Evaluation of Orthodontic Extrusion of Impacted Mandibular Third Molar in Close Proximity to Inferior Alveolar Nerve Prior to Extraction (A Clinical Trial)

Background: The impacted lower third molar is a prevalent condition that necessitates extraction in most cases. Injury to the IAN is a major complication. Its injury causes sensory dysfunction and numbness in the lower lip. The current study aimed to examine the use of orthodontic mini-screws in the maxillary bone and elastic power chain for orthodontic traction of the third molar, which is impacted near the mandibular canal, in order to limit the risk of nerve injury after extraction. Materials and methods: The trial featured nine participants, all of whom had their third molars surgically exposed. A button with a chain was placed on its crown, an orthodontic mini-screw was inserted into the maxillary bone, and a cross-arch elastic power chain was attached between the mini-screw and the metal chain. Postoperative follow-up and activation were performed every two weeks, and after traction, Cone Beam Computed Tomography (CBCT) was performed to confirm tooth separation from the mandibular canal, followed by surgical extraction. Brush stroke, two-point discrimination, and pinprick tests were used to assess the IAN's clinical neurosensory function two weeks following extraction, and a blink reflex test was performed preoperatively and two weeks after extraction. Results: All the extruded teeth were extracted quickly and rapidly without any IAN injury symptoms after extraction. Conclusions: The orthodontic extrusion technique, which employs an orthodontic maxillary mini-screw and an elastic power chain, is considered a safe method for extracting the impacted MTM near the IAN, with a lower risk of neurologic consequences.