Wisdom Tooth's Collateral Damages

This case involves the surgical removal of a completely impacted wisdom tooth. The horizontal impaction had caused a subgingival carious lesion in the adjacent tooth. Because of the extent of the subgingival cavitiy, the adjacent tooth now could not be saved, and required to be extracted at the same time of the wisdom tooth.

 Panorex examination revealed 4 impacted wisdom teeth (1,16, 17, 32). Teeth # 17 and #32 are completely horizontally impacted and are causing the large carious lesion subgingivally for its adjacent teeth # 18 and # 32. A diagnosis of impacted wisdom teeth 1,16,17,32 and acute abscess teeth # 18, 31.

 

 

Due to the level of the carious lesions, teeth # 18 and 32 were determined to be non-restorable and required extraction as well. Because of financial constraint, the patient requested for the surgical removal of the affected teeth lower left side (#17 & #18) at this time only.

 

 
The patient was anesthetized locally. We began by sectioning the tooth # 18 in half. Due to the carious lesion subgingivally, the distal half of the crown # 18 was undermined and broke off, leaving the distal root behind.

 

 
A closer view showing the level of subgingival carious lesion on tooth # 18.

 
A closer look at the occlusal cavity on the impacted wisdom tooth #17. 

 The distal root of tooth # 18 was then extracted.

  

The mesial half of crown and the mesial root of tooth # 18 then extracted.

A full thickness periosteal flap was raised to expose the crown of tooth # 17. A trench was made with a 703 surgical carbide around the buccal aspect of the tooth. Mobility was accomplished using the #301 and 34 straight elevators respectively.

The crown of the wisdom tooth # 17 was sectioned, so that the tooth can be extracted mesially.

 

 
Impacted tooth # 17 were elevated out mesially.

 
All wound was irrigated copiously with normal saline.

4-0 chromic suture was used to close the surgical flap. Patient tolerated procedure well. Postoperative instruction was given in writing and by caesy video.

 
Closer look at the final wound with the suture in place. Antibiotic and pain killer were prescribed. Patient is scheduled to follow up in 1 week in our office.







So, the lesson from this case for the doctors is to remove the from the front-to-back. This is the exception to the general rule of back-to-front in oral surgery. The lesson for the public is to remove the impacted tooth early in late teen or early twenty before it destroys the adjacent tooth.


Thank you for viewing.

Houston dentist
Minh Nguyen, D.D.S.