An interesting study titled “Comparison of an alveolar expansion technique and buccal guttering technique in the extraction of mandibular third molar. A pilot study,” appeared in the Open Journal of Stomatology (vol 1, pages 103-108, 2011) written by Babatunde O. Akinbami and Lukcy I. Ofomala from Nigeria.
As stated in the abstract the background for this study was
“The over-ambitious use of surgical drills for almost every case of third molar impaction is on the increase in most established oral surgery centers. The purpose of this study was to assess and compare the severity of post operative symptoms of swelling and pain that accompany the use of surgical drill in the buccal guttering technique and the non application of drill in an alveolar expansion technique.”
The authors open in the introduction by discussion how bone around impacted third molar teeth is usually dense and can require the use of cutting drills which can cause vibration and friction.
A total of 10 patients were included in the study. Five patients had the guttering technique performed on the right side and alveolar expansion technique on the left side, 3 patients had the alveolar expansion technique performed on the right side and buccal guttering technique of the left side, and the final 2 cases served as control.
Periapical x-rays were taken to assess the root configuration to the inferior alveolar nerve bundle and impaction against the adjacent second molar. Each patient was given 2% lidocaine with 1:80,000 epinephrine.
The authors discuss how many techniques have been used to remove impacted third molars (wisdom teeth). The authors state
“Other techniques like therapeutic agenesis of the tooth bud using electrocautery, laser energy and use of sclerosing agents have been tried in lower mammals and animals but no human clinical studies are available to attest the validity of these later techniques.”
This study found that most patients included preferred the alveolar expansion technique to reduce the use of drills. The authors point out that it is possible to remove wisdom teeth without using drills.
Near the end of the study the authors state
“The alveolar expansion technique is however, better applicable in younger patients with less dense bone, patients with soft tissue impacted third molar, vertically or mesially impacted tooth with sufficient space for the elevator to move the tooth into, when there is no impaction against the second molars and in cases of close proximity of the neurovascular bundle with enough clearance around the tooth. Absolute contraindications of the use of this technique include high bone density, completely buried tooth/tooth with high Winter’s red line, horizontal impaction associated with impaction against the second molar, distal or vertical impaction with part of the tooth buried under the ascending ramus, anteriorly extended external oblique ridge and in patients with very low pain threshold.”