Thanks to Dr. Meyer for his nice letter and kind comments. Through the 1990s, I myself would have made the same comments as Dr. Meyer: if it is absolutely necessary to remove an impacted lower third molar, I’ll undertake a surgical treatment as best as I can, informing the patient beforehand about the risk of complications, including neurological ones.
This is no longer true in the 21st century. The orthodontic-surgical approach to the extraction of high-risk impacted mandibular third molars, the so called "orthodontic extraction,"1,2 allows us to avoid even that 1 percent of permanent neurological complications that, according to Kipp and colleagues,3 may arise even in postgraduate oral surgery schools.
The dentist cannot always rely definitively on optical projection orthopantomography or periapical radiographs. As stated in our article, if there are two or more predicting parameters or a deviation of the mandibular canal, a contact with the alveolar nerve is very likely to occur. Such contact must absolutely be pointed out through a CT.
It is the dentist’s responsibility to explain the diagnostic process, and to suggest to the patient the best solution among the ones offered by our science,1,2,4 keeping in mind the Hippocratic oath, and that the patient’s health and wellness must always be guaranteed. Only at this moment will the patient be able to choose between the two therapies.
It is also important to point out that, in Italy, radiograph expenses are paid by the National Health Service.
Last, but not least, how can a dental surgeon defend himself or herself against medico-legal proceedings, when he or she has not carried out all diagnostic and therapeutic actions?
Anyway, many thanks to Dr. Meyer, who made us think of these ethical, technical and legal aspects.
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