Surgical approach to impacted mandibular third molars--operative classification. 2010

Imad Abu-El Naaj, and Refael Braun, and Yoav Leiser, and Micha Peled
Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Haifa, Israel.

OBJECTIVE The aim of the present study is to suggest a convenient way to classify the position of the impacted third mandibular molar relative to the mandibular canal and to suggest indications for the use of each surgical approach for mandibular third molar extraction. METHODS The presented new typing system, Third Molar Classification (TMC), is a simple and easy-to-apply method for the surgical management of mandibular third molars and can be extended for any ectopic or impacted mandibular tooth. There are 3 major types of third molar positions. The second type is subdivided further into 2 subtypes. In the present study, 9 patients with high-risk mandibular third molars were treated according to the present classification and are presented and discussed. Patients typed as TMC IIb were treated with a sagittal split osteotomy approach and patients typed as TMC III were treated with an extraoral approach. RESULTS The operative classification was successfully implemented in very rare cases of deeply impacted mandibular third molars. In 3 of 9 cases (33%) minor complications included some degree of hypoesthesia using the extraoral approach; these complications resolved spontaneously without the need for any intervention. CONCLUSIONS The present study describes the use of a new surgical classification system for treatment planning in all types of mandibular third molar extractions. We believe that the present classification could help the oral and maxillofacial surgeon in decision-making and limit the possible risks that are present when attempting to extract impacted mandibular third molars.

UI MeSH Term Description Entries
D008297 Male Males
D008334 Mandible The largest and strongest bone of the FACE constituting the lower jaw. It supports the lower teeth. Mylohyoid Groove,Mylohyoid Ridge,Groove, Mylohyoid,Grooves, Mylohyoid,Mandibles,Mylohyoid Grooves,Mylohyoid Ridges,Ridge, Mylohyoid,Ridges, Mylohyoid
D008340 Mandibular Nerve A branch of the trigeminal (5th cranial) nerve. The mandibular nerve carries motor fibers to the muscles of mastication and sensory fibers to the teeth and gingivae, the face in the region of the mandible, and parts of the dura. Alveolar Nerve, Inferior,Auriculotemporal Nerve,Buccal Nerve,Deep Temporal Nerve,Lateral Pterygoid Nerve,Masseteric Nerve,Mental Nerve,Mylohyoid Nerve,Auriculotemporal Nerves,Buccal Nerves,Deep Temporal Nerves,Inferior Alveolar Nerve,Inferior Alveolar Nerves,Lateral Pterygoid Nerves,Mandibular Nerves,Masseteric Nerves,Mental Nerves,Mylohyoid Nerves,Nerve, Auriculotemporal,Nerve, Buccal,Nerve, Deep Temporal,Nerve, Inferior Alveolar,Nerve, Lateral Pterygoid,Nerve, Mandibular,Nerve, Masseteric,Nerve, Mental,Nerve, Mylohyoid,Pterygoid Nerve, Lateral,Pterygoid Nerves, Lateral,Temporal Nerve, Deep,Temporal Nerves, Deep
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D008964 Molar, Third The aftermost permanent tooth on each side in the maxilla and mandible. Tooth, Wisdom,Teeth, Wisdom,Molars, Third,Third Molar,Third Molars,Wisdom Teeth,Wisdom Tooth
D011859 Radiography Examination of any part of the body for diagnostic purposes by means of X-RAYS or GAMMA RAYS, recording the image on a sensitized surface (such as photographic film). Radiology, Diagnostic X-Ray,Roentgenography,X-Ray, Diagnostic,Diagnostic X-Ray,Diagnostic X-Ray Radiology,X-Ray Radiology, Diagnostic,Diagnostic X Ray,Diagnostic X Ray Radiology,Diagnostic X-Rays,Radiology, Diagnostic X Ray,X Ray Radiology, Diagnostic,X Ray, Diagnostic,X-Rays, Diagnostic
D003751 Dental Fistula An abnormal passage in the oral cavity on the gingiva. Gingival Fistula,Dental Fistulas,Fistula, Dental,Fistulas, Dental,Fistula, Gingival,Fistulas, Gingival,Gingival Fistulas
D003803 Dentigerous Cyst Most common follicular odontogenic cyst. Occurs in relation to a partially erupted or unerupted tooth with at least the crown of the tooth to which the cyst is attached protruding into the cystic cavity. May give rise to an ameloblastoma and, in rare instances, undergo malignant transformation. Cyst, Dentigerous,Cysts, Dentigerous,Dentigerous Cysts
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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