from 01.01.2019 to 01.01.2024
Moscow Medical University "Reaviz" (Dental Surgeon, Prosthodontist)
employee
Moscow, Moscow, Russian Federation
Moscow, Moscow, Russian Federation
employee
Samara, Samara, Russian Federation
Moscow, Moscow, Russian Federation
student
Moscow, Moscow, Russian Federation
UDC 616.31
CSCSTI 76.29
Background: Removal of impacted mandibular third molars carries a risk of inferior alveolar nerve (IAN) injury due to the anatomical proximity of the tooth roots to the mandibular canal. The key and technically most challenging step of the operation is the creation of surgical access and the elevation of the mucoperiosteal flap, especially in the retromolar area, where dense periosteal adhesion to the bone and the presence of tendinous fibers of the temporalis muscle predispose to instrument slippage. Objective: To present a clinical case of successful use of an individualized surgical navigation template for creating operative access during removal of a highly complex impacted 4.8 tooth. Methodology: A digital planning protocol was used: cone-beam computed tomography (CBCT), intraoral scanning, data fusion in software, and 3D printing of the template from sterilizable photopolymer. Surgery was performed to remove impacted tooth 4.8 (Winter class – C, Pell-Gregory – class III) in a 25-year-old patient. Outcomes were assessed clinically (pain using a visual analogue scale (VAS), neurological status, flap condition) and radiographically at 3, 10, 30 days, and 3 and 6 months. Results. The template enabled precise incisions and guided flap elevation without instrument slippage, providing excellent visualization of the osteotomy site. Tooth extraction was performed with minimal trauma. Total operation time was 22 minutes, flap elevation time was less than 2 minutes. The postoperative period was uneventful with no neurological complications; VAS pain scores were 3 on day 1, 1.5 on day 3, and 0 on day 10. At 6 months, CBCT showed complete bone regeneration of the socket. Conclusion. The use of an individualized surgical navigation template resolves the problem of difficult mucoperiosteal flap elevation in the retromolar area, minimizes the risk of periosteal elevator slippage, and improves visualization of the surgical field.
impacted third molar, individualized surgical navigation template, mucoperiosteal flap, retromolar area, inferior alveolar nerve
1. Kuz'mina E.M., Yanushevich O.O. Profilakticheskaya stomatologiya: uchebnik. 2-e izd., pererab. Moskva: Prakticheskaya medicina; 2023. 539 s. [Kuzmina E.M., Yanushevich O.O. Preventive dentistry: textbook. 2nd ed., revised. Moscow: Prakticheskaya meditsina; 2023. 539 p.].
2. Badalyan V.A., Drobot G.V., Brutyan V.A., Kopylov M.V. Metodika udaleniya retinirovannyh tret'ih molyarov pri tesnom raspolozhenii s nizhneal'veolyarnym nervom. Klinicheskaya stomatologiya. 2019;(2):58-61. [Badalyan V.A., Drobot G.V., Brutian V.A., Kopilov M.V. Method for removal of impacted third molars in close proximity with the lower alveolar nerve. Clinical Dentistry (Russia). 2019;(2):58-61. (In Russ.)]. https://doi.org/10.37988/1811-153X_2019_2_58
3. Mihaylov E.M., Karimova L.M., Larionova D.V., Tinyukova V.A. Udalenie retinirovannyh i distopirovannyh zubov mudrosti. Biologiya i integrativnaya medicina. 2026;(2):82-89. [Mikhailov E.M., Karimova L.M., Larionova D.V., Tinyukova V.A. Removal of retinated and dystopian wisdom teeth. Biologiâ i integrativnaâ medicina. 2026;(2):82-89. (In Russ.)]. https://doi.org/10.24412/cl-34438-2026-280-82-89
4. Guseynov N.M., Shafieva A.E., Zhirnova Ya.A. Oslozhneniya posle udaleniya tret'ih molyarov: analiz faktorov riska i profilaktika. Vestnik nauki. 2025;2(4):935-940. [Guseynov N.M., Shafieva A.E., Zhirnova Ya.A. Complications after the removal of the third molars: risk factor analysis and prevention. Vestnik nauki. 2025;2(4):935-940. (In Russ.)]. https://www.vestnik-nauki.rf/article/22297
5. Iordanishvili A.K., Ponomarev A.A., Korovin N.V., Lyskov N.V. Oslozhneniya posle udaleniya zubov mudrosti i ih lechenie. Kurskiy nauchno-prakticheskiy vestnik «Chelovek i ego zdorov'e». 2017;(2):24-28. [Iordanishvili A.K., Ponomarev A.A., Korovin N.V., Lyskov N.V. Complications after wisdom teeth extraction and their treatment. Kursk Scientific and Practical Bulletin "Man and His Health". 2017;(2):24-28. (In Russ.)]. https://doi.org/10.21626/vestnik/2017-2/04
6. Gayvoronskiy I.V., Nikolenko V.N., Iordanishvili A.K., Gayvoronskaya M.G., Ponomarev A.A. Anatomicheskie prichiny razvitiya retencii tret'ih molyarov na nizhney chelyusti. Kurskiy nauchno-prakticheskiy vestnik "Chelovek i ego zdorov'e". 2015;(2):61-65. [Gaivoronskiy I.V., Nikolenko V.N., Iordanishvili A.K., Gaivoronskaya M.G., Ponomarev A.A. Anatomical reasons for the retention of third molars on mandibula. Kursk Scientific and Practical Bulletin "Man and His Health". 2015;(2):61-65. (In Russ.)]. https://elibrary.ru/item.asp?id=23757109
7. Gasparyan K.K., Mostovoy S.O., Volobuev V.V., Uvarova A.G. Formirovanie operativnogo dostupa pri udalenii retenirovannyh zubov na nizhney chelyusti: klinicheskie sluchai. Stomatologiya detskogo vozrasta i profilaktika. 2024;24(4):399-406. [Gasparyan K.K., Mostovoy S.O., Volobuev V.V., Uvarova A.G. Approaches to surgical access for impacted tooth removal in the mandible: clinical case reports. Pediatric dentistry and dental prophylaxis. 2024;24(4):399-406. (In Russ.)]. https://doi.org/10.33925/1683-3031-2024-845
8. Panin A.M., Afanas'ev V.V., red. Hirurgicheskaya stomatologiya i chelyustno-licevaya hirurgiya. Tematicheskie testy. Chast' 2. Moskva: GEOTAR-Media; 2009. 768 s. [Panin A.M., Afanasyev V.V., eds. Surgical dentistry and maxillofacial surgery. Thematic tests. Part 2. Moscow: GEOTAR-Media; 2009. 768 p. (In Russ.)]. http://www.studentlibrary.ru/book/ISBN9785970412466.html
9. Vasil'chenko G.A. Anatomicheskie predposylki zatrudnennogo prorezyvaniya nizhnih tret'ih molyarov (kraniologicheskoe i klinicheskoe issledovanie): avtoreferat dissertacii na soiskanie uchenoy stepeni kandidata medicinskih nauk. Sankt-Peterburg; 2012. 20 s. [Vasilchenko G.A. Anatomical prerequisites for difficult eruption of lower third molars (craniological and clinical study): abstract of a dissertation for the degree of candidate of medical sciences. St. Petersburg; 2012. 20 p. (In Russ.)]. https://rusneb.ru/catalog/000200_000018_RU_NLR_bibl_1948260/?ysclid=mqeuv4tx9d216232676
10. Alevoryan S.S., Kolomycev K.A., P'yanov V.V. Udalenie retinirovannyh distopirovannyh zubov. Vestnik nauki. 2024;1(12):1572-1580. [Alevorian S.S., Kolomytsev K.A., Pyanov V.V. Removal of retinated dystopian teeth. Vestnik nauki. 2024;1(12):1572-1580. (In Russ.)]. https://elibrary.ru/item.asp?id=75141476
11. Zayavka na izobretenie № 2026106317. Rossiyskaya Federaciya. [Invention application No. 2026106317. Russian Federation. (In Russ.)]. https://www1.fips.ru/iiss/document.xhtml?faces-redirect=true&id=20b082b2a2d47cf32f81da97c11fee79
12. Rabinovich S.A., Vasil'ev Yu.L., Velichko E.V., Daravushe H.M.C. Mestnoe obezbolivanie v stomatologii: obrazovatel'nye, klinicheskie i yuridicheskie aspekty. Moskva: Libri plyus; 2023. 130 s. [Rabinovich S.A., Vasiliev Yu.L., Velichko E.V., Daravushe Kh.M.S. Local Anesthesia in Dentistry: Educational, Clinical and Legal Aspects. Moscow: Libri Plus; 2023. 130 p. (In Russ.)].
13. Volohov O.I., Podgornaya N.V., Daraushe H.M., Meylanova R.D., Kanukoeva E.Yu., Pavlov A.V. Anatomicheskie osobennosti stroeniya retromolyarnogo treugol'nika nizhney chelyusti kak celevogo punkta mestnogo obezbolivaniya v stomatologii i chelyustno-licevoy hirurgii. Operativnaya hirurgiya i klinicheskaya anatomiya (Pirogovskiy nauchnyy zhurnal). 2024;8(2):51-58. [Volokhov O.I., Podgornaya N.V., Darawsheh H.M., Meylanova R.D., Kanukoeva E.Yu., Pavlov A.V. Anatomical features of the structure of the mandibular retromolar triangle as a target point for local anesthesia in dentistry and maxillofacial surgery. Russian Journal of Operative Surgery and Clinical Anatomy. 2024;8(2):51‑58. (In Russ.)]. https://doi.org/10.17116/operhirurg2024802151
