Staged removal of horizontally impacted third molars to reduce risk of inferior alveolar nerve injury.

Damage to the inferior alveolar nerve (IAN) during third molar extraction is a major concern for patients and clinicians. A wide range of the incidence of temporary and permanent neurologic disturbances of the IAN as a consequence of mandibular impacted third molar extraction has been reported in the literature. The incidence of IAN injury reported in the literature ranges from 1.3% to 5.3%. The risk of this complication depends mainly on the position of the impacted tooth in relation to the inferior alveolar canal. To reduce this risk, several approaches have been proposed. Some authors advocated orthodontic-assisted extraction of the impacted mandibular third molars. Others introduced partial odontectomy, that is, the surgical removal of the anatomic crown leaving the roots in place. This case report describes a novel approach to the extraction of horizontally and mesially inclined impacted third molars with the root apexes in close contact with the IAN.