Is early extraction really the silver bullet to avoid nerve injury in lower third molar removal?

I read the article ‘Early extraction: a silver bullet to avoid nerve injury in lower third molar removal?’ by Zhang et al. with great interest. The authors concluded that ‘lower third molar removal before the age of 23 is effective at avoiding some postoperative complications, especially nerve injury’. In their study there was no reversible paresthesia in the young patient group (≤23 years), suggesting that operations are ‘nerve injury free’, and safe in this group.

While it can be agreed that earlier extraction has several advantages, the prediction of inferior alveolar nerve (IAN) injury requires an individual estimation. According to our experience, approximately 12–15% of IAN exposures occur in patients below the age of 23. Moreover the influence of ethnicity on the mineralization status of third molars may be very different. Neither the fact of immature root development (‘apical foramen closed or not’) nor a universally stated, fixed age can determine a totally safe and riskless operation.

To illustrate my concerns, I would like to represent two cases, where lower third molar surgical removal was followed by IAN exposure with concurrent reversible paresthesia ( Figs 1 and 2 ).

Fig. 1
(a) Lower right impacted third molar at 15 years of age. (b) The same tooth in a panoramic radiograph of the patient at 20 years. The third molar root and the inferior alveolar canal (IAC) are superimposed and the upper cortex of the IAC is interrupted. (c) The IAN was exposed without visible injury intraoperatively (arrow). (d) The root conformation proves the interradicular nerve localization (arrow).

Jan 24, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Is early extraction really the silver bullet to avoid nerve injury in lower third molar removal?
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