The effect of surgical technique on lingual nerve damage during lower 3rd molar removal by dental students

We have previously shown that avoidance of lingual flap retraction with a Howarth periosteal elevator during lower 3rd molar removal, reduces the incidence of lingual nerve damage. In that study, the surgery was undertaken by qualified staff and we have now assessed the effect of revising the method taught to our junior undergraduate dental students. We evaluated the outcome of surgery undertaken by 2 consecutive years of students, each group being taught 1 of the 2 methods. A total of 200 patients requiring lower 3rd molar removal under local anaesthesia were included in the study. In year 1, the surgery included elevation of a lingual flap and insertion of a Howarth elevator adjacent to the lingual plate; in year 2 this part of the procedure was avoided by using a purely buccal approach. There were no significant differences between the levels of tooth eruption and types of impaction of the teeth removed in each year. Lingual sensory disturbance occurred in 3 patients in the 'flap' group (3.3%) and in 1 patient (0.9%) in the 'no flap' group. As this incidence is not significantly different in the 2 groups (P < 0.4), we conclude that avoidance of lingual retraction by students undertaking lower 3rd molar removal does not appear to place the lingual nerve at greater risk. In view of the results of our previous study, we therefore advocate this method for use in undergraduate dental education.