2: Surgical exposure of the third molar crown and bracket bonding to the occlusal surface. Phase 3: Orthodontic extrusion of the third molar. A cantilever is anchored to the first molar to produce the extrusive forces. Phase 4: Radiographic assessment of the extrusion level. A new radiological check is requested to confirm the tooth movement. Phase 5: Third molar extraction. Results This therapeutic approach makes extraction of impacted lower third molar easier and quicker, with less post-operative discomfort, without risk of paresthesia or mandibular fracture and with periodontal advantages. This technique allows extraction of lower third molars otherwise impossible for the high risk of complications. Conclusion The orthodontic-surgical approach to the high-risk extraction of impacted lower third molar has proved to be a technique quite simple for the doctor and minimally traumatizing for the patient. It is a prudent, safe and biologically more conservative therapeutic choice.