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.
