Hard Tissue Preservation in Minimally Invasive Mandibular Third Molar Surgery Using In Situ Hardening TCP Bone Filler

Maintenance of hard tissue in the case of impacted third molars (M3M) with close relationship to the mandibular canal is still a surgical challenge which may be overcome using the inward fragmentation technique.

A consecutive case series of 12 patients required the extraction of 13 impacted M3M with a close relationship to the inferior alveolar nerve (IAN). Via occlusal miniflaps, M3M were exposed occlusal under endoscopic vision and removed by inward fragmentation. All patients received socket preservation with resorbable in situ hardening TCP particles to reduce the risk of pocket formation at the second molar.

All 13 sites healed uneventfully. Bone height was assessed using CBCT cross-sectional reformats pre- and 3 months postoperatively. The bone height was reduced by 1.54 mm lingual (SD 0.88), 2.91 mm central (SD 0.93), and 2.08 mm buccal (SD 1.09). Differences were significant at a 0.05% level. No tissue invagination at the extraction sites was observed.

Major bone defects can be avoided safely using inward fragmentation surgery. The self-hardening bone filler appears to enhance the mineralization of the intrabony defect.