Predictable removal of deeply impacted mandibular third molars via custom sagittal split osteotomies – a case report

A 31-year-old female patient presented to the oral and maxillofacial surgery (OMFS) clinic for evaluation of pain in the bilateral lower third molar regions. Unexplained pain and pressure sensation in the third molar region was noted, along with periodontal defects with probing depths >6mm. Review of the cone beam computerized tomography (CBCT) scan noted intimate relationship of the inferior alveolar nerve (IAN) at the mid-portion of the roots, making this a difficult extraction case for traditional or coronectomy/partial odontectomy approaches. Custom guides and plates were utilized to complete a bilateral sagittal split osteotomy (BSSO) to facilitate the third molar removal on the mandible with an intact, undamaged IAN bilaterally. The patient post-operatively noted gradual improvement in sensation of the IAN bilaterally.