The Buccal Lid Approach for Removal of Impacted Mandibular Molars—When, How and Why?

Abstract

Background: The surgical removal of impacted mandibular molars represents one of the most prevalent procedures carried out by the oral and maxillofacial surgeon. Despite its prevalence, unusual impaction location of mandibular molars necessitates alternative extraction approaches. One of the methods described for extraction of deeply impacted molars is the bony lid approach which was first presented for surgical endodontic treatment of mandibular molars. The aim of this study was to evaluate the outcome of the bony lid approach in extracting mandibular molars. In addition, critical clinical key points, new aspects while performing this procedure, indications and contraindications are discussed. Materials and Methods: 9 patients were treated with the bony lid technique. A retrospective analysis of medical charts was conducted to evaluate the results of surgery. Results: The operative technique described in the article was successfully carried out in 12 cases of impacted mandibular molars. No incidence of permanent sensory deficit was recorded. In one patient, an infection mandated the removal of the bony lids. In all other cases the healing process was uneventful. Conclusion: The bony lid technique has many advantages over alternative extraction methods and should be considered as a treatment option in cases of critical proximity between an impacted tooth and the inferior alveolar nerve.

The Bone Lid Technique in Oral and Maxillofacial Surgery: A Scoping Review

“…In half of the included papers, the surgical procedures were performed under local anesthesia, while in the other three articles, they were also completed in combination with conscious sedation [4,46] or general anesthesia [17,46]. In three studies, the surgeries were carried out either under general or local anesthesia [48,52,54]. The remaining four articles reported no information regarding the type of anesthesia [3,51,53,56].…”

“…Rotary instruments, sometimes in combination with chisels, were also used to create the bony windows. The majority of neuronal complications were reported when disks and burs were utilized [1,25,47,48,54,55], whereas only one case of permanent paresthesia occurred with piezosurgery [4].…”

“…Bone lid resorption, necrosis, and removal were rather infrequent, as only 20 cases were found out of 752, of which 5 were in the maxilla [26,51,53] and 12 were in the mandible [1,3,4,46,48], while it was not specified in 3 cases [9]. In 5 cases out of 17, bone lid complications were clearly associated with suture stabilization or no fixation [1,48,53], 2 with rigid fixation methods [4,26], and 3 with resorbable plates [46]; whereas in 10 cases, the fixation method could not be identified [3,9,51]. In Sukegawa et al, different resorbable plates were utilized, and the osteosynthesis material was not found to be related to the bone lid necrosis [46].…”

“…Six papers [2][3][4][46][47][48], including 139 bone lids, described the use of this approach to gain access to lesions, such as cysts and impacted teeth in the mandible (Table 4). An RCT comparing the bone lid with piezosurgery versus bone removal with conventional rotary instruments showed a better postoperative recovery in the bone lid group [2].…”

“…The recurrence rate was rarely described as a clear outcome [3,4,17,46,48,50]. No recurrence was reported after cyst removal bone lid surgeries.…”