Available Online at http://www.recentscientific.com International Journal of CODEN: IJRSFP (USA) Recent Scientific

International Journal of Recent Scientific Research Research Vol. 10, Issue, 09(A), pp. 34594-34599, September, 2019 ISSN: 0976-3031 DOI: 10.24327/IJRSR Research Article

COMPARISON BETWEEN CONVENTIONAL ROTARY SURGICAL TECHNIQUE AND CHISEL MALLET TECHNIQUE FOR SURGICAL REMOVAL OF IMPACTED MANDIBULAR THIRD MOLAR

Devesh Tiwari1, Akanksha Srivastava2 and Gaurav Kumar Saha3*

1Department of Dentistry, Hind Institute of Medical Sciences, AtariaSitapur (UP). India 2Department of Oral Medicine and Radiology, Index Institute of Dental Sciences, Indore, (MP) India 3Department of Dentistry, T.S. Misra Medical College & Hospital, Lucknow (UP) India

DOI: http://dx.doi.org/10.24327/ijrsr.2019.1009.3930

ARTICLE INFO ABSTRACT

Tooth impaction is a pathological situation where a tooth fails to attain its normal functional Article History: position. Impacted third molars are commonly encountered in routine dental practice. The impaction th Received 10 June, 2019 rate is higher for third molars when compared with other teeth. The mandibular third molar nd Received in revised form 2 July, 2019 impaction is said to be due to the inadequate space between the distal of the second mandibular th Accepted 26 July, 2019 molar and the anterior border of the ascending ramus of the mandible. Impacted teeth may remain th Published online 28 September, 2019 asymptomatic or may be associated with various pathologies such as caries, pericoronitis, cysts, tumors, and also root resorption of the adjacent tooth.

Key Words:

Rotary surgical technique, chisel-Mallet technique, Impacted Mandibular third Molar

Copyright © Devesh Tiwari et al, 2019, this is an open-access article distributed under the terms of the Creative Commons

Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is

properly cited.

INTRODUCTION Kruger’s Envelop incision1 was used to expose the impacted mandibular third molar in both the groups. Exposure was Surgical removal of impacted third molars is one of the most followed by the removal of overlying bone to expose the crown common procedures carried out in oral and maxillofacial with the help of surgical rose head bur in Group I and by Chisel surgery. Surgical management of impacted third molar is & mallet in Group II. difficult because of its anatomical position, poor accessibility, and potential injuries to the surrounding vital structures, nerves, Surgical Techniques vessels soft tissues, and adjacent teeth during surgeries. The Group I-After exposure of surgical site with envelop incision factors contributing to the post‑operative morbidity are many, either no. 7/8 round bur or a straight no. 703 fissure bur is used. but the most important one is the trauma from bone cutting as The bur is used in a sweeping motion under constant irrigation, the procedure involve significant bone cutting, which is carried buccal and distal aspect of the mandibular third molar crown to out either by rotary cutting instruments or by chisel and mallet. exposed with the bur to the cervical level of the crown contour and a buccal trough or gutter is created .The buccal trough MATERIAL AND METHOD should be made in the cancellous bone. It is important that the The present study comprised of 30 patients with impacted adequate amount of trough is created to remove any bony mandibular third molar. The patients were randomly divided obstruction for exposure and the delivery of the tooth , into two equal groups especially around the distal aspect of the crown .The distolingual portion of the tooth should be exposed without Group I- Surgical procedure performed by surgical bur (15 cutting through the lingual bony plate to prevent damage to the patients) lingual nerve. Group II- Surgical Procedure performed by Chisel and Mallet (15 Patients)

*Corresponding author: Gaurav Kumar Saha Department of Dentistry, T.S. Misra Medical College & Hospital, Lucknow (UP) India International Journal of Recent Scientific Research Vol. 10, Issue, 09(A), pp. 34594-34599, September, 2019

RESULTS

To evaluate the effect of surgical Bur versus Chisel and mallet technique for removal of impacted third molar, study has been carried out over 30 patients divided in equal numbers of two groups.

Group-I consisted of 15 patients and bone removal by surgical bur

Group-II:-Consist of 15 patients and bone removal by chisel and mallet

Table 1 Age wise Distribution

Age group No. of % (in yrs) Patients 20 – 30 18 60 31 – 40 8 26.6 Fig 1Removal of Impacted mandibular third molar with conventional rotary 41 – 50 4 13.4 bur technique Total 30 100.00 Group II Age 20 – 30 year was most common with 60% of total patients The first chisel cut is a vertical “stop cut” which will prevent followed by 31 – 40 year of age with 26.6% of total patients. splitting of the bone along the buccal aspect the second molar Table 2 Sex wise Distribution .This is affected with a 3mm chisel used with the flat surface No. of facing anteriorly. The placing of the chisel is such that the cut Sex % is made parallel to the long axis of the second molar and Patients Male 21 70 immediately distal to it. The cut is made through the buccal Female 9 30 cortical bone and is carried as far toward the lower border of Total 30 100.00 the mandible as is required. The greater the depth of the wisdom tooth, the longer the “stop cut” will be necessary. Male gender was most common sex of patients 70% and females were 30%. The chisel is placed with its beveled edge downwards and a cut Table 3 Sex wise comparison of patients in two groups is made at an angle of 45degrees to the initial vertical cut, in such a way as to from a “V”. The chisel is driven through the Group I Group II buccal cortical bone and is the twisted, splitting a triangular N % N % piece of bone form the mesio-buccal aspect of the third molar. Male 10 66.6 11 73.3 Female 5 33.3 4 26.7 This should allow the application of an elevator under the Total 15 100.00 15 100.00 tooth. Having established this point of application, the distal  = 0.69, p>0.05 (NS) bone must be removed to allow the tooth to be delivered. To remove this piece of bone, a 5mm. chisel is placed distal to the Statistically there was no significant difference in gender of third molar, with the beveled side upwards and the cutting edge two groups. Sex wise groups were similar. parallel to the external oblique ridge. (if it is placed parallel to Table 4 Comparison of Radiological Grading (WHARFE the internal aspect of the mandible, then the split may extend to Scale) in two groups the coronoid process). Group I Group II N 15 15 Mean WHERFE 8.56 9.80 Scale SD 1.88 2.30

t=1.41, p=0.16 (NS)

The WHARFE scoring of group II was higher than group I but there was no significant difference in radiological grading in two groups.

Table 5 Comparison of Operating Time in two groups

Group I Group II N 15 15 Mean Time 37.26 34.33 SD 11.41 10.75

t=1.02, p=0.31 (NS) Fig 2 Removal of Impacted mandibular third molar with chisel mallet technique There was non-significant difference in operating time in two groups.

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Table 6 Analysis of pain at different time interval from Pre- Table 10 Analysis of Mouth Opening at different time interval operative in the groups from Pre-operative in group Group-I Group – II

Change from Change Mouth Pain in Pain (n=15) Pre- Mouth Opening Opening from 't' 'p' Sig. Time Interval 't' 'p' Sig. VAS Mn±SD operative (in mm) Mn±SD Pre-operative Mn±SD Mn±SD Pre- Pre-Operative 42.33±5.39 – – – – 1.53±0.68 – – – – st Operative 1 Day 25.67±7.86 -16.67±6.97 13.08 p>0.001 Sig 1st Day 1.76±0.43 +0.23±0.99 1.36 p>0.05 NS 3rd Day 20.67±5.96 -21.66±4.52 26.25 p<0.001 Sig. 3rd Day 1.50±1.65 0.03±1.71 0.11 p<0.05 NS 8th Day 24.33±5.94 -18.00±4.65 21.20 p<0.001 Sig. 8th Day 0.57±0.56 0.96±0.96 5.49 p<0.001 Sig. 10th Day 39.83±3.71 -2.5±3.16 4.41 p<0.001 Sig. 10th Day 0.06±0.25 1.46±0.68 11.78 p<0.001 Sig. 15th Day 42.73±4.33 +0.40±2.17 1.01 p=0.32 NS. th 15 Day 0 1.53±0.68 12.32 p<0.001 Sig. -ve sign shows decrease in Mouth Opening

st +ve sign shows increase in Mouth Opening from Pre-operative Positive sign shows increase in pain at 1 from pre-operative. There was significant decrease in Mouth Opening at 1st day, 3rd Table 7 Analysis of pain at different time interval from Pre- day, 8th day and 10th day from pre-operative. At 15th day there operative in the groups was non-significant difference in mouth opening from pre- Group – II operative. The mouth opening first gradually decrease on 1st& 3rd post-operative day then there was continuous increase in Pain Change from th Pain in VAS (n=30) Pre-operative 't' 'p' Sig. mouth opening from 8 day post-operative onward.

Mn±SD Mn±SD Table – 11 Comparison of Mouth Opening reduction at Pre- 1.73±0.58 – – – – Operative different time interval in Group I and II from Pre-operative st 1 Day 1.70±0.54 0.03±0.76 0.24 p>0.05 NS Group-I Group-II rd Time 3 Day 1.26±0.45 0.46±0.77 3.29 p<0.001 Sig. (n=30) (n=30) 't' 'p' Sig. 8th Day 0.37±0.49 1.36±0.81 12.84 p<0.001 Sig. Interval th Mn±SD Mn±SD 10 Day 0±0 1.73±0.58 16.27 p<0.001 Sig. st th 1 Day -19.27±7.59 -16.67±6.97 1.38 p>0.05 NS. 15 Day 0±0 1.73±0.58 16.27 p<0.001 Sig. 3rd Day -12.96±5.93 -10.68±4.52 1.67 p>0.05 NS.

rd th th 8th Day -7.43±4.19 -6.0±4.65 1.25 p>0.05 NS. There was significant reduction in pain at 3 day, 8 day, 10 th th st 10 Day -4.26±3.06 -2.5±3.16 2.21 p<0.05 Sig. day, 15 day from pre-operative. At 1 day non-significant 15th Day 1.07±1.63 -+0.40±2.17 2.97 p<0.01 Sig. th th change in pain and there was no pain at 10 day and 15 day. Mouth Opening Table 8 Comparison of pain reduction in Group I and Group II at different Time Intervals At 1st day, 3rd day, 8th day mouth opening reduction was more in Group-I than Group-II But difference was non-significant. Group-I Group-II Time Pain Pain th 't' 'p' Sig. At 10 day mouth opening reduction was significantly more in Interval reduction reduction Group-I than Group-II Mn±SD Mn±SD st 1 Day 0.23±0.99 0.03±0.76 1.14 p>0.05 NS At 15th day difference in mouth opening reduction was 3rd Day 0.03±1.71 0.46±0.77 1.25 p>0.05 NS th significantly more in Group-I than Group-II 8 Day 0.96±0.96 1.73±0.58 1.74 p>0.05 NS. 10th Day 1.46±0.68 1.73±0.58 1.65 p>0.05 NS. th Table 12 Patient acceptance (Intra-operative) 15 Day 1.53±0.68 1.73±0.58 1.22 p>0.05 NS. Bur CM  'p' Sig. Pain reduction was more in group II than group I at different N % N % Time Interval. But the difference was not statistically Satisfied 11 73.33 4 26.7 significant at different Time Intervals. Moderate-satisfied 2 13.33 2 13.33 Dissatisfied 2 13.33 3 20 19.36 <0.01 Sig. Table 9 Analysis of Mouth Opening at different time High Dissatisfied – – 6 40.0

interval from pre-operative in Group-I Total 15 100 15 100 

 = 19.36, p<0.01 (Sig.) Change Mouth Mouth Opening Opening from Time Interval 't' 'p' Sig. Number of patients with treatment acceptance was significantly (in mm) Mn±SD Pre-operative more in bur than CM with (73.33%) satisfied percentage while Mn±SD Pre-Operative 45.96±5.13 – – – – 0% was highly dissatisfied. Highly dissatisfied patients were 1st Day 22.68±7.50 -19.27±7.59 13.66 p>0.001 Sig more 40% in chisel mallet group. rd 3 Day 22.80±5.18 -23.96±5.93 22.13 p<0.001 Sig. 8th Day 26.53±3.67 -19.43±4.19 25.40 p<0.001 Sig. Table 13 Patient acceptance (At 1 week post operative) 10th Day 41.50±3.88 -4.26±3.06 7.63 p<0.001 Sig. Bur CM 15th Day 44.70±4.30 -1.07±1.63 3.58 p<0.01 Sig.  'p' Sig. N % N % Satisfied 8 53.3 8 53.3 There was significant decrease in Mouth Opening at different Moderately th 4 26.6 2 13.3 Time Interval from Pre-operative. At 15 day mouth opening Satisfied 1.6 <0.05 NS was less than pre-operative mouth opening and significant Dissatisfied 2 13.33 4 26.6 Highly Dissatisfied 1 6.6 1 6.6 Total 15 100 15 100  = 1.6, p>0.05 (NS) 34596 | P a g e International Journal of Recent Scientific Research Vol. 10, Issue, 09(A), pp. 34594-34599, September, 2019

During suture removal at 1 week post-operative follow up Male are predominating with 70% while females were 30%. number of satisfied patient with chisel & mallet were more than Majority of article quote female predominance as 65% by with bur but the difference was statically non significant. Hidemichi Yuasa (2004)5 57.3% by Srinivas M. Susarla 2 6 Table 14 Comparison of TN (Tragus-Sub-Nasal) increase in (2005) , 86% found by Iowna Anna Niedzielska (2006) . Male Group I and II at different Time Interval predominance seen in this study cannot point towards the incidence rate because of limited sample size. A possible Time Group-I Group-II 't' 'p' Sig. reason for this could be the social fabric of society in the area Interval Mn±SD Mn±SD where female tends to visit hospital less as compare to males 1st Day +6.32±5.46 +5.50±3.55 0.73 p>0.05 NS. 3rd Day +18.16±8.13 15.83±6.32 1.23 p>0.05 NS. for initial problems.

8th Day +4.76±4.76 3.76±3.76 0.81 p>0.05 NS. 10th Day +1.40±4.76 0.33±1.26 1.19 p<0.05 NS. For evaluation of difficulty in removal of impacted mandibular 15th Day 0.20±1.06 -0±2.33 0.43 p<0.05 NS. third molar WHARFE scale has been used, higher the value of WHARFE scale more difficult impaction is considered. The There was non-significant difference in TN increase in Group-I resulting model showed that an increase in radiographic scoring and Group-II at different Time Intervals. of difficulty according to the WHARFE classification system Table 15 Comparison of TP (Tragus-pogonion) increase in was associated with increased operating time. Group I and II at different Time Interval Surgical time for a patient depends upon various factors for Time Group-I Group-II example type of instrumentation, expertise of the surgeon, 't' 'p' Sig. Interval Mn±SD Mn±SD patient’s cooperation and accessibility in a particular patient. In st 1 Day +5.83±3.91 +5.77±5.51 0.04 p>0.05 NS. this study while comparing the operating time in the two 3rd Day +17.80±8.14 +16.40±6.55 0.73 p>0.05 NS. 8th Day +3.20±4.66 +2.73±3.63 0.43 p>0.05 NS. groups the difference was found non- significant. Mean 10th Day +1.03±3.64 +0.27±1.33 1.07 p<0.05 NS. operating time for removal of mandibular third molar by chisel 15th Day -0.33±1.67 -0.07±0.35 0.83 p<0.05 NS. and mallet is found 34.33 minutes while for bur is 37.26

There was non-significant difference in TP increase at 1st day, minutes. Patients in this study were operated within 15 minutes 3rd day, 8th day, 10th day& 15th day in Group-I and Group-II. and also there were cases, which took up to 1 hour. Most of the cases in each group were operated within 25-45 minutes. Table-16 Comparison of Complication in Group-I & Group-II Though statistical difference in (mean total surgical time) taken

Group-I Group-II was non-significant, but arithmetically the study shows that Complication 't' 'p' Sig. (n=15) (n=15) group two took lesser time, the reasons in favour of finding Dry Socket 2(13.33) 2(13.33) 0 NS. might be that suction tip which is mandatory in cases of using Wound 1 (6.66) 1 (6.66) 0 NS. burs for cutting is not mandatory for Group two. Crowding of dehiscence Paresthesia 2(13.33) 1(6.66) 1.96 p=0.16 NS. Instruments which is already there at the operation site is minimized while using chisel and mallet so giving better Dry Socket incidence was equal in Group-I Group-II. accessibility to the surgeon and lesser operating time. This is

Incidence of wound dehiscence was also found in Group-I and in agreement with Absi and Shepherd (1993)7Praveen G. Group-II. Paresthesia incidence was more in Group-I then (2007)8 who took more time for removal of mandibular third Group-II but non-significant difference. molar by surgical bur in comparison to chisel and mallet.

9 10 DISCUSSION Pain: Kruger (1959) and Thoma (1963) have mentioned pain to be the postoperative complications in thirds molar surgery, Impacted mandibular third molars are developmental while using buccal split (chisel/mallet) than the buccal bone pathologic medical deformities characteristic of a modern cutting. The subjective pain is significantly related to surgical civilization. They account for 98% of all impacted teeth. trauma, degree of the impaction, and the operating time.

The present study was conducted on 30 patients to evaluate In group II there was significant reduction in pain at 3rd day, 8th clinically the effectiveness of two techniques viz. surgical bur day, 10thday and 15th day from pre-operative. At 1st day non- and Chisel mallet in the removal of mandibular third molar significant change in pain and there was no pain at 10th day and impactions. For this purpose patients were selected at random 15th day. While in group I there was non significant change in and the whole sample was divided into two groups (15 cases in pain at day 1st and day 3rd from pre-operative. After it there was each group). All the patient received more or less same drugs significant reduction in pain from pre-operative at day 8th, day pre- and post-operatively and were given same post operative 10th and day 15th and there was no pain at day 15th in group I. instructions. While comparing the pain reduction in both the group pain reduction was more in group II than in group I but the The incidence of impacted mandibular third molar in this study difference was statically non significant at different time is highest in 20-30 years with incidence of 60% total patients interval. This was correlated with the results revealed by followed by 31-40 year of age with 26.6%. Mean age in group I Praveen G. (2007)8 was found to be 29.93 years and in group II mean age was 31.43 years. This is almost similar with the study of Srinivas Trismus: Trismus (Decrease in mouth opening) is one of the M. Susarla (2005)2 having patients of mean age 26 ± 10.7 common postoperative sequaele. Deeply impacted teeth need years, Olalekan Micah (2007)3 having patients of mean age wider flap reflection and more amount of bone removal for the 26.6 ± 6.2 years Jose Barreiro- Torres (2010)4 having patients extraction; they cause more damage to adjacent tissues leading of mean age 25.4 ± 6.6 years to more trismus. In this study trismus starts from 1st day post operative and reaches to maximum on 3rdpost operative day 34597 | P a g e Devesh Tiwari et al., Comparison Between Conventional Rotary Surgical Technique and Chisel Mallet Technique for surgical Removal of Impacted Mandibular Third molar then it diminishes gradually with time in both the group. While Paresthesia: Among the serious complication from impacted comparing the trismus at different time interval in both the mandibular third molar surgery is injury of either inferior groups’ trismus was found to be more in group I at 1st day, 3rd alveolar or lingual nerve which can be as a result of direct or day, 8th day, 10th day and 15th day. However there were few indirect forces. In this study Paresthesia was more in group I cases presenting opening limitations at 10th day post than in group II. In group I the Paresthesia was of lingual nerve operatively. which regained sensation after 7 post operative day. In group II in one case lingual nerve was involvedand lingual nerve Patient Acceptance th regained sensation in 10 day post operatively. This was in co - Patient acceptance for removal of mandibular third molar was relation with the study of Abi and Shepherd (1993)7 who found found to be more with bur than with chisel and mallet as 73% more incidence of Paresthesia with surgical bur in comparison of patients were satisfied and only two patients were to chisel and mallet Rood (1983)12 reported an initial incidence dissatisfied when osteotomy was done with bur. While nearly of 6.6% lingual nerve injury, Blackburn andBramley (1989)13 half of patients were highly dissatisfied by use of chisel and 11% and Jeevanlata and Aruneshkumar tiwari14reported 22%. mallet and around 1/4th of patient shows satisfaction with the The cause of lingual nerve damage during third molar surgery use of chisel and mallet. Probable reason for this may be are lingual plate perforation and lingual flap trauma during because of use of mallet which cause jerk and fear to the ostectomy or tooth sectioning, usage of lingual flap retractor patients. and supracrestal incision because the nerve can be located in

th this region and in some cases may be sectioned. During suture removal at 7 day post-operative patient acceptance drastically increase in case of chisel and mallet in CONCLUSION comparison to bur because of less stormy healing process less oedema, trismus and smooth post operative phase Following conclusions were withdrawn from the study of impacted mandibular third molar removal with the use of chisel In our opinion individual patients should be weighted and if mallet or surgical bur for ostectomy and odontectomy. with the use of conscious sedation intra- operative fear and jerk of chisel and mallet is gone, and as less post operative sequels The incidence of impacted mandibular third molar removal is are there osteomy with the help of chisel and mallet will be highest in 20-30 years. In this study male gender was better opinion than with the bur. predominant (70%).Use of chisel and mallet requires less time in comparison to surgical bur for removal of impacted Swelling: Swelling is a known complication of third molar mandibular third molar. The VAS score for the subjective pain surgery. In this study swelling was measured from Tragus to shows more reduction of VAS pain score with the use of chisel sub-nasal (TN) and Tragus to Pogonion (TP). In both the group and mallet post operatively. Patient acceptance with the use of st swelling (TN and TP) starts increasing from 1 post operative bur for osteotomy was more intra operatively but rd day with peak on 3 day after that it gradually diminishes and postoperatively at the time of suture removal acceptance was th at the end of 10 day almost the presurgical level has been more in chisel and mallet group owing to less post achieved. The post operative swelling does not diminish operativesequele in the chisel mallet group. Post operative continuously, but changes according to a circaseptan (about 10- swelling is more with the use of surgical bur. Incidence of days) rhythm. When comparing the increase in TN and TP in paresthesia is more with the use of surgical bur. The possibility both the group these values were higher in surgical bur group of wound dehiscence and dry socket developing is similar with than in chisel and mallet at all the follow ups. This was in use of chisel mallet and surgical bur for cutting bone. 7 correlation with the study of Absi and Shepherd (1993) who found more swelling by surgical burs on 3rd postoperative day On the basis of above findings we concluded that Chisel and and Praveen G. (2007)8. Mallet use for removal of impacted mandibular third molar had less morbidity than surgical bur which in turn is also cost Complications effective. Although the results obtained in the present study

Incidence of dry Socket. Alveolar osteitis (Dry socket) is one were quite encouraging, however owing to limited number of of the most common complications associated with dental patients and shorter duration of follow up the trends obtained extractions. Dry socket incidence was found equal in Group I with the present study need to be corroborated in a larger (2 patient) & Group II (2 patient). Dry socket or Alveolar sample with longer duration of follow ups in order to reach any osteitis is a known complication in which patient factor like definite conclusion. age, gender, use of contraceptive, smoking have been 11 References implicated. In addition study by AleenL. Sisk (1986) et al have shown that operators experience also has a role in 1. Textbook of Oral and Maxillofacial Surgery. Kurger development of dry socket. Since in this study procedures were GO, editor. 6th ed. Mosby: New Delhi: Jaypee Brothers; done by the same operator in both groups and other patient 1990. factor were similar in both groups. No significant inference can 2. Sriniva M. Susarla, AB, (2005) How well Do clinicians be drawn in regards to development of dry socket with use of Estimate third molar Extraction Difficulty J Oral chisel or surgical bur. MaxillofacSurg 63:191-199, 2005. 3. OlalekanMicabGbotolorun, (2007) Assessment of Wound dehiscence: One patient each in both groups had Factors Associated with Surgical Difficulty in impacted wound dehiscence on third day. The merit or demerit of using Mandibular Third molar extraction. J. Oral chisel mallet or surgical bur could not be established in respect Maxillofacsurg 65:1977-1983,2007. to wound dehiscence in this study. 34598 | P a g e International Journal of Recent Scientific Research Vol. 10, Issue, 09(A), pp. 34594-34599, September, 2019

4. Jose Barreiro- Torres (2010) Evaluation of the surgical 9. Kruger GO (1959). Managment of impaction.DClin N difficulty in lower third molar extraction. Med oral Pato American P. 707 (Nov) 1959. Oral Cir Bucal 2010 Nov 1:15(6):e869-74.ter 10. Thoma KIT (1963). Oral Surgery 4thed, St Louis, The 5. Hidemichi Yuasa (2004) clinical postoperative findings CV Mosby Co. after removal of impacted mandibular third molars: 11. Allen l.sisk. complications following removal of Prediction of postoperative facial swelling pain based on impacted third molas: journal of oral maxillofacial preoperative variables. British journal of oral and surgery 44:855-859.1996. Maxillofacial Surgery 42,209-214. 12. Rood (1983) Incidence of lingual nerve paraesthesia 6. Iwona Anna Niedzielska, (2006) Panoramic following mandibular third molar surgery Year : 2011 | radiographic predictors of mandibular third molar Volume : 2 | Issue : 2 | Page : 137-140 eruption (Oral Surg Oral Med Oral Pathol Oral 13. Blackburn CW, Bramley PA. Lingual nerve damage RadiolEndod 2006; 102:154-8). associated with the removal of lower third molars. Br 7. Absi& Shepherd. A comparison of morbidity following Dent J 1989; 167:103-7. the removal of lower third molars by the lingual split 14. Jeevanlata and AruneshkumarTiwari: Incidence of and surgical bur methods. int j. Oral maxillofac Surg. lingual nerve paraesthesia following mandibular third 1993;22:149-153. molar surgery, National journal of oral and 8. Praveen G, Comparison of morbidity following the maxillofacial surgery: year 2011, volume -3 page 141- removal of mandibular third molar by lingual split, 143 surgical bur and simplified split bone technique India J Dent Res;18 (1(2007).

How to cite this article:

Devesh Tiwari et al.2019, Comparison Between Conventional Rotary Surgical Technique and Chisel Mallet Technique for surgical Removal of Impacted Mandibular Third molar. Int J Recent Sci Res. 10(09), pp. 34594-34599. DOI: http://dx.doi.org/10.24327/ijrsr.2019.1009.3930

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