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Dynamic Navigation System-assisted extraction of fully impacted mandibular second molars under conscious sedation: a case report and literature review

British Dental Journal volume 240, pages 149–154 (2026)Cite this article

Abstract

The extraction of fully impacted mandibular teeth often involves risk of damage to adjacent anatomical structures, and patients often experience anxiety. Traditional pre-operative imaging modalities lack the ability for real-time precise localisation of teeth during surgery. A dynamic navigation system (DNS) employs optical principles to achieve real-time tracking of both the patient and surgical instruments. This is the first case report describing the use of a DNS for the extraction of an impacted second molar. Additionally, we conducted a systematic literature review to summarise the applications of DNSs in dentoalveolar surgery. In the case report, a 19-year-old male presented with unerupted 37. Pre-operative image data revealed that tooth 37 was deeply vertically impacted close to the mandibular canal, with a suspicious cystic lesion in the pericoronal region. Considering its anatomical relationship with adjacent structures, and the patient's pre-operative anxiety, the surgical method ultimately chosen was extraction under conscious sedation via DNS. The surgery successfully achieved the goal of precise, minimally invasive and patient comfort-oriented treatment, with excellent post-operative healing and no complications. This case report and literature review suggest that DNS is characterised by high precision, synchronous positioning capability, and intra-operative visualisation. It may have specific applications in dentoalveolar surgery.

Key points

  • Mandibular-impacted second molars are relatively rare in clinical practice, with a prevalence of approximately 1% in China. This is the first case report describing the use of a dynamic navigation system for the extraction of a fully impacted second molar.

  • The tooth was successfully surgically extracted using minimally invasive techniques such as single-tooth anaesthesia injection and an ultrasonic bone knife, in combination with dynamic navigation techniques under intravenous sedation and analgesia.

  • We also collected 13 papers and compiled a table to summarise the applications of dynamic navigation systems in dentoalveolar surgery.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

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Funding

This work was supported by the Jinan Municipal Health Commission Science and Technology Development Plan Project (Fund Number: 2024206007).

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Authors and Affiliations

  1. Binzhou Medical University, Yantai, Shandong 264000, China; Oral and Maxillofacial Surgery Department, Central Laboratory, Jinan Key Medical and Health Laboratory of Oral Diseases and Tissue Regeneration, Jinan Key Laboratory of Oral Diseases and Tissue Regeneration, Shandong Provincial Key Medical and Health Laboratory of Oral Diseases and Tissue Regeneration, Jinan Stomatological Hospital, Jinan 250001, Shandong Province, China

    Ziyue Zhang

  2. Oral and Maxillofacial Surgery Department, Central Laboratory, Jinan Key Medical and Health Laboratory of Oral Diseases and Tissue Regeneration, Jinan Key Laboratory of Oral Diseases and Tissue Regeneration, Shandong Provincial Key Medical and Health Laboratory of Oral Diseases and Tissue Regeneration, Jinan Stomatological Hospital, Jinan 250001, Shandong Province, China

    Guoqian Huang, Zhenjiang Gong & Shimao Yang

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  1. Ziyue Zhang
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Contributions

Z-YZ and G-QH contributed equally to this work. S-MY completed the surgery and supervised this work; Z-JG was responsible for data collection; Z-YZ and G-QH conducted the experimental design, collected information, and wrote the manuscript. All the authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Shimao Yang.

Ethics declarations

The authors declare that they have no competing interests. The treatment protocol was approved by the Ethics Committee of the Jinan Stomatological Hospital (JNSKQYY-2024-020). Written consent for publication has been obtained from the patient.

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Zhang, Z., Huang, G., Gong, Z. et al. Dynamic Navigation System-assisted extraction of fully impacted mandibular second molars under conscious sedation: a case report and literature review. Br Dent J 240, 149–154 (2026). https://doi.org/10.1038/s41415-025-9198-x

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