CLINICAL IMPACT OF MODIFIED LINGUAL SPLIT BONE TECHNIQUE USING PIEZOTOME ON POST-OPERATIVE SEQUELAE OF MANDIBULAR 3RD MOLAR REMOVAL

Problem statement: Permanent nerve damage represented one of the most severe complications following third molar extractions. Such rate increases especially, following lingual split bone technique either during bone splitting or dissecting procedures. So, this study was directed to assess clinical impact of modified lingual split bone technique using piezotome versus conventional technique on postoperative sequelae following mandibular 3rd molar removal.
Patient and Methods: Eighteen patients of comparable surgical difficulty of impacted lower third molar representing a common pool divided randomly into two uniform equal groups. The 1st group contained nine patients subjected to tooth removal using conventional lingual split bone technique. While, the 2nd group contained nine patients treated by modified lingual split bone technique using peizotome. After recording the operation time, all patients were assessed postoperatively for pain, trismus, swelling at the 2nd and 7th day. Neurosensory deficit/paraesthesiae was assesed either at 7, 15 and 30 postoperative days. Postoperative symptom severity (PoSSe) scale and prognosis score of healing were assessed at the 7th postoperative day.
Results: Comparing both groups, a significant difference was recorded regarding to severity of pain after 48h (P=0.037). However, no significant difference was recorded among both groups with regard to severity of pain at 7th day postoperatively (P=0.169). Regarding to recorded inter-incisal distance and sum of facial swelling, a clear detectable significant differences were recorded between both groups at the 2nd and 7th day of follow up (P= 0.009, 0.005- 0.001, 0.001 respectively). A statistical significant differences were recorded between both groups after 7 and 15 days of follow up (p=0.035) regarding to two point discrimination.
Conclusion: Although, a remarkable improvement in the postoperative sequelae associated with piezotome versus conventional lingual split bone technique. However, such technique sensitive maneuver related to operator experience and device adoption can lead to a significant prolonged operation time making a restrictive insult to achieve optimal clinical outcomes among oral surgeons.