Impacted Wisdom Tooth: How to Prevent Complications (4/5)
Discover the various techniques of bone removal for impacted teeth on our website. find out the best methods for successful tooth extraction.
Table of Contents
Introduction
The article discusses the various techniques for removing impacted mandibular third molars, including mesio-angular, disto-angular, vertically impacted, and horizontally impacted. It also covers wound closure and postoperative care instructions. Complications during and after extraction are outlined, as well as the importance of prompt diagnosis and treatment to prevent complications. The article concludes with recommendations for the timing of extraction and the importance of assessing eruption patterns.
Tooth Extraction
Once sufficient access is achieved, the impacted mandibular third molar is carefully extracted using specialized dental instruments such as forceps or elevators.
Mesio-Angular Impacted Mandibular 3rd Molar Removal
- In mesio-angular mandibular impaction, tooth division is necessary.
- The tooth is bisected at the neck because the enamel is very thin.
- Buccal and distal troughs are created, and the tooth is elevated distally with an elevator.
- Just below the cervical line, the distal half of the crown is sectioned off at the buccal groove and is removed.
- On the mesial surface, the elevator is positioned under the cement-enamel junction.
- The tooth is then moved upward and backward.
- The roots are sectioned with the elevation of the distal segment and followed by elevation of the mesial segment.
Disto-Angular Impacted Mandibular 3rd Molar Removal
- In the disto-angular position, the 3rd molar is directly under the ascending ramus.
- After sufficient amount of bone is removed, the crown is sectioned horizontally from the roots just above the cervical line.
- The crown is removed entirely.
- In the case of fused roots, a straight elevator can be used to elevate the roots into the space made by removing the crown.
- In cases of divergent roots, the roots are sectioned and removed individually.
- This type of extraction is more difficult as more of the distal bone has to be removed.
Vertically Impacted Mandibular 3rd Molar Removal
- The procedures of bone removal and sectioning of the tooth are similar as in the case of mesio-angularly impacted third molar.
- The crown is removed horizontally, and the roots are split in half.
- The distal half of the tooth is removed first, and then the mesial half is removed.
- The disto-angular impaction is more difficult than mesio-angular impaction because there is less access around the 2nd molar and it requires more removal of the bone on the distal and buccal sides.
Horizontally Impacted Mandibular 3rd Molar
- This procedure requires the most amount of bone removal.
- The bone should be removed from the cervical line to expose the majority of the buccal surface of the crown and the superior aspect of the distal root.
- The crown is sectioned from the root and is removed as a unit, or if necessary, may be sectioned, and the superior (distal) part is removed first, followed by the inferior (mesial) part.
- If roots are divergent, then the roots are split into two pieces and removed individually, first the upper half and followed by the lower half.
Wound Closure
- After extraction, any debris is cleaned from the site, and sutures are placed to close the incision properly.
- Once the impacted tooth is removed from the alveolar process, the wound should be debrided of all the bone chips and other debris.
- This is best done by periapical curette.
- A bone file or an acrylic trimmer is used to smooth any rough or sharp edges of the bone.
- Finally, the socket and the wound margins are irrigated with saline to remove any bony or tooth debris.
- As more irrigation is done, the patient is less likely to develop dry socket, delayed healing, or any other complications.
- The type of sutures used can vary depending on the extent of surgery and healing requirements.
Postoperative Care
- Patients are provided with postoperative instructions regarding pain management, swelling reduction techniques, diet restrictions, and proper oral hygiene practices to promote healing and prevent complications.
- Following instructions should be given to the patient following surgical removal of the impacted tooth:
- Remove the gauze pack 30 minutes to 1 hour after the surgery.
- Apply ice packs on the face for the first 24 hours.
- Take cold liquids or semi-solids on the first day after the surgery.
- Avoid warm saline rinses for the first 24 hours of the day.
- Take the medications as prescribed by the doctor.
Complications
- There can be many complications during the extraction of an impacted third molar.
- The complications can either be intraoperative complications or postoperative complications.
Intraoperative complications:
- During the incision, injury may be caused to the facial nerve.
- During the bone removal, damage may be caused to the second molar or the bur might slip into the soft tissues and cause injury.
- During the elevation of the tooth, there might be:
- Fracture of the mandible
- The neighbouring tooth luxation
- TMJ dislocation
- Due to slipping of elevator, there may be soft tissue injury.
Post-operative:
The postoperative complications include:
- Hematoma
- Bleeding
- Swelling or oedema
- Pain
- TMJ pain
- Trismus
- Dry socket
- Infection
- Sensitivity
Conclusion
- Impacted teeth can be a common dental issue affecting individuals of various ages, with wisdom teeth being a frequent site of impaction.
- The study on impacted lower third molars concluded that the frequency of vertical impaction increases with age, with a higher prevalence in patients older than 20 years.
- In contrast, horizontal impactions were more common in younger patients.
- The research suggests that late extraction of mandibular third molar teeth (after the age of 20) is recommended when considering prophylactic extraction.
- The findings also indicated a constant pattern of increase in the retromolar space with age, emphasizing the importance of assessing the eruption patterns to determine the optimal timing for extraction.
- Symptoms such as pain, swelling, and difficulty chewing may indicate the presence of impacted teeth.
- Prompt diagnosis and appropriate treatment are essential to prevent complications like infections or damage to neighbouring teeth.
- Treatment options range from simple extractions to surgical interventions, depending on the severity of the impaction.
