Lingual vertical release

[ToothFixerUpper]

This is a question I have asked many surgeons and no one gives me the same answer, except to say, be careful down there..... So the lingual nerve traverses coronally in contact effectively with the mandible around the 3rd molar, to the 2nd molar, but then quickly falls apically and medially. The question I have is in regards to dropping a lingual vertical incision to assist in lingual flap reflection.
For example, doing a crown lengthening on the 2nd lower molar, and trying to remove bone at the disto-lingual position, means the lingual flap has to be stretched quite a bit to allow access. This stretching is one of the most common causes of lingual nerve injury. So to avoid this, why wouldn't we drop a slight vertical incision say at the mesial of the second premolar (not deep, just beyond the keratinized attached gingiva) that would allow much more movement of the flap but without risk of stretching it?

Am I missing something here?

Thanks

 

[honestdoc]

Since Periodontists do a lot of crown lengthening procedures, they may provide more insights. Anecdotally, lingual nerve may situated really close to the coronal aspect and can be risky to flap near it. Risk vs benefit of your crown lengthening case may not be worth the trouble. Any alternative treatment options such as extraction, implant, etc. that may be more predictable?

 

[ToothFixerUpper]

I would agree but I am suggesting a vertical release at the lower premolars which seems to be well clear of the lingual nerve. Like, not even remotely close. I just wanted opinions and to see if anyone does this because it isn't discussed in any of the textbooks I have ever read.

Thanks

Since Periodontists do a lot of crown lengthening procedures, they may provide more insights. Anecdotally, lingual nerve may situated really close to the coronal aspect and can be risky to flap near it. Risk vs benefit of your crown lengthening case may not be worth the trouble. Any alternative treatment options such as extraction, implant, etc. that may be more predictable?