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The Brief

This document summarizes the presurgical assessment and planned treatment for a 23-year-old female requiring extraction of a partially impacted upper right third molar. An examination found a mesoangular impaction with bone coverage and mild pain. Radiographs confirmed bone loss around the second molar related to the impacted tooth. The proposed treatment plan is to surgically extract the impacted tooth under local anesthesia using a triangular flap and bone removal with a bur to expose the crown for elevation and removal. The patient will be informed about potential outcomes like pain, swelling and trismus that should resolve in 2-3 weeks, as well as complications like dry socket, retained fragments or infection.

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40 views6 pages

The Brief

This document summarizes the presurgical assessment and planned treatment for a 23-year-old female requiring extraction of a partially impacted upper right third molar. An examination found a mesoangular impaction with bone coverage and mild pain. Radiographs confirmed bone loss around the second molar related to the impacted tooth. The proposed treatment plan is to surgically extract the impacted tooth under local anesthesia using a triangular flap and bone removal with a bur to expose the crown for elevation and removal. The patient will be informed about potential outcomes like pain, swelling and trismus that should resolve in 2-3 weeks, as well as complications like dry socket, retained fragments or infection.

Uploaded by

Hola Hola
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Presurgical assessment of partially

impacted upper third molar


By Dr.Ahmed Esam Ameen
Oral & maxillofacial surgery department buc intern dentist
20175223

Case presentation
23 years old female intern physiotherapist refered from periodontic department of BUC dental school
for extraction of partially impacted right upper third molar, with cheif complain of localized pain on
tooth region.

Medical history revealed absence of any medical complications. dental history proved that she passed
a periods of swelling, pain on biting, with opposing lower 1st 2nd molars composite filling. Extraoral
examination shows normal facial profile with no presence of any inflammation or swelling.

Intraoral examination shows partially impacted wisdom “prominent distal cusp”. on palpation it seems
to be mesoangular impaction, shallow tuberosity, little bone coverage with no evidence of inflammation
or any pathology related condition. pain with air and lateral percussion noticed. and no cavitation with
probing.
panoramic rag‫ي‬iograph shows mesoangular impacted upper 3rd molar with moderate crown size
seems to be only covered by soft tissue, club shaped or conical roots seems to be fused with a little
root surface area, away from maxillary antrum .

periapical radiographs shows interlocking of mesial cusps with bone loss and deep wide pocket
distally to upper second molar.
Diagnosis
deep pocket and bone loss in distal side of upper second molar
related to mesoangular impacted wisdom seems to cause minimum
cavitation on distal upper 7

Treatment plan
surgical extraction of impacted impacted tooth
all infection control measures should be achieved ‘well cleaned wrapped unit, masks, gowns,
gloves, sterilized instruments...’

Local anesthesia – buccal&lingual infiltration


Flap design
Triangular flap will be given starting the Incision from the Maxillary tuberosity and extend along the
crown of the third molar towards the distal part of the second molar. using Minnesota retractor and
incision with #15 blade then elevation of buccal flap by mucoperiosteal elevator
Bone removal
done primarily on the lateral aspect of the tooth down to the cervical line to expose the crown using
round surgical bur

NO sectioning because the overlying bone is thin and relatively


elastic.
Elevation of root with right-curved Warwick James elevator
applied on the mesio-buccal with rotational and lever types of motions. The tooth will delivered in a
disto-buccal and occlusal direction

Irrigate socket with saline and smoothen with bone file if


necessary
Suturing the wound using
Absorbable sutures such as catgut and polyglycolic acid, Needle holders, toothed forcepes

Giving patient instructions

outcome
During normal healing it is usual for the patient to experience some discomfort, swelling and trismus
over the first 3 postoperative days. Symptoms should gradually resolve over the next 2 weeks.

• Pain visual analog scale (VAS).


The inflammation induced by surgical trauma results in pain of which the patient must be forewarned.
This will be worst in the first 24 hours postoperatively and should be resolved within 3–4 days. If pain
persists there may be dry socket or infective complications.

• Hemorrhage
must be controlled at the time of surgery. Soft tissue bleeding may require hemostatic agents, bipolar
diathermy, and sutures.

• Ecchymosis.
Patients should be informed that bruising is common and self-limiting and will usuallyresolve within 2
weeks of surgery.

• Swelling
caused by surgically induced inflammation is a common sequel and usually correlates with the degree
of difficulty of surgery. The patient must be warned of this risk and advised that it should resolve within
24–36 hours. can.

• Trismus.
Limited interincisal opening is related to the inflammation around the masseter insertion. This is
interlinked with postoperative pain and swelling and should also resolve at 3–4 days postsurgically

• Sensitivity.
Subsequent to raising a flap adjacent to the second molar, exposure of root dentine may occur during
healing of the third molar socket. This may cause local sensitivity of the second molar during this
period.

• Defect.
The third molar socket may take several months to completely infill and the resulting defect may cause
the patient some concern. It is important to reassure the patient.

• Temporomandibular joint (TMJ) pain


may arise due to prolonged opening of the patient’s mouth during treatment. The joint may remain
painful for several weeks and the patient should be reassured.undergoing any prolonged dental
treatment.

Complications associated with treatment


Dry socket. Alveolar osteitis
Retention of root fragment
Displacement of tooth or root fragment.
Any tooth or fragment may be at risk of being swallowed or inhaled.
infection
Fractured tuberosity

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