Tooth Multi-Sectioning with the Use of Magnification, for Extraction of a Deeply Impacted Lower Second Molar with Entrapment of the Inferior Alveolar Nerve: Report of a Case

Download Article

1 / Stilianos Dalambiras2 / Maria Lazaridou2 / Lambros Zouloumis2

1Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Greece, Agion Panton 4H Pefka Thessaloniki, PO 57 010 Greece
2Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Greece


Inferior alveolar nerve injury is one of the most serious complications of mandibular molar surgery and may lead to litigation for mal-practice. Entrapment of the inferior alveolar nerve to roots of an impacted mandibular molars is extremely rare. The aim of this case report is to stress the importance of tooth multisectioning with the use of magnification for the safe removal of a deeply impacted second molar with entrapment of the inferior alveolar nerve in its proximal root.

Keywords: Impacted Lower Molar; Inferior Alveolar Nerve; Entrapment; Magnification


  1. Robert RC, Bachetti P, Pogrel MA. Frequency of trigeminal nerve injuries following third molar removal. J Oral Maxillofac Surg, 2005; 63:732-735.
  2. Kraut RA, Chahal O. Management of patients with trigeminal nerve injuries after mandibular implant placement. J Am Dent Assoc, 2002; 133:1351-1354. [Crossref]
  3. Grotz KA, Al-Nawas B, De Aguiar EG, Schulz A, Wagner W. Treatment of injuries to the inferior alveolar nerve after endodontic procedures. Clin Oral Investig, 1998; 2:73-76.
  4. Chaushu G, Taicher S, Halamish-Shani T, Givel N. Medicolegal aspects of altered sensation following implant placement in the mandible. Int J Oral Maxillofac Implants, 2002; 17:413-415.
  5. Sisk Al, Hammer WB, Shelton DW, Joy ED. Complications following removal of impacted third molars. J Oral Maxillofac Surg, 1986: 44:855-859.
  6. Schultze-Mosgau S, Reich RH. Assessment of inferior alveolar and lingual nerve disturbances after dentoalveolar surgery, and of recovery of sensitivity. Int J Oral Maxillofac Surg, 1993; 22:214-217.
  7. Rood JP, Shehab BAA. The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg, 1990; 28:20-25.
  8. Blaeser BF, August MA, Donoff RB, Kaban LB, Dodson TB. Panoramic radiography risk factors for inferior alveolar nerve injury after third molar extraction. J Oral Maxillofac Surg, 2003; 61:417-421. [Web of Science]
  9. Ohman A, Kivijarivi K, Blomback U, Flygare L. Preoperative radiographic evaluation of lower third molars with computed tomography. Dentomaxillofacial Radiol, 2006; 35:30-35.
  10. Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, Berge SJ. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg, 2009, 38:964-971.
  11. Walker JEG. Inferior dental nerve perforating root. A case report. Br Dent J, 1968; 124:467-468.
  12. Howe GL, Poyton HG. Prevention of damage to the inferior dental nerve during the extraction of mandibular third molars. Br Dent J, 1960; 109:355-363.
  13. Hosein Kalantar Motamedi M. Impacted lower third molar and the inferior alveolar nerve. Oral Surg Oral Med Oral Pathol, 1999; 87:3-4.
  14. Mishra YC. Entrapment of the neurovascular bundle by the roots of an impacted mandibular third molar – A case report. Br J Oral Maxillafac Surg, 1987; 25:261-264.
  15. Pippi R. A case of inferior alveolar nerve entrapment in the roots of partially erupted mandibular third molar. J Oral Maxillofac Surg, 2010; 68:1170-1173. [Web of Science]
  16. Jerjes W, Upile T, Shah P, et al. Risk factors associated with injury to the inferior alveolar and lingual nerves following third molar surgery – revisited. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010; 109:335-345. [Web of Science]
  17. Miloro M, DaBell J, Neb O. Radiographic proximity of the mandibular third molar to the inferior alveolar canal. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2005; 100:545-549.
  18. Pogrel MA, Lee SJ, Muff DF. Coronectomy: A technique to protect the inferior alveolar nerve. J Oral Maxillofac Surg, 2004; 62:1447-1452.
  19. Garcia-Garcia A. Is coronectomy really preferable to extraction? Br J Oral Maxillofac Surg, 2006; 44:75.
  20. Drage N, Renton T. Inferior alveolar nerve injury related to mandibular third molar surgery: An unusual case presentation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2002; 93:358-361.
  21. Tay ABG. Buccal corticotomy for removal of deeply impacted mandibular third molars. Br J Oral Maxillofac Surg, 2007; 45:83-84.
  22. Jones TA, Garg T, Monaghan A. Removal of a deeply impacted mandibular third molar through a sagittal split ramus osteotomy approach. Br J Oral Maxillofac Surg, 2004; 42:365-368.
Citation Information: Balkan Journal of Dental Medicine. Volume 20, Issue 1, Pages 49–53, ISSN (Online) 2335-0245, DOI:, April 2016