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Background Inferior alveolar nerve injury is the most serious complication of impacted lower third molar surgery. Objectives This study aims to optimize surgical procedure to safely remove wisdom tooth in contact or near the inferior alveolar canal and estimate the incidence of nerve injury in such cases. Methods and Methods this prospective controlled clinical study was implemented in Specialized Dental Center from February 2018 to May 2019. The sample was composed of 100 patients divided into two groups according to the distance of root apex from the inferior alveolar canal (the predictive variable), For the study group, the root apex is in contact or = 1mm from the inferior alveolar canal (buccal, lingual, or above the canal or canal between roots). For the control group the distance > 1mm. The primary outcome variable was inferior alveolar nerve injury after surgery. Another study variable was nerve recovery. Descriptive and bivariate statistics were computed and the P-value was set at .05. Results The study group involves 40 patients (18 males, 22 females) with a mean age of 23.5. The Control group involves 60 patients (26 males, 34 females) with a mean age of 24.5. There was a non-significant association between the distance of root apex to the inferior alveolar canal and paresthesia at p-value <.05 as revealed by fisher's exact test (p=.061). Conclusion The results of this study suggest that surgical removal of wisdom teeth with a close relation to the inferior alveolar canal is a safe procedure when specific precautions and techniques are performed. [ABSTRACT FROM AUTHOR]