Piezoelectric Bone Surgery for Treatment of Complex Odontoma in the Mental Foramen Region in Adolescents.
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BACKGROUND: Odontogenic tumors are common benign dental lesions in adolescents; however, the mixed type is relatively uncommon. When these lesions occur in the mandibular premolar region near the mental foramen, they may lead to nerve compression and displacement of adjacent teeth. Treatment difficulty arises from balancing the complete removal of the lesion with the protection of the nerve. CASE BRIEF: A 13-year-old female presented with a painless mass in the left mandible. CBCT revealed a high-density mass measuring ∼2.2 cm in the left mandibular premolar area, compressing the inferior alveolar nerve near the mental foramen. The left mandibular second premolar was significantly inclined mesially. Under general anesthesia, the lesion was accessed through the vestibular sulcus approach, and bone removal was performed using a piezoelectric bone surgery device. The lesion was completely excised under direct visualization while protecting the mental nerve. Postoperative pathology confirmed a complex odontoma. No abnormal sensation was noted in the lower lip or chin after surgery. The displaced second premolar was observed without immediate traction or extraction. At the 6-month follow-up, no recurrence was observed. The mesial inclination of the left mandibular second premolar improved, and bone repair in the surgical area was satisfactory. CONCLUSION: Although a complex odontoma located in the mental foramen region is benign, it should be managed as an anatomically high-risk lesion. Combining CBCT with the piezoelectric bone surgery device is beneficial for achieving complete tumor removal and protecting nerves. The phased strategy of "observation first, intervention later" for managing mechanically displaced teeth in adolescents, after removing the compressive lesion, is clinically feasible. This approach reduces overtreatment and supports long-term functional reconstruction.