Encased and Entangled: Managing an Impacted Tooth with Rare Nerve Anatomy

Abstract

Introduction: The inferior alveolar nerve (IAN), branching from the mandibular division of the trigeminal nerve, supplies sensation to the mandibular teeth, lower lip, and chin. Variations in its anatomy, particularly the incisive branch, can pose challenges during surgical procedures in the interforaminal zone, often considered a safe area. However, complications such as hemorrhage, neuropathic pain, and neurosensory disturbances can arise, especially when anatomical anomalies are present. Case Report: A 32-year-old female presented to the Oral Surgery Department with concerns about resorption and potential cystic changes in the lower right lateral incisor (LR2). Imaging revealed an impacted lower right canine (LR3) with resorption and a small branch of the incisive canal traversing its apical third. Cone Beam CT also identified a bifid mental foramen. Treatment options included monitoring, coronectomy, or extraction. Due to risks of nerve damage, the patient opted for coronectomy. Discussion(s): While coronectomy is frequently used to manage mandibular third molars near the IAN, its application in the interforaminal zone is less common. This case highlights the risks associated with even minor variations in the incisive nerve's anatomy. Resorption of the LR3, associated with prolonged impaction, required careful evaluation with Cone Beam CT imaging. The treatment plan balanced preserving nerve integrity and addressing resorption, reflecting a tailored approach. Conclusion(s): This case underscores the importance of precise imaging and individualized treatment in managing impacted teeth with rare anatomical anomalies. Further research is needed to establish specific guidelines for such cases.Copyright © 2025