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Published on: October 18, 2021
A Review of In-Office Dynamic Image Navigation for Extraction of Complex Mandibular Third Molars
Robert W Emery1, Oxana Korj2, Ravi Agarwal3
1Senior Attending Surgeon, Department of Oral and Maxillofacial Surgery, Washington Hospital Center, Washington, DC.
Summary
This study shows dynamic image navigation systems (DINS) enable successful in-office removal of complex mandibular third molars. The technology offers improved visualization and control, aiding complex surgical procedures.
Area of Science:
- Oral and Maxillofacial Surgery
- Surgical Navigation Technologies
- Dental Implantology
Background:
- Complex mandibular third molar extractions pose significant surgical challenges.
- Minimally invasive techniques are sought to improve patient outcomes and reduce complications.
- Dynamic image navigation systems (DINS) offer potential advancements in surgical precision.
Purpose of the Study:
- To evaluate the efficacy and safety of using a dynamic image navigation system (DINS) for in-office removal of complex mandibular third molars.
- To assess the potential benefits and limitations of DINS in this surgical context.
Main Methods:
- Retrospective review of 25 cases of complex mandibular third molar extractions (Juodzbalys and Daugela complexity score ≥ 9) performed between 2010-2014.
- Utilized custom intraoral splints for tracking array fixation and cone-beam computed tomography (CBCT) for image acquisition.
- All procedures employed a precalibrated tracking straight handpiece under dynamic navigation guidance.
Main Results:
- Successful treatment in all 25 cases using DINS.
- Twelve cases involved pathologic lesions; three patients experienced inferior alveolar nerve paresthesia.
- One patient had a pathologic fracture, seven had postoperative infections, and one had temporary mouth opening limitation.
- One coronectomy was performed.
Conclusions:
- Dynamic image navigation system (DINS) facilitates successful in-office removal of complex mandibular third molars.
- Potential advantages include enhanced visualization, improved surgical control, reduced bone removal, and suitability for in-office procedures.
- Limitations include increased cost, presurgical planning time, and a learning curve.
