Managing Impacted Mandibular Third Molars: A Scoping Review of Surgical Extraction versus Orthodontic Traction and Nerve Injury Risk

The management of impacted mandibular third molars can be a difficult clinical issue due to the proximity of the tooth to critical neurovascular structures. Surgical removal is routinely performed, but the technique carries a known risk of injury to the inferior alveolar and lingual nerves. The complication may induce temporary or permanent sensory impairment. Orthodontic traction can be an alternative to reposition the tooth in a more desirable location before surgical removal. The selection of the appropriate treatment is important to avoid a mechanical injury and to allow the adjacent bone and soft tissue to adapt, which may reduce the risk of nerve injury from compression or transection. This review discusses the anatomy of the inferior alveolar canal and the lingual nerve route, describes the known mechanisms and classifications of nerve injury, and outlines how orthodontic traction may diminish these risks. Technical aspects of traction, including the surgical exposure with coronectomy or not, force application, anchorage methods, and radiographic observation, are reviewed. Potential complications, including root resorption and unwanted tooth movement, were also explained. Criteria for patient selection are discussed, with emphasis on age, root morphology, eruption space, and imaging findings that indicate proximity to neurovascular structures. The purpose of this scoping review was to compare orthodontic traction and complete surgical extraction of mandibular impacted third molars with respect to injury of the inferior alveolar nerve (IAN) and lingual nerve (LN). The limited but growing evidence allows us to identify gaps in long-term outcome data and calls for further prospective studies. Orthodontic traction cannot replace extraction in every case, but for carefully chosen patients, it may offer a practical treatment option for preserving neurosensory function. The approach requires interdisciplinary collaboration, precise biomechanical planning, and a clear explanation of treatment goals to support informed decision-making.