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Background: The aim of this study was to investigate the effectiveness of topical application with dexamethasone during BSSO due to its anti-inflammatory effect and decreasing of postoperative nerve oedema in minimising clinical symptoms of NSD associated with inferior alveolar nerve (IAN) injury in postoperative period, based on the results of sensory diagnostic tests, such as light touch test and its modifications., Methods: Through randomisation, 2 groups were selected from 22 patients: the experimental- where topical application with solution of dexamethasone phosphate 0.4% (4 mg/1 ml ampules) during sagittal split osteotomy of the mandible was used, and the control- where the classical technique of BSSO was held., Results: Authors performed diagnostics of NSD using Light Touch test on 1st day, 1st week, 1st month, 3rd month and 6th month postoperatively. The experimental group showed improvements in sensory recovery compared to the control group, particularly from 1 week to 3 months post-surgery. By 6 months, both groups achieved similar levels of sensitivity restoration., Conclusions: This confirms the effectiveness of proposed method and opens up further prospects for the updated function of the IAN following the BSSO., Clinical Trial Number: Not applicable., Competing Interests: Declarations. Ethics approval: All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. A study was approved by the Ethics Committee of Central Laboratory Diagnosis of the Head, Kyiv, approval number 501. The authors informed the participants about the anonymous and voluntary participation, and the participants provided their consent. Consent for publication: Written informed consent was provided by all participants allowing the publication of any identifying images or clinical information related to them in this study. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Backround: This study was designed to analyse the value of preoperative Cone Beam CTs (CBCT) prior to the surgical removal of complex lower third molars. Furthermore, the aim was to assess injuries to the inferior alveolar nerve (IAN) bundle and postoperative neurological disorders depending on the position of the lower third molar and the inferior alveolar nerve bundle., Methods: In this retrospective examination preoperative Cone Beam CTs and Orthopantomographs (OPT) of 324 patients were analysed concerning the location of the lower third molars in relation to the mandible and the inferior alveolar nerve bundle. Surgery protocols of all patients who underwent the surgical removal of at least one complex lower third molar were analysed concerning patient data, length of surgery, intraoperative haemorrhage, intraoperative exposure of the inferior alveolar nerve bundle, postoperative swelling and postoperative neurological disorders. The data was then compared to data from international studies., Results: In all 324 patients a permanent neurological damage was not found. Temporary neurological damage was recorded in 13 cases (2.6%). A caudal nerve position with no measurable distance to the root of the lower third molar was associated with the highest risk of a temporal neurological damage. A vestibular touching nerve route also correlated with postoperative sensitivity impairment. If a mesioangulation (Winter) or a Pell and Gregory Type IIIC appears in the OPT, risk of neurological damage is at its highest., Conclusions: Three-dimensional radiographic imaging, in our patient group, does not significantly affect the risk for complications during the surgical removal of complex lower third molars. Therefore, it should only be utilized for risk assessment, especially in cases of symptom-free lower third molars. A preoperative orthopantomogram still can be accepted as standard for radiographic imaging. An intraoperative exposure of the IAN bundle does not necessarily predict simultaneous neurological damage. Exposure of the IAN bundle is no indication for a discontinuation of the surgery., (© 2021. The Author(s).)

Placement of dental implants in the posterior mandibular alveolar ridges may become a challenging procedure because of limited bone height between the crest of the ridge and the inferior alveolar canal. The aim of this study was to introduce an innovative, less invasive, highly accurate, and easy surgical technique of inferior alveolar nerve lateralization in the posterior deficient mandible using a special customized 3-dimensional-printed surgical guide to enhance the bone height for implant placement. This case series study included 7 patients with unilateral edentulous mandibular alveolar ridges. Customized surgical guides were manufactured using fused deposition modeling technology to accurately place a rectangular window to uncover the canal and also for immediate placement of dental implants in all cases. The results of this limited study provided information on an innovative technique that decreased intraoperative time and demonstrated decreased risks for (1) inferior alveolar nerve injury and (2) postoperative nerve dysfunction.

DesignMulticentre, randomised controlled clinical trial.InterventionPatients referred for third molar removal received a digital panoramic radiograph(PR). Adults with one or more lower third molars in a close relationship with the mandibular canal were eligible for the study. Patients randomised to the cone beam computed tomography (CBCT) group received a high resolution CBCT scan in addition to the PR. All lower third molar extractions were performed under local anaesthesia without sedation and without antibiotic prophylaxis. Information on variables such as experience of the surgeon, duration of surgery and technique for third molar removal were recorded.Outcome measureThe primary outcome measure was the number of patient-reported altered sensations one week after surgery. Secondary outcomes included the number of patients with an objective IAN injury; permanent IAN injury (>6 months); occurrence of other postoperative complications (wound infection, alveolar osteitis); Oral Health Related Quality of Life-14, questionnaire responses; pain (VAS score); duration of surgery; number of emergency visits; and number of missed days of work or study.ResultsThree hundred and forty-one patients with 477 lower third molars were randomised from three centres. Two hundred and sixty-eight patients with 320 mandibular third molars were analysed according to the intention-to-treat principle for the primary and secondary outcomes. The overall incidence of patient-reported altered sensations one week after surgery was 6.3%. At one week there was no difference in subjective IAN injury between the CBCT and PR group. No significant differences were noted between the two groups for any of the secondary outcomes recorded.ConclusionsAlthough CBCT is a valuable diagnostic adjunct for identification of an increased risk for IAN injury, the use of CBCT does not translate into a reduction of IAN injury and other postoperative complications, after removal of the complete mandibular third molar. In these selected cases with a high risk for IAN injury, an alternative strategy, such as monitoring or a coronectomy, might be more appropriate.

Extractions of mandibular third molars are a common procedure in dental practice. In cases where a close anatomical relationship of the root and the inferior alveolar nerve exists, the risk of transient or even permanent nerve injury increases. Nerve injury is difficult to manage and symptoms may cause severe patient discomfort, i.e. lifelong dysesthesia, i.e. painful sensation of the lower lip and chin area on the affected side. An alternative surgical procedure is coronectomy, which has first been described 25 year ago. Instead of complete tooth removal only the crown is extracted and the root is intentionally left in situ. A lower incidence of inferior alveolar nerve injury has been found with coronectomy in case of high-risk mandibular third molars, as was shown in randomized controlled trials. Coronectomy is presented in detail with indications as well as contraindications. A patient case is shown and recent literature is discussed.

Background: Coronectomy is the surgical removal of the crown of the tooth deliberately leaving part of its roots. This is done with the hope of eliminating the pathology caused, and since the roots are still intact, the integrity of the inferior alveolar nerve is preserved., Objective: The aim is to carry out a systematic review in order to be able to provide results and conclusions with the greatest scientific evidence possible., Material and Methods: A literature review is carried out through the following search engines: Pubmed MEDLINE, Scielo, Cochrane library and EMI. The level of evidence criteria from the Agency for Healthcare Research and Quality was applied, and the clinical trials' level of quality was analyzed by means of the JADAD criteria., Results: The following articles were obtained which represents a total of 17: 1 systematic review, 2 randomized clinical trials and 2 non-randomized clinical trials, 3 cohort studies, 2 retrospective studies, 3 case studies and 4 literature reviews., Conclusions: Coronectomy is an adequate preventative technique in protecting the inferior alveolar nerve, which is an alternative to the conventional extraction of third molars, which unlike the former technique, presents a high risk of injury to the inferior alveolar nerve. However, there is a need for new clinical studies, with a greater number of samples and with a longer follow-up period in order to detect potential adverse effects of the retained roots.

Nerve repositioning surgery is one of the treatments chosen for the patients with edentulous posterior atrophic mandible. Like any other treatments, this therapy has its advantages and disadvantages, indications and contraindications. The most important complication of this procedure is neurosensory disturbance. This problem may occur at different stages of the treatment. One common time when nerve damage happens is when the nerve is located outside the canal and drilling and insertion of the implant are performed. Accordingly, this report describes a simple and feasible method to retract and protect nerves outside the canal during the treatment of nerve transposition. This will reduce the risk of nerve damage.

Objectives: The solid/multicystic ameloblastoma is a slowly growing, locally invasive epithelial odontogenic tumour. In 80% of cases this lesion occurs in the mandible, mainly in the posterior region, and it is characterized by the involvement of the inferior alveolar nerve. A panoramic radiograph of a 43-year-old man with chronic deep pain in the posterior area of the mandible showed a multilocular radiolucent lesion with scalloped borders in the left mandibular ramus. After the execution of a computed tomography of the jaws, to accurately determine the limits of the lesion and the relationship with the the inferior alveolar nerve, the magnetic resonance imaging was used., Methods: The spatial relationship between the lesion and the inferior alveolar nerve was defined comparing different imaging methods: panoramic radiography, computed tomography and magnetic resonance imaging. T1-weighted fast spoiled gradient-recalled echo, T1-weighted fast imaging employing steady-state acquisition, T2-weighted interactive decomposition of water and fat with echo asymmetry least-squares estimation and Diffusion weighted imaging acquisition sequences were used on a 3.0 T unit., Results: Regarding the inferior alveolar nerve course and its spatial relationship with the mandibular lesion, magnetic resonance imaging provided more detailed spatial and structural information than other imaging methods., Conclusion: The described acquisition sequences allowed us to highlight the diagnostic efficacy of the magnetic resonance in the morpho-structural characterization of a maxillofacial lesion and showed the importance of this imaging method as an additional technique to the computerized tomography in the maxillofacial surgical planning, resulting in a risk reduction of the inferior alveolar nerve surgical injury., Key Words: Ameloblastoma, Mandibular Nerve, Magnetic Resonance Imaging, Tomography X-Ray Computed.

Data Sources: TPubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and the grey literature database SIGLE., Study Selection: Randomised controlled trials (RCTs) and non-randomised controlled trials (CCTs) that compared coronectomy with total removal for third molar extractions with high risk of nerve injury were included., Data Extraction and Synthesis: Data were extracted independently and in duplicate by two reviewers. Risk of bias was assessed according to the Cochrane Reviewers' Handbook. Meta-analysis and sensitivity analysis were performed., Results: Four studies (two RCTs and two CCTs) involving 699 patients and 940 third molars were included. Pooled risk ratios for coronectomy compared with total removal are shown in table 1.Coronectomy was changed to total removal during surgery due to root loosening or mobilisation in 2.3% to 38.3% of cases. In 0% to 4.9% of cases reoperation was required in the coronectomy group due to persistent pain, root exposure or persistent apical infections. Root migration was only reported in three studies and ranged from 13.2% to 85.9%., Conclusions: We suggest that coronectomy can protect inferior alveolar nerves in the extraction of third molars with high risk of nerve injury as compared with total removal, and that the risk ratios of post-operative infections were similar between the two surgical modalities.

Bone atrophy occurs after tooth extraction in the posterior mandible, placing the mandibular canal and its neural, arterial, and venous contents closer to the osseous facial aspect and the coronal crest. This proximity places the structure in danger of damage when dental implants are surgically placed to support fixed or removable prostheses. Several options are available to treat these areas for implant-supported fixed and removable complete or partial dentures. Osseous grafting and ridge expansion are surgical options that enable acceptance of standard sized dental implants but have serious morbidities. Additionally, vertical osseous augmentation is not predictable at this time. Narrow diameter dental implants can be placed to avoid the mandibular canal, but some bone volume situations preclude this. Very wide and very short (6.5 × 5 mm) dental implants may be placed at an angle in atrophic sites to successfully support fixed partial dentures. An anterior guidance occlusal scheme may be used in maxillary dentate patients or group function in maxillary complete denture patients. A 100 micron occlusal relief in fixed partial dentures in dentate patients may be required to account for natural tooth intrusion and to prevent occlusal overload of the implant-supported partial denture.