NHỔ CHỈNH HÌNH RĂNG CỐI LỚN THỨ HAI HÀM DƯỚI LỆCH NGẦM NẰM GẦN THẦN KINH XƯƠNG Ổ DƯỚI: BÁO CÁO TRƯỜNG HỢP LÂM SÀNG

Abstract

Inferior alveolar nerve (IAN) injury following tooth extraction is a serious complication, significantly affects the patient's quality of life. Additionally, if the tooth is located deeply and adjacent to the inferior border of the mandible, there is a heightened risk of mandibular fracture – either primary during the extraction procedure or secondary due to thinning of the mandibular base that creates a structural weak point. This report presents the case of a 17-year-old female patient with a deeply impacted mandibular right second molar located near the inferior border of the mandible, posing substantial risk for both IAN injury and mandibular fracture during extraction. We employed an orthodontic-assisted extraction technique using a modified lingual arch appliance with a hook arm to gradually move the impacted tooth to a safer position prior to extraction. After 6 months of treatment, the tooth had been orthodontically extruded to a position more than 3 mm away from the nerve canal, with evidence of new bone formation along the inferior mandibular border. The extraction was performed smoothly without any postoperative complications. This clinical case demonstrates that orthodontic-assisted extraction is an effective and safe option for managing complex impacted teeth, particularly when these are in close proximity to critical anatomical structures.