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
Randomized Controlled Trial
. 2025 Jul 2;25(1):1036.
doi: 10.1186/s12903-025-06402-7.

Traditional vs. orthodontic extraction of impacted teeth related to the inferior alveolar nerve: a randomized control trial

Senem Askin Ekinci  1 , Zeynep Beyza Kiristioglu  2 , Ozan Ates  2 , Gokhan Gocmen  2
Affiliations
Randomized Controlled Trial

Traditional vs. orthodontic extraction of impacted teeth related to the inferior alveolar nerve: a randomized control trial

Senem Askin Ekinci et al. BMC Oral Health. .

Abstract

Background: The aim of this prospective randomized controlled trial was to compare the effects of orthodontic and traditional extraction methods on nerve injury following the extraction of impacted third molars close to the inferior alveolar nerve and to demonstrate the impact of factors such as gender, age, systemic diseases, the side of the third molar, its position, and classification on nerve recovery.

Methods: Patients with impacted third molars close to the inferior alveolar nerve and an indication for impacted third molar extraction were included in the study. The patients were divided into two groups according to the surgical approach to be applied.

Results: Preoperative 2-point discrimination (2PD) test values, as well as postoperative 2PD test and visual analog scales (VAS) values on the 7th day, 14th day, and 1st, 3rd, and 6th months, were compared. In the traditional extraction group, the results of the 2PD test were statistically significantly higher on the 7th day, 14th day, 1 month, and 3 months compared to the orthodontic extraction group (P < 0.05). Sex, age, systemic disease, M3 side, position, and classification had no statistically significant effect on nerve recovery (P > 0.05).

Conclusions: The orthodontic extraction was found to be safer than traditional extraction in terms of nerve injury for high-risk M3s.

Clinical trial registration: This study was registered on www.

Clinicaltrials: govin13/02/2024 .

Clinical trial number: NCT06270784.

Keywords: Impacted tooth; Inferior alveolar nerve; Mandibular nerve injuries; Orthodontic extrusion; Third molar; Tooth extraction.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The present study was performed according to the guidelines of the Helsinki Declaration and complied with the CONSORT guidelines. Ethical approval was obtained from Marmara University Faculty of Medicine Clinical Research Ethical Commitee (IRB Approval No. 09.2024.122). Every patient signed a written informed consent form. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Selecting the anchorage site according to the position of the mandibular third molar for orthodontic extrusion. The red arrows indicate the force vectors. (A-C) The mandibular ramus area was used in the mesioangular, horizontal, and vertical positions. (D) The zygomaticomaxillary buttress area was used in the distoangular position
Fig. 2
Fig. 2
The stages of the first operation of the orthodontic extraction group. (A) Preoperative orthopantomography image. (B) Incisional biopsy and osteotomy procedure following elevation of the mucoperiosteal flap. (C) Placement of an orthodontic button and mini-screw. Attachment of the elastic and ligature wire fixed to the button to the mini-screw. (D) Closure of the flap
Fig. 3
Fig. 3
Observation of orthodontic movement of the mandibular third molar on orthopantomography images. (A) Postoperative 7th day follow-up. (B) Postoperative third week follow-up. (C) Postoperative fifth week follow-up. (D) Postoperative seventh week follow-up
Fig. 4
Fig. 4
Comparison of the position of the mandibular third molar in preoperative and postoperative cone beam computed tomography images. (A) Preoperative cone beam computed tomography image. (B) Postoperative cone beam computed tomography image
Fig. 5
Fig. 5
The stages of the second operation of the orthodontic extraction group. (A) Preoperative intraoral view. (B) Elevation of the mucoperiosteal flap and the new position of the extruded mandibular third molar. (C-E) Extraction of the mandibular third molar. (F) Closure of the flap
Fig. 6
Fig. 6
CONSORT flow-diagram of patient selection and allocation
Fig. 7
Fig. 7
The distribution of patients present and not present inferior alveolar nerve injury in groups
See this image and copyright information in PMC

References

    1. Steel BJ, Surendran KSB, Braithwaite C, Mehta D, Keith DJW. Current thinking in lower third molar surgery. Br J Oral Maxillofac Surg. 2022;60(3):257–65. 10.1016/j.bjoms.2021.06.016. - PubMed
    1. Sarikov R, Juodzbalys G. Inferior alveolar nerve injury after mandibular third molar extraction: a literature review. J Oral Maxillofac Res. 2014;5(4):e1. 10.5037/jomr.2014.5401. - PMC - PubMed
    1. Flanagan D. Forced extrusion for removal of impacted third molars close to the mandibular Canal. Revista Española De Cirugía Oral Y Maxilofacial. 2012;34:25. 10.1016/j.maxilo.2011.10.003.
    1. Gencheva A, Georgiev T, Arnautska H, Ivanova G, Nogalchev K. Orthodontic extrusion followed by a surgical extraction of high-risk lower third molar: case report. Scripta Scientifica Medicinae Dentalis. 2016;2(2):33–8. 10.14748/ssmd.v2i2.1814.
    1. Bataineh AB. Sensory nerve impairment following mandibular third molar surgery. J Oral Maxillofac Surg. 2001;59(9):1012–7. 10.1053/joms.2001.25827. discussion 1017. - PubMed

Publication types

Associated data