An article titled “Use of Computer-Assisted Navigation in the Retrieval of Accidentally Displaced Third Molars,” appears in the 2016 Journal of Oral and Maxilofacial Surgery, written by Yi Guo and et al., vol. 74, pp. 889-894. The article describes using a computer to retrieve accidentally displaced mandibular third molars. A total of 12 patients in the study successfully had their roots retrieved. They all healed successfully without complications.
In rare cases when performing wisdom teeth surgery, a tooth or a tooth root can be displaced. When they are displaced into difficult to access areas surgery retrieving the displaced molars should be performed by conventional methods which include extending the original operative exposure or planning a new operative approach and then finding and removing the tooth. This surgery can cause severe tissue injury or complications.
The paper discusses computer-assisted navigation in the retrieval of displaced mandibular third molars and to evaluate the effectiveness of this method. The criterion for using this technique of computer-assisted navigation involved teeth or tooth fragments that were displaced into difficult-to-access areas (sublingual space, pterygomandibular space, lateral pharyngeal space, submandibular space, and lateral cervical space). To localize the displaced mandibular third molar or root fragment computed tomographic (CT) examination was performed before retrieval.
Continuous fine-cut CT data were imported to the system to accomplish presurgical planning, and then the displaced mandibular third molar or root fragment was labeled in each layer of the CT data. A forceps was used to clamp and retrieve the molar, which was registered for visualization in real time on the patient’s images. Once the patient and instrument registrations were done, the surgery could begin. Under the guidance of computer-assisted navigation, the tip of the registered forceps was inserted accurately and reached the displaced molar which was carefully clamped and removed. Afterwards the wound was irrigated with saline.
In the study all 12 patients were referred to the authors’ department because the teeth were displaced into difficult-to-access areas (sublingual space, n = 7; pterygomandibular space, n = 4; lateral pharyngeal space, n = 1). They were referred on the day of the accidental displacement (1 to 12 hours after the accident), with symptoms such as swelling, trismus, and pain when swallowing. Using computer-assisted navigation, the operation proceeded successfully in all patients. The entire procedure was completed smoothly and no case exceeded 30 minutes. All patients displayed uneventful healing without complications.
The authors conclude by saying in summary, the present study indicated that computer-assisted navigation is a safe, straightforward, and minimally invasive treatment method that can be applied for the retrieval of accidentally displaced third molars. Of course it really should only be used in difficult to access areas. The authors never tried this technique on displaced molars in the maxillary sinus.