Mandibular Sagittal Split Osteotomy for Removal of Impacted Mandibular Teeth: Indications, Surgical Pitfalls, and Final Outcome.

PURPOSE: The purpose of this study was to determine the indications for mandibular sagittal split osteotomy (MSSO) for the removal of impacted mandibular teeth and to evaluate the surgical pitfalls and final outcomes.

PATIENTS AND METHODS: In this retrospective case-series study, radiologic and clinical data of all patients who underwent MSSO for the removal of impacted mandibular teeth between 2008 and 2015 at the University Hospitals of Geneva were reviewed. The primary outcome variables were 1) the indication for the removal of impacted mandibular teeth by MSSO, 2) complications, and 3) surgical pitfalls. Other variables included age, gender, teeth involved, indication for tooth removal, concomitant lesions such as cysts and/or tumors, and radiologic features.

RESULTS: In 18 consecutive patients, 21 impacted mandibular teeth (18 third molars, 2 second molars, and 1 first molar) were extracted by MSSO. In all patients the indication for the MSSO approach included deeply impacted teeth associated with an intimate relationship between the inferior alveolar nerve and the dental roots as shown on computed tomography or cone-beam computed tomography scan images. A non-disabling hypoesthesia of the inferior alveolar nerve developed in 6 patients (33.3%). Major complications occurred in 3 patients (16.6%), including 2 cases of infection (11.1%) and 1 case of a "bad split" (5.5%).

CONCLUSIONS: This study showed that the MSSO approach is a valuable method for removing deeply impacted teeth in proximity to the mandibular canal. Local factors, such as bone remodeling, concomitant large lesions (cysts and/or tumors), and the mandibular canal within the buccal cortex, represent pitfalls that might increase the risk of complications developing.