Removal of a severely impacted mandibular third molar minimizing the risks of compromised periodontium, nerve injury, and mandibular fracture

A technique is presented for severely impacted and dentigerous-cyst-related mandibular third molar removal, avoiding any associated risks. Case Presentation: A healthy patient complained about unpleasant smell and taste in the mouth and unilateral extraoral palpation of a protuberance, at the right corner of the mandible. Restricted field CBCT showed a severely impacted third molar, which penetrated the inferior cortical bone of the mandibular corner and was associated with a dentigerous cyst that had resorbed considerable bone in the region. Surgical exposure of the impacted tooth and cyst marsupialization procedures under local anesthesia were combined with orthodontic extrusion of the impacted tooth to facilitate third molar removal. Treatment resulted in successful bone formation and safe tooth removal. The symptoms gradually improved after the first surgery and were eliminated by 14 months later, when the third molar was removed. Follow-up examination 1 year after removal showed favorable periodontal conditions. Conclusion: Although it is not normally the first treatment of choice, orthodontically assisted impacted tooth removal is an alternative that can minimize the risk of compromised periodontium or injury to the adjacent tooth and the inferior alveolar nerve, as well as the risk of mandibular fracture, in complicated cases. Keywords: dentigerous cyst, extraction, impacted tooth, marsupialization, orthodontic extrusion, third molar