RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / Name of the Candidate
and Address
/ Dr. SHAZIA RAHIMAN
D/o abdul rahiman.g
#102, “Ashiyana”, IV Cross,
Vijayanagar, Nagarbhavi Road,
Bangalore - 560078
KARNATAKA.
Temporary Address / Post graduate student ,
Department of oral and maxillofacial surgery,
AL-BADAR RURAL DENTAL COLLEGE AND HOSPITAL,
GULBARGA-585 102
KARNATAKA.
2. / Name of the Institution / AL-BADAR RURAL DENTAL COLLEGE AND HOSPITAL,
GULBARGA-585 102
KARNATAKA.
3. / Course of the study and subject / Master of Dental Surgery (M.D.S) department of Oral And Maxillofacial Surgery
4. / Date of admission to the course / 12-06-2008
5. / Title of the Topic / “Partial odontectomy for management of impacted mandibular third molar teeth in close approximation with inferior alveolar nerve.”
6. / Brief Resume of the Intended Work
6.1. / Need for the study :
The problem of inferior alveolar nerve involvement during removal of lower third molar is a clinical and more often a serious medico legal issue. The results of damage to the inferior alveolar nerve are unpredictable, in that, many cases do recover, but some do not. So it is preferable to carry out a clinical and correct radiographic assessment with specific surgical technique to decrease the incidence of its complication. Partial odontectomy or deliberate root retention is one such surgical technique to protect inferior alveolar nerve and minimize the occurrence of injury to the same.
6.2 / Review of Literature :
In his case report in the year 1992 with impacted left mandibular third molar whose roots extended below the inferior border of mandible, intentional partial odontectomy was performed. One year post operative radiograph showed bone formation above residual roots and 2 year post operative radiograph showed complete osseous healing and no evidence of inferior alveolar nerve injury1.
In this retrospective study in the year 2004, for over 52 patients who were operated on over a 10 year period where in, the criteria for selection of patients was impacted mandibular third molars with symptoms of pain or signs of infection or other pathology such as cysts, who were assessed on a dental panoramic tomogram for proximity to the inferior alveolar nerve using Howe and Poytons criteria which involved three categories and 76% of selected patients fell into category1 i.e, with a radiolucent band across the root ,11% of the selected patients fell into category 2 ie, loss of one or both white lines of the inferior dental canal and 2% of the patients fell into category 3 where narrowing of canal was present and excluded those patients based on preoperative decision where in, on reflecting the flap, infection was found to be tracking apically or if the angulation of tooth made it difficult to transect, and performed coronectomy and reported that only 3 of the 52 patients had to have the roots subsequently removed due to pain or infection. The assessment of the results disclosed that 5.7% of cases had to get their roots subsequently removed the incidence of inferior alveolar nerve damage encountered was 1.8%2.
In his study in the year 2004, for over 41 patients who underwent coronectomy on 50 lower third molars with a follow up of 6 months who had the radiographic evidence of close relationship between the roots of the tooth to inferior alveolar nerve excluding those cases with active infection or tooth mobility, he reported that there were no cases of inferior alveolar nerve damage. There was 1 case of transient lingual nerve involvement, probably from the use of the lingual retractor. One patient required subsequent removal of roots of both lower 3rd molars because of failure to heal, and 1 patient required subsequent removal of a root because of its migration to the surface. However the assessment of the results disclosed that there was no incidence of inferior alveolar nerve damage3.
In their randomized controlled clinical trail for over 128 patients who were judged to be at high risk of injury to inferior alveolar nerve in the preoperative dental pantamographs which include following features of proximity of mandibular 3rd molars to nerve canal, angulation of tooth (mesioangular, distoangular or horizontal), periapical or paradontal radiolucent area, excluding the patients who were more predisposed to local and systemic infection or with neuromuscular disorders or non vital 3rd molars, were subjected to coronectomy and routine extraction. About 102 patients underwent routine extraction, 94 coronectomy among whom 36 underwent failed coronectomy and 58 successful coronectomy. After follow up of 25 months, 19% nerves were damaged after routine extraction, none after successful coronectomy and 8% after failed coronectomy. The percentage of nerve damage in coronectomy is definitely less even though about 50% failures are encountered4.
M. Anthony Pogrel in the year 2007 conducted a study of over 300 cases with teeth in close approximation to inferior alveolar nerve of which maximum were mesioangular, distoangular and vertically impacted excluding the teeth that were mobile, horizontally impacted, teeth with active infection around them, and performed partial odontectomy. The mean follow up was 5 years with follow up radiographs taken at 6 months, 1 year and 2 years postoperatively showed that in 30% of cases there was a genuine coronal migration of the root fragments away from the inferior alveolar nerve .Among the 300 cases studied the author encountered only two failures of which one case had to have the coronally migrating root apices removed and in the other case there was a failure to heal after surgery, following which the root fragments on both the sides were removed and were found to be mobile. The 6 month radiographs tend to show that bone does form over the retained roots in most cases. The assessment of the results disclosed that nerve damage encountered was approximately 0.66% with this procedure of partial odontectomy as against the well documented fact of inferior alveolar nerve damage caused due to routine surgical extraction ranging between 1.2—7% with the mean of 4%in British Dental journal 2002; 43-45.Thus with this view we would like to assess the percentage of inferior alveolar nerve damage with partial odontectomy5.
6.3 / Objectives of study :
1.  To perform partial odontectomy versus routine extraction of impacted mandibular third molars in close approximation with inferior alveolar nerve with clinical and radiographic assessment.
2.  To assess the effectiveness of partial odontectomy to protect inferior alveolar nerve due to surgical injury.
3.  To assess the possible complications post operatively and its management.
7. / Materials and Methods
7.1 / Source of data:
The patients with impacted mandibular third molars in close approximation with the inferior alveolar nerve reporting to the
1.  OPD Department of Oral and Maxillofacial Surgery of Al Badar Rural Dental College Gulbarga.
2.  Selected patients reporting to the Dental OPD of the Government Hospital Gulbarga.
3.  Selected surveyed patients from the Primary Health Centre adopted by Al Badar Rural Dental College Gulbarga.
Criteria for selection of subjects:
1.  Subjects involved in the study are those with impacted mandibular third molars in close approximation with the inferior alveolar nerve.
2.  The radiographic criteria for selection is based on Howe and Poyton’s criteria:
a.  Category I : Radiolucent band across the root
b.  Category II: Loss or discontinuity of one or both white lines of inferior dental canal
c.  Category III: Narrowing of canal
7.2 / Method of collection of data(Including sampling procedure ):
This study will be conducted in Al-Badar Rural Dental College and Hospital with a sample size of 20 cases. Partial Odontectomy will be performed on ten cases and routine surgical extraction on the other similar ten cases in close approximation to the inferior alveolar nerve. Pre and post operative radiographs will be taken within the first 24 hrs, 5th day, 3rd month interval and 6th month interval when subjects are recalled for review.
Inclusion Criteria
·  Patients with impacted mandibular 3rd molars in close approximation with inferior alveolar nerve.
·  Patients within the age group of 19-40 years without any systemic diseases or immune deficiency.
Exclusion Criteria
·  Patients with horizontally impacted mandibular third molars.
·  Patients below 19 years and above 40 years of age.
·  Patients with systemic diseases and immune deficiency.
Duration of study
Six months follow up study with radiographs at regular intervals i.e. post operatively within the first 24hrs, 5th day, 3rd month and 6th month recall visit.
7.3 / Does the study need any investigation or interactions to be conducted on patients or animals?
Yes
7.4 / Has the ethical clearance been obtained from your institution (in case of 7.3)?
Yes
8. / List of References:
1.  Gary Freedman L. Intentional Partial Odontectomy: Report of case. J Oral Maxillofac Surg, 1992; 50: 419 -421.
2.  Brain C. O’ Riordan. Coronectomy (Intentional partial odontectomy of lower third molars). Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004 September; 98: 274-80.
3.  Anthony Pogrel M. Coronectomy: A Technique to Protect Inferior Alveolar Nerve. J Oral Maxillofac Surg 2004; 62: 1447-1452.
4.  Renton T, Hankins M, Sproate C, McGurk M. A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars. British Journal of Oral and Maxillofacial Surgery 2005; 43: 7 – 12.
5.  Anthony Pogrel M. Partial Odontectomy. Oral Maxillofacial Surg Clin N Am 2007; 19: 85-91.
9. / Signature of Candidate
10. / Remarks of Guide / The technique which is used for preservation of inferior alveolar never i,e. “Partial Odontectomy” or deliberate root retention is an alternative modality of treatment. It is practiced by many professionals abroad, but a few in India. We found little literature or none regarding this procedure in most of our national journals. Partial Odontectomy is a simple surgical technique which will benefit most practitioners in rural areas with minimal facilities to manage the impacted 3rd molars without causing inadvertent damage to the Inferior Alveolar Nerve, provided our study proves to be beneficial.
11. / Name and Designation of the Guide (In block letters)
11.1 / Guide / Dr. Syed Ahmed mohiuddin
M.D.S
Professor & Head
Department of Oral and Maxillofacial Surgery
Al – Badar Rural Dental College & Hospital, Gulbarga
11.2 / Signature
11.3 / Co-guide
11.4 / Signature
11.5 / Head of the Department / Dr. Syed Ahmed mohiuddin
M.D.S
Professor & Head
Department of Oral and Maxillofacial Surgery
Al – Badar Rural Dental College & Hospital, Gulbarga
11.6 / Signature
12. / 12.1 / Remarks of Chairman and Principal / The technique which is used for preservation of inferior alveolar never i,e. “Partial Odontectomy” or deliberate root retention is an alternative modality of treatment. It is practiced by many professionals abroad, but a few in India. We found little literature or none regarding this procedure in most of our national journals. Partial Odontectomy is a simple surgical technique which will benefit most practitioners in rural areas with minimal facilities to manage the impacted 3rd molars without causing inadvertent damage to the Inferior Alveolar Nerve, provided our study proves to be beneficial.
12. 2 / Signature