Coronectomia em terceirosmolares inferiores: relato de dois casos / Coronectomy in inferior third molars: two cases case reports

A parestesia do nervo alveolar inferior, uma complicação decorrente de cirurgias de terceiros molares inferiores, é passível de acontecer principalmente quando sinais radiográficos indicam um íntimo contato das raízes com o canal da mandíbula. A tomografia computadorizada cone beam é o exame que confirma esse contato. Para estes casos, a coronectomia é uma opção cirúrgica, na qual é realizada a remoção apenas da porção coronária, com a manutenção das raízes localmente, minimizando, desta forma, o risco de parestesia. Objetivo: Apresentar o relato de dois casos clínicos de coronectomia no manejo de terceiros molares inferiores cuja radiografia panorâmica evidenciava íntima relação das raízes com o canal da mandíbula. Relato do caso: A técnica cirúrgica utilizada foi a mesma em ambos os casos. Sob anestesia local, realizou-se uma incisão tipo envelope, e o descolamento do retalho mucoperiostal. A osteotomia vestibular e distal foi realizada, expondo o dente ao nível da junção cemento-esmalte. Em seguida, iniciou-se a odontosecção, sendo realizada com uma extensão de 2/3 no sentido vestíbulo-lingual e 2 mm abaixo da junção cemento-esmalte; uma alavanca foi utilizada para separar a coroa das raízes. Realizou-se, por fim, o acabamento da superfície, deixando a superfície radicular 3 mm abaixo da crista óssea. Não houveram intercorrências trans ou pós-operatórias. Os pacientes permanecem sob acompanhamento radiográfico anual. Conclusão: A coronectomia é uma técnica eficaz, que reduz o risco de parestesia alveolar inferior, após a cirurgia de terceiros molares inferiores, cujas raízes estão próximas ao canal da mandíbula...

Oroantral communication is a pathological communication that occurs between the oral cavity and the maxillary sinus. When this communication suffers epithelialization it is called oroantral fistula. It can occur mainly after extraction of posterior maxillary teeth, due to the close relationship between their roots and the maxillary sinus floor. Aim: To present the surgical options for the treatment of oroantral communication and report a case of a large oroantral fistula, explaining the technique step. Case Report: Female patient female, 37-year-old, presented bucossinusal fistula in the left upper molars area and was surgically treated for its closure. Under local anesthesia an incision was made around the fistula, cutting epithelial tissue to allow the union of the wound edges, and it was sutured by layers: initially sinus mucosa with 4-0 catgut and then the gums, with nylon. The suture was removed 10 days later and by this time the complete closure of the fistula was observed. Conclusion: The decision of which treatment modality to use for oroantral communication is influenced by many factors, such as its size, the tissue conditions and the surgeon’s skills. The surgical technique presented in this case proved effective and easy to perform, with a confortable postoperative period for the patient and with no recurrence of the communication...

Correlation between radiographic signs of third molar proximity with inferior alveolar nerve and postoperative occurrence of neurosensory disorders: A prospective, double-blind study

PURPOSE: To evaluate the interference of radiographic factors in the appearance of sensory deficit related to inferior alveolar nerve (IAN) after third molars (3Ms) removal. METHODS: A prospective, double-blind, observational, unicentric study was performed with 126 patients submitted to a surgical procedure of lower 3Ms removal in the period from March to October/2011. Collected data included gender, age, eruption stage of 3Ms, position/angle of 3Ms (Pell-Gregory and Winter classifications, respectively), presence/absence of radiographic signs of 3Ms proximity with the inferior alveolar canal and surgical technique. Occurrence evaluation of the IAN injury was performed on the seventh postoperative day through pin-prick, two-point discrimination and brush directional stroke tests. RESULTS: Predominant radiographic signs were: narrowing of the inferior alveolar canal (68.25%), darkening of root (46.82%) and diversion of the canal (31%). None of the patients presented sensory loss. Sixty-one (48.41%) of the cases had at least one or two radiographic signs of proximity with NAI. Forty-seven (37.3%) had 3 or more signs, and 18 (14.29%) did not have any radiographic signs of proximity to mandibular canal. CONCLUSION: There was not a positive correlation between presence of radiographic signs of 3Ms with IAN proximity and postoperative neurosensory disorders occurrence.

Lower third molar region / Región del tercer molar inferior

The lower third molar region is an important region for the odontostomatological practice, since it presents a great amount of pathological processes related to the development and eruption of the third molar; thus having a considerable number of surgical interventions. Despite its importance, this region is not accounted for in anatomical terminology nor is it described in topographic anatomy; and in spite of the great number of studies that analyze the surgical anatomy of the region, it is necessary to systematize the description of its boundaries, planes, content, risk elements, anatomical repairs, etc.; therefore, the purpose of the present article is to review the modern concepts related to the surgical anatomy of the lower third molar region and to establish a description based on these concepts...

La región del tercer molar inferior es una región importante para la práctica odontoestomatológica, en ella se presenta una gran cantidad de procesos patológicos relacionados con el desarrollo y erupción del tercer molar, por lo que se practican un gran número de intervenciones quirúrgicas. No obstante su importancia, esta región no se encuentra considerada en la terminología anatómica ni descrita en la anatomía topográfica y a pesar de la gran cantidad de estudios que analizan la anatomía quirúrgica de la región, es necesario sistematizar la descripción de sus límites, planos, contenidos, elementos de riesgo, puntos de reparo, etc., es por ello que el propósito de este artículo es revisar los conceptos modernos relacionados con la anatomía quirúrgica de la región del tercer molar inferior y proponer una descripción basada en estos conceptos...

Lingual nerve morbidity and mandibular third molar surgery: a prospective study

The objective of this study was to estimate the frequency of postoperative lingual nerve [LN] impairment after the surgical removal of mandibular third molars [M3] and to identify potential risk indicators. A prospective cohort study involving 321 subjects who had 443 mandibular M3 surgically extracted at the University Hospital, Amman, Jordan. Predictor variables were categorized as patient-, anatomy- and operation-specific. The outcome variable was the presence or absence of LN impairment. Bivariate and multivariate analyses were performed to identify independent predictors. The prevalence of temporary LN hypoesthesia was 2.5% and all 11 cases resolved within 6 months. Factors that predicted LN injury by univariate analysis were horizontal and mesioangular tooth angulation, bone removal, tooth sectioning, longer operations, lingual flap retraction and bleeding into the socket. In the multivariate logistic regression model, lingual flap retraction [p = 0.002, OR = 26.790] and bleeding into the socket [p = 0.044, OR = 4.918] were the independent predictors. Operative variables were the main predictors of temporary LN damage