Two-stage Method for the Extraction of a Horizontally Impacted Lower Third Molar

A modification of the surgical technique for extracting impacted lower third molars is required to decrease the rate of complications including inferior alveolar nerve injury. In this study, a new two-stage extraction method for the horizontally impacted lower third molar was developed. During the first stage, only the crown was removed after separating the impacted tooth at the neck. Thereafter, the root(s) was pulled toward the anterior direction with an elastic band at 130–150 g over a 7-day period. Next, the root(s) was extracted. This method was firstly attempted for 20 horizontally impacted lower third molars, the roots of which had been close to the mandibular canal in panoramic radiographs and were pulled for 20.8 ± 11.5 (n = 20) days. The roots in 17 of 20 cases (85%) were loosened from the sockets and extracted easily without any complications. These outcomes suggest that this two-stage method is useful for the extraction of a horizontally impacted lower third molar in order to decrease the rate of inferior alveolar nerve injury.