FREQUENCY OF LINGUAL NERVE INJURY IN MANDIBULAR THIRD MOLAR EXTRACTION: A COMPARISON OF TWO SURGICAL TECHNIQUES

BACKGROUND

Surgical removal of impacted mandibular third molar is associated with a number of complications including postoperative bleeding, dry socket, postoperative infection, and injury to regional nerves. Lingual nerve damage is one of the main complications. To prevent this complication different techniques had been used. Lingual flap reflection is one of these procedures in which lingual soft tissue is reflected and retracted deliberately, the nerve is identified and is kept out of the surgical field. The objective of this study was to evaluate a surgical technique for third molar removal which is associated with minimum frequency of lingual nerve damage.

METHODS

A randomized controlled trial was performed. A total of 380 patients with impacted mandibular third molars were included in this study. Each patient was allotted randomly by blocked randomization to group A where procedure was performed by reflection and retraction of lingual flap in addition to buccal flap and group B where procedure was performed by retraction of buccal flap only.

RESULTS

Lingual nerve damage occurred in 8.94% in Group A in which lingual flap retraction was performed but damage was reversible. In group B, 2.63% lingual nerve damage was observed and nature of damage was permanent. The difference was statistically significant (p=0.008).

CONCLUSIONS

Lingual flap retraction poses 3.4 times increased risk of lingual nerve damage during extraction of mandibular third molar when lingual flap is retracted but the nature of damage is reversible.

Analysis of professional malpractice claims in implant dentistry in Italy from insurance company technical reports, 2006 to 2010

PURPOSE

The aim of the study was to analyze the characteristics of implant dentistry claims in Italy based on insurance company technical reports for malpractice claims.

MATERIALS AND METHODS

One hundred twenty-one technical reports of cases of professional malpractice in implant dentistry between 2006 and 2010 were included in the study. Data included the sex and age of the patient and dentist, the kind of negligence claimed, and the damages awarded as a consequence of the alleged misconduct.

RESULTS

Of the cases examined in this study, 9.9% went to court. The patients were female in 73.6% of the cases. Most of the technical errors were committed during implant insertion (82.6%). In 50.4% of cases, the technical error involved the surrounding structures, such as damage to the inferior alveolar nerve (32.2%) or the lingual nerve (2.5%), invasion of the maxillary sinus (9.1%), or pulpal dental necrosis in adjacent teeth (6.6%). Incomplete clinical documentation was apparent in 54.5% of cases. In 9.9% of cases, a civil suit had already been filed before a visit, and medicolegal advice from the insurance expert had been procured.

CONCLUSION

The discrepancy between the total number of cases examined and those that went to court indicates that implant malpractice claims in Italy are most often settled out of court. The large number of intraoperative errors seen and the high proportion of injuries to surrounding structures suggest that implant dentists would benefit from further specific training. Also, clinical documentation vital to a defense against any claims relating to professional misconduct was incomplete or absent in more than half of the cases.