Background.Maintenance of hard tissue in the case of impacted thirdmolars (M3M)with close relationship to themandibular canal\nis still a surgical challenge which may be overcome using the inward fragmentation technique. Methods. A consecutive case series\nof 12 patients required the extraction of 13 impactedM3Mwith a close relationship to the inferior alveolar nerve (IAN).Via occlusal\nminiflaps,M3Mwere exposed occlusal under endoscopic vision and removed by inward fragmentation.All patients received socket\npreservation with resorbable in situ hardening TCP particles to reduce the risk of pocket formation at the second molar. Results.\nAll 13 sites healed uneventfully. Bone height was assessed using CBCT cross-sectional reformats pre- and 3 months postoperatively.\nThe bone height was reduced by 1.54 mm lingual (SD 0.88), 2.91 mm central (SD 0.93), and 2.08 mm buccal (SD 1.09). Differences\nwere significant at a 0.05% level. No tissue invagination at the extraction sites was observed. Conclusions. Major bone defects can\nbe avoided safely using inward fragmentation surgery. The self-hardening bone filler appears to enhance the mineralization of the\nintrabony defect.
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