Computed Tomography-Based Custom Cutting Guide Enables Safe Buccal Corticotomy in the Presence of a Buccal Neurovascular Bundle.

Conventional extraction of deeply impacted mandibular teeth often requires extensive bone removal, increasing the risk of nerve injury when the neurovascular bundle is positioned buccally. Although buccal corticotomy can enhance access and visibility, it is typically contraindicated in such cases due to the high risk of nerve damage. We present the successful extraction of a deeply impacted mandibular third molar with a buccally positioned inferior alveolar neurovascular bundle using a computed tomography-based custom cutting guide. This guide enabled precise buccal corticotomy, avoided nerve injury, and preserved mandibular integrity by allowing cortical bone repositioning. To our knowledge, this is the first report of a computed tomography-guided buccal corticotomy in a case with a buccal neurovascular bundle. This approach may safely expand the indications for buccal corticotomy in anatomically high-risk cases.