Orthodontic extraction of a mandibular third molar to avoid nerve injury: A case report

Surgical removal of impacted mandibular third molars is a common procedure with the potential of causing side-effects such as inferior alveolar nerve (IAN) injury and damaging of adjacent tissues. Orthodontic extrusion of such molars is an alternative treatment modality that reduces unwelcome risks. This case report presents the orthodontic extrusion and consequent surgical extraction of an impacted mandibular third molar intersecting the IAN canal and the 6-month follow-up status. A 41-year-old female with facial pain on the left side as the main complaint was diagnosed with a severely impacted mandibular third molar that required extraction. Radiographic evaluation revealed the critical proximity of the tooth to the IAN. The impacted third molar was surgically exposed and closed orthodontic extrusion protocol with light forces was administered. The third molar was surgically extracted following a 9-month traction period and bone healing was monitored for 6 months. The facial pain reduced gradually following the extrusion of the impacted molar. No neurological complications were observed immediately after and during the long-term follow-up the surgical extraction. Clinically and radiographically, significant healing distal to the second molar was obtained at the end of follow-up period. Orthodontic extrusion and surgical extraction of severely impacted third molars may be an alternative treatment modality that facilitates easier surgical procedures with lower neurological risks.