Incidence of neurosensory deficits and recovery after lower third molar surgery: a prospective clinical study of 4338 cases

A prospective study of all lower third molar surgery performed in the outpatient extraction clinic of a teaching dental hospital was conducted from January 1998 through October 2005 to determine the incidence of subsequent neurosensory deficit due to inferior alveolar nerve (IAN) and lingual nerve (LN) injury, to examine possible contributing risk factors and to describe the pattern of recovery. 3595 patients were included (61% female, 39% male; age range, 14-82 years). Of the 4338 lower third molar extractions performed by various grades of operators, 0.35% developed IAN deficit and 0.69% developed LN deficit. Distoangular impaction was found to increase the risk of LN deficit significantly (p<0.001). Depth of impaction was related to the risk of IAN deficit (p<0.001). Undergraduates caused more LN deficits (p<0.001). Sex, age, raising of a lingual flap, protection of LN with a retractor, removal of distolingual cortex, tooth sectioning and difficulty in tooth elevation were not significantly related to IAN or LN injury. Postoperative recovery from IAN and LN deficits was noted most significantly at 3 and 6 months, respectively. By the end of the follow-up period, 67% of IAN deficits and 72% of LN deficits had recovered completely.