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.

Dental Surgery Review: Partially Impacted Wisdom Teeth

Surgically removal of two lower partially impacted wisdom teeth. This procedure was done under local anesthesia in our office on May 16, 2012 for a young female patient.

 

Panorex xray shows partially impacted wisdom teeth (#17 and #32) on mandible.  Noted there is also a completed bony impacted on the maxillary left wisdom tooth (#16) as well.

Our patient was a young healthy female.  She came to our office with a complaint of pain on her lower right jaw and difficult in chewing.  A diagnosis of acute operculitis was made and she was treated immediately with incision and drainage procedure.  The patient was discharged with antibiotic and rescheduled for surgery in 1 week.

A picture of her lower right wisdom tooth (#32) a week after.  Noted that the inflammation was reduced.  Also noted for a carious lesion on the chewing surface and partially erupted condition. The tooth also had slight rotation counter-clockwise.

Lower left wisdom tooth was also partially impacted and rotated.  There was a carious lesion on the chewing surface as well.

After the wisdom tooth was anesthetized, a small incision was made to expose the crown of tooth.

Standing from behind the patient,  a dental forcep was used to extracted the wisdom tooth in standard fashion.

Extraction socket of the lower right impacted wisdom tooth was irrigated with normal saline.

Partially impacted right wisdom tooth showing calculus on the distal surface and carious lesion on the occlusal surface

The wisdom tooth on the left side was then extracted in similar fashion. Photo showing the extracted socket after normal saline irrigation.

Lower left partially impacted wisdom tooth extracted.  Note for the fused roots and the carious lesion on the distal surface in addition to the one on the occlusal surface.

Photos of the 2 extracted partially impacted wisdom teeth.  The patient tolerated procedure well and she was scheduled for a follow-up visit in one week.


Houston dentist
Minh Nguyen, D.D.S.

Impacted Wisdom Tooth - Surgically Removal

This is a case report of a surgically removal of the impacted wisdom teeth done in our office today.  The patient is an 18 years old Asian healthy female.

 

 Panorex shows partially impacted wisdom tooth on low right and left jaw. Plan was to remove the wisdom tooth on the lower right side under local anesthesia. Softdental - Minh Nguyen, D.D.S.

Oral exam shows the tip of the right wisdom tooth erupted, the rest of the tooth still submerged under the gum. Softdental - Minh Nguyen, D.D.S.


 

 After the area was anesthetized, the incision was made on the area of the wisdom tooth (#32) and the molar tooth in front of it (#31). Softdental - Minh Nguyen, D.D.S.

Full thickness periosteal flap was raised and the wisdom tooth was dissected and visualized.

Softdental - Minh Nguyen, D.D.S.

The wisdom tooth was elevated with an extraction elevator through the incision out to the oral cavity. Softdental - Minh Nguyen, D.D.S.

The wisdom tooth was surgically removed and inspected. Softdental - Minh Nguyen, D.D.S.

The remain extraction socket of the wisdom tooth, showing minimal bleeding. Softdental

- Minh Nguyen, D.D.S.

The surgical flap was closed with 2 dissolvable stitches (chromic gut suture). Softdental

- Minh Nguyen, D.D.S.

Patient tolerated procedure well, no complication noted for this wisdom tooth surgery. We will follow her up in one week. Softdental - Minh Nguyen, D.D.S.


Her prescription:

1. Decadron 4mg x2 tabbles right away in office
2. Amoxil 250mg one three times a day x 30
3. Vicodin ES one every 6 hours as needed for pain x 30

Houston dentist
Minh Nguyen, D.D.S.