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Virtual Surgical Planning-Assisted Mandibular Sagittal Split Osteotomy for Complex Third Molar Extraction.

Gabriel Conceição Brito1, Maria Júlia Assis Vicentin Calori1, Márcio de Moraes1

  • 1Division of Oral and Maxillofacial Surgery, Universidade Estadual de Campinas, Piracicaba, São Paulo, Brazil.

The Journal of Craniofacial Surgery
|August 14, 2025
PubMed
Summary

Mandibular sagittal split osteotomy (MSSO) with virtual surgical planning offers a safe method for impacted third molar extraction. This technique successfully removed a complex impacted molar while preserving the inferior alveolar nerve.

Keywords:
Sagittal split ramus osteotomythird molarsvirtual surgery planning

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Dental Implantology
  • Surgical Planning

Background:

  • Impacted third molars pose significant surgical challenges, particularly when anatomically complex or near critical structures like the inferior alveolar nerve.
  • Limited mouth opening and tongue mobility can further complicate standard extraction procedures.

Purpose of the Study:

  • To report a rare application of mandibular sagittal split osteotomy (MSSO) for the extraction of a horizontally impacted third molar.
  • To evaluate the efficacy and safety of virtual surgical planning and 3D-printed guides in conjunction with MSSO for complex third molar removal.

Main Methods:

  • A 32-year-old male with a horizontally impacted right mandibular third molar underwent extraction using MSSO.
  • Virtual surgical planning was employed, and a 3D-printed surgical guide was utilized for procedural execution.
  • The osteotomy site was stabilized with a 2.0 4-hole miniplate post-extraction.

Main Results:

  • Successful extraction of the impacted third molar was achieved.
  • The inferior alveolar nerve was preserved during the procedure.
  • No postoperative complications or adverse occlusal changes were observed.

Conclusions:

  • Mandibular sagittal split osteotomy (MSSO), augmented by virtual surgical planning and 3D guides, is a viable and safe approach for extracting impacted third molars in challenging anatomical positions.
  • This technique minimizes risks associated with nerve injury and ensures predictable outcomes in complex cases.