Conservative Management of a Partially Impacted Mandibular Second Molar at Risk of Inferior Alveolar Nerve Injury...

This case report describes the conservative management of an incompletely erupted, subgingivally positioned mandibular right second molar with extensive caries and periapical pathosis in close anatomical relationship to the IAN canal. Complete extraction was initially considered as a provisional treatment option; however, CBCT revealed partial encirclement of the IAN canal by the roots, leading to a conservative treatment plan comprising root canal treatment followed by coronectomy. The initial treatment involved the extraction of tooth 48, followed by root canal treatment and tooth restoration of tooth 47; the patient declined coronectomy. At the 1-year follow-up, the patient was asymptomatic and periapical radiographs and CBCT scans indicated substantial periapical healing and preservation of the IAN. This case illustrates the role of CBCT-guided conservative endodontic management of impacted teeth as a viable alternative to extraction in high-risk anatomical situations.