Endoscopically assisted removal of a lingually displaced third molar adjacent to the inferior alveolar nerve

Osteotomy of impacted lower third molars still represents a major trauma because of periosteal flap preparation and buccal bone loss. We present a new occlusal flapless approach for the removal of lingually impacted lower third molars adjacent to the inferior alveolar nerve without lateral or lingual osteotomy.

After occlusal exposure under local anesthesia, visualization of the third molar region is obtained from a posterior perspective using support endoscopy. Under magnifying endoscopic visualization, the crown is removed using an inward fragmentation technique. After exposure of the furcation area, the roots are separated and removed via the occlusal cavity.

Endoscopically assisted removal of mandibular third molars allows the maintenance of the adjacent bone structures and the integrity of the mandibular canal. It is valuable in complex anatomic sites in particular.