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Article: Volume 44 Number 3 Page 221 - March 2017

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  Dent Update 2017; 44: 221-228

Oral surgery:  Treatment Planning for Mandibular Third Molars

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Abstract: NICE guidance for mandibular third molars has been available since 2000. This was set up to limit the surgical treatment of these teeth to symptomatic patients. There are numerous risks involved with surgical treatment of mandibular third molars and these should be explained in detail to the patient. Common and serious complications of mandibular third molar surgery are damage to the inferior alveolar and lingual nerve. Predicting the risk of inferior alveolar nerve injury is useful for treatment planning. The orthopantomogram (OPT) is the baseline special test for assessing this and numerous signs on an OPT can predict an increased risk of injury to the nerve. Cone beam computed tomography (CBCT) is being more frequently used to assess this relationship further and can influence treatment planning. Coronectomy is a technique whereby the crown of the tooth is sectioned and removed leaving the roots in situ. This has proven to be a useful technique in high risk cases, but is not without its own complications. The increase in availability of CBCT imaging and the recent resurgence of coronectomy as a treatment modality can increase the number of treatment options available to patients. We have proposed an algorithm to aid the treatment planning and informed consent processes associated with mandibular third molar surgery.

Clinical relevance: This article is relevant to primary and secondary care dental practitioners as it will aid the investigation, treatment planning, correct referral and management of patients with problematic mandibular third molars.

Author notes: James Barraclough, BDS(Hons), MFDS, DCT2, Leeds General Infirmary, Andrew Power, BChD, MBChB, MFDS, MRCS, Maxillofacial Registrar, Yorkshire and the Humber and Amit Pattni BDS, MFDS RCS(Edin), StR Oral Surgery, Yorkshire and the Humber.

Objective: To explain the selection of patients for surgical treatment of mandibular third molars within the NICE guidance, the difference between surgical removal and coronectomy and their risks and assess the risk of damage to the inferior alveolar nerve radiographically on OPT and understand when to consider CBCT.