New insert for piezoelectric surgery in the avulsion of an impacted third molar

OBJECTIVES The aim of this paper is to illustrate how piezoelectric technology, and in particular the use of a new dedicated insert, is decisive in reducing the risk of neurological injury in cases of deep impaction of mandibular third molars, complicated by the relationship of these elements with the inferior alveolar nerve (IAN). MATERIALS AND METHODS It is described the avulsion of a carious and semi-included bony element 4.8, through whose roots the inferior alveolar nerve results incarcerated after performing level I and II radiographic investigations (orthopantomography and Cone Beam CT), is described. Because of this close anatomical relationship, the procedure is performed using piezoelectric technology and in particular the FF lever, Mectron (R) insert. RESULTS AND CONCLUSIONS The avulsion of mandibular third molars in bone impaction may be associated with intra- or post-operative complications, particularly when these elements are located near noble structures such as the inferior alveolar nerve. The pre-surgical planning must be based on classification criteria referring to a scrupulous objective examination and a careful analysis of radiographic examinations, which allow to categorize the type of impaction and therefore the difficulty of the extraction. Thanks to careful pre-surgical planning and the use of piezoelectric technology, it was possible to perform targeted odontotomies in a nearly bloodless operatory field, particularly during root separation. Both in the surgical revision of the socket and during the post-operative clinical follow-ups, the absence of neurological sequelae was reported in the patient. CLINICAL SIGNIFICANCE In agreement with the literature and with the well-established diffusion of piezoelectric technology in lower third molar surgery, considering the limitations of this study, the use of the new dedicated insert may be crucial in situations with high risk of neurological damage, with close contact between the lower alveolar nerve and the impacted element.