PriMera Scientific Surgical Research and Practice (ISSN: 2836-0028)

Case Report

Volume 2 Issue 5

Incomplete Sagittal Split Osteotomy for the Extraction of a Fully Impacted Lower Third Molar: A Case Report

Ori Blanc*, Andrei Krasovsky*, Dekel Shilo, Tal Capucha, Chaim Ohayon and Adi Rachmiel

October 28, 2023

DOI : 10.56831/PSSRP-02-069


Background: The sagittal split osteotomy method for extraction of the mandibular third molars can be used in cases of deeply seated teeth, positioned in proximity to the mandibular canal, jeopardizing the integrity of the inferior alveolar nerve and the mandible itself. The classic sagittal split osteotomy approach, adopted from orthognathic surgery, may increase the risk of postoperative malocclusion and Temporomandibular joint dysfunction. For this reason, we would like to purpose a modified technique of sagittal split osteotomy that can be used for extractions.

Methods: This study presents a case of using a modified incomplete sagittal split osteotomy approach for the extraction of a deeply impacted right mandibular third molar in a 43-year-old man under general anesthesia.

Results: Only the superior border of the mandibular cortex was separated for approaching the impacted tooth while leaving the inferior cortex intact. After the surgery no inferior alveolar nerve sensory deficit was observed and the incomplete fracture was reduced back to the original anatomical position.

Conclusions: We suggest using the incomplete sagittal split osteotomy technique in deeply impacted third molars which pose a high risk when extracted. It allows for superior healing with perfect alignment of the segments.

Keywords: Sagittal split osteotomy; Third molars; Extraction; Wisdom teeth; Impacted


  1. RD Marciani. “Third Molar Removal: An Overview of Indications, Imaging, Evaluation, and Assessment of Risk”. Oral and Maxillofacial Surgery Clinics of North America 19.1 (2007): 1-13.
  2. LK Rafetto. “Managing Impacted Third Molars”. Oral and Maxillofacial Surgery Clinics of North America 27.3 (2015): 363-371.
  3. YD Kwon., et al. “Separation of the buccal cortical plate for removal of the deeply impacted mandibular molars”. International Journal of Oral and Maxillofacial Surgery 35.2 (2006): 180-182.
  4. MA Pogrel, JS Lee and DF Muff. “Coronectomy: A technique to protect the inferior alveolar nerve”. Journal of Oral and Maxillofacial Surgery 62.12 (2004): 1447-1452.
  5. N Milner and A Baker. “Extraoral removal of a lower third molar tooth”. British Dental Journal 199.6 (2005): 345-346.
  6. Z Catherine and P Scolozzi. “Mandibular Sagittal Split Osteotomy for Removal of Impacted Mandibular Teeth: Indications, Surgical Pitfalls, and Final Outcome”. Journal of Oral and Maxillofacial Surgery 75.5 (2017): 915-923.
  7. DS Precious. “Removal of third molars with sagittal split osteotomies: The case for”. Journal of Oral and Maxillofacial Surgery 62.9 (2004): 1144-1146.
  8. A Toffanin, A Zupi and A Cicognini. “Sagittal split osteotomy in removal of impacted third molar”. Journal of Oral and Maxillofacial Surgery 61.5 (2003): 638-640.
  9. E Cansiz, SC Isler and BA Gultekin. “Removal of deeply impacted mandibular molars by sagittal split osteotomy”. Case Reports in Dentistry (2016).
  10. IA El Naaj., et al. “Surgical Approach to Impacted Mandibular Third Molars-Operative Classification”. Journal of Oral and Maxillofacial Surgery 68.3 (2010): 628-633.
  11. M Friscia., et al. “Complications after orthognathic surgery: our experience on 423 cases”. Oral and Maxillofacial Surgery 21.2 (2017): 171-177.
  12. MT Robl, BB Farrell and MR Tucker. “Complications in orthognathic surgery a report of 1000 cases”. Oral and Maxillofacial Surgery Clinics of North America 26.4 (2014): 599-609.
  13. JP Reyneke and C Ferretti. “Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy”. British Journal of Oral and Maxillofacial Surgery 40.4 (2002): 285-292.
  14. GF Bouloux, MB Steed and VJ Perciaccante. “Complications of Third Molar Surgery”. Oral and Maxillofacial Surgery Clinics of North America 19.1 (2007): 117-128.
  15. M Sencimen., et al. “Extraction of a deeply impacted lower third molar by sagittal split osteotomy”. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology 108.5 (2009).