Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan 1;24(1):e130-e135.
doi: 10.4317/medoral.22596.

The assesment of relationship between the angulation of impacted mandibular third molar teeth and the thickness of lingual bone: A prospective clinical study

D Menziletoglu  1 , M Tassoker, B Kubilay-Isik, A Esen
Affiliations

The assesment of relationship between the angulation of impacted mandibular third molar teeth and the thickness of lingual bone: A prospective clinical study

D Menziletoglu et al. Med Oral Patol Oral Cir Bucal. .

Abstract

Background: Our purpose was to investigate the relationship between the angulation of mandibular third molars and the thickness of the lingual bone, which can affect the risk of lingual nerve damage during lower third molars surgical extraction.

Material and methods: This study consisted of 104 patients (42 males and 62 females), aged between 18-42 years (24.67 ± 6.11 years). Cone Beam Computed Tomography (CBCT) images were taken for preoperative assessment. The teeth were divided into four groups according to their positions: mesioangular, distoangular, vertical and horizontal. Lingual bone thickness around impacted teeth were measured at three points: cementoenamel junction (CEJ) of the mandibular second molar, mid-root of the impacted third molar, and apex of the impacted third molar root. Two predisposing factors of lingual nerve damage were recorded: lingual bone perforated by the impacted tooth and lingual bone thinner than 1 mm. Additionally, buccolingual angulations of the teeth in each group were measured. Impacted mandibular third molars were removed in usual way. One week after surgery, the patients were evaluated regarding lingual nerve paresthesia.

Results: None of the 104 patients experienced paresthesia, including the ones who had teeth with close proximity with lingual nerve. The mean thickness of bone was 1.21±0.63 mm at CEJ of the second molar; 1.25±1.02 mm at the mid-root; and 1.06±1.31 mm at the apex. Horizontally impacted teeth had thinner lingual bone at mid-root level (p=0.016). Buccolingual angulated teeth were more often associated with perforated lingual bone (p=0.002). Buccolingual and mesial/distal angulation had negative correlation with lingual bone thickness (p<0.05).

Conclusions: As the buccolingual and mesiodistal angulations increase, lingual bone thickness decreases. Horizontally impacted teeth seemed to compromise the integrity of the lingual bone more than impacted teeth in other positions. During the surgery, thin or perforated lingual bone may result in displacement of the impacted tooth lingually.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement:The authors have declared that no conflict of interest exist.

Figures

Figure 1
Figure 1
A-Lingual cortical bone thickness at the level of cementoenamel junction of the mandibular second molar. B-Lingual cortical bone thickness at mid-root level of the impacted third molar. C- Lingual cortical bone thickness at the apex of third molar.
Figure 2
Figure 2
D- Lingual cortical plate perforation. E- Lingual cortical bone thinning (<1mm).
Figure 3
Figure 3
F-Mesio-distal angulation of the impacted third molar. G- Bucco-lingual angulation of the impacted third molar on an coronal CBCT slice.
See this image and copyright information in PMC

References

    1. Baqain ZH, Abukaraky A, Hassoneh Y, Sawair F. Lingual nerve morbidity and mandibular third molar surgery: a prospective study. Med Princ Pract. 2010;19:28–32. - PubMed
    1. Charan BHS, Reddy PB, Pattathan RK, Desai R, Shubha AB. Factors influencing lingual nerve paraesthesia following third molar surgery: a prospective clinical study. J Maxillofac Oral Surg. 2013;12:168–72. - PMC - PubMed
    1. Jerjes W, Upile T, Shah P, Nhembe F, Gudka D, Kafas P. Risk factors associated with injury to the inferior alveolar and lingual nerves following third molar surgery-revisited. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109:335–45. - PubMed
    1. Gulicher D, Gerlach KL. Sensory impairment of the lingual and inferior alveolar nerves following removal of impacted mandibular third molars. Int J Oral Maxillofac Surg. 2001;30:306–12. - PubMed
    1. Renton T, McGurk M. Evaluation of factors predictive of lingual nerve injury in third molar surgery. Br J Oral Maxillofac Surg. 2001;39:423–8. - PubMed

Publication types