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. 2018 Dec 19;6(12):2395-2401.
doi: 10.3889/oamjms.2018.371. eCollection 2018 Dec 20.

Computer-Aided Design/Computer-Aided Manufacturing Cutting Guides for Odontectomy of Deeply Impacted Mandibular Third Molars

Mamdouhh Ahmed  1 , Mariam Kamel Salah  1 , Nesrine Khairy  1
Affiliations

Computer-Aided Design/Computer-Aided Manufacturing Cutting Guides for Odontectomy of Deeply Impacted Mandibular Third Molars

Mamdouhh Ahmed et al. Open Access Maced J Med Sci. .

Abstract

Aim: To evaluate a new technique for surgical removal of deeply impacted mandibular third molars (DIMTM), using computer-guided cutting guide to maintain inferior alveolar nerve (IAN) integrity and the covering buccal bone.

Patients and methods: Eighteen cases indicated for removal of DIMTM. Cone-beam Computed Tomography (CBCTs) used to determine the tooth's relation to the IAN. Computer-guided software used for fabrication of surgical cutting guide stent to expose the impacted tooth and repositioning of bone after odontectomy without fixation. Clinical assessment included a neurosensory deficit of IAN, pain using a visual analogue scale (VAS), facial swelling, and maximal mouth opening (MMO). CBCTs were taken immediately and six months postoperatively to evaluate position and healing of bone.

Results: None of the patients showed a permanent neurological deficit of IAN while all patients showed normal parameters of pain, facial swelling and MMO.

Conclusion: this technique has shown the accurate determination of the bony window cuts with subsequent preservation of IAN and external oblique ridge.

Keywords: Computer guided cutting guide; Deeply impacted mandibular third molar (DIMTM); External oblique ridge; Inferior alveolar nerve (IAN) injury.

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Figures

Figure 1
Figure 1
A) and B) Radiographic pictures of pre-operative CBCTs to determine the position of the impacted molar about the IAN
Figure 2
Figure 2
A) CBCT as DICOM files with virtual surgical planning determining the vertical cutting plans; B) Matic software with bone – borne cutting guide with the virtual cutting slots
Figure 3
Figure 3
A) The surgical cutting guide in place; B) the reciprocating saw; C) The FRIOS micro saw disc; D) The bony window cuts and the chisel for splitting the segment; E) The osteotomized bony segment; F) The impacted molar with the furcation after separation; G) The repositioning of the osteotomized bony segment after odontectomy
Figure 4
Figure 4
Column chart showing mean VAS score pre-and post-operatively
Figure 5
Figure 5
Column chart showing mean MMO (cm) pre-and post-operatively
Figure 6
Figure 6
Column chart showing mean facial swelling (cm) pre-and post-operatively
Figure 7
Figure 7
Immediate postoperative CBCTs radiograph
Figure 8
Figure 8
A), B) CBCTs; A) axial and B) coronal cuts 6 months postoperative showing normal bone healing
See this image and copyright information in PMC

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