(TC31) Safe and Efficient Techniques to Manage the Mental Nerve During Mandibular Root End Surgery: Photo and Video Demonstration on Human Cadavers

Abstract: A major challenge of root end surgery in the mandibular posterior region is the management of the mental nerve. If not properly managed, the mental nerve may be cut, stretched, or crushed, leading to unfavorable outcomes and undesirable sequelae such as paresthesia, dysesthesia, or anesthesia. The purpose of our table clinic is to demonstrate four techniques that can aid a clinician in managing the mental nerve during mandibular root end surgery: preoperative cone beam computed tomography (CBCT) assessment, distal releasing incision, bone groove technique, and piezoelectric technique. CBCT is essential for surgical treatment planning; it helps the clinician accurately locate anatomical landmarks including the mental foramen and mental nerve. Second, in cases where a mesial release would approximate the mental nerve, a triangular flap with a distal releasing incision can provide adequate access and help prevent stretching of the neurovascular bundle. Third, a groove on the buccal bone placed above the mental nerve provides a positive stop and prevents iatrogenic impairment of the neurovascular bundle during retraction. Lastly, piezoelectric techniques during the osteotomy can help cut hard tissue without damaging the nerve even in direct contact. The techniques will be presented with photography and video demonstrations on human cadavers. With knowledge of these techniques, the clinician will be able to safely and confidently perform mandibular root end surgery while preventing injury to the mental nerve and avoiding undesirable outcomes.