ODONTECTOMY• A case when an impacted tooth fails toerupt into the dental arch within theexpected time.• The tooth becomes impacted because itsadjacent teeth, dense overlying bone, orexcessive soft tissue prevents eruption.Because impacted teeth do not erupt, theyare retained for the patients lifetimeunless surgically removed.
Premedications Mefenamic acid (500mg)Disp. #1Take 1 cap 1 hour before the treatment tolessen pain.Amoxicillin (500mg)Disp. #1Take 1 cap 1 hour before the treatment toprevent infection.Tranexamic acid (500mg)Disp. #1Take 1 cap 1 hour before the treatment toprevent excessive bleeding.
Procedure1.Aseptic Technique-minimizes wound contaminationby pathogens through the following:a. Sterilization of Instrumentsb. Operatory Disinfectionsc. Surgical Staff Preparation2.Pain and Anxiety Controla. Dry the mucosa and apply topical anes, on surgical areab. Admin. Local anes, using Mandibular Block Tech.3.Flap Designa. Full thickness flap will be used to reflect the soft tissue forremoval of impacted molar.
SURGICAL PROCEDURE1. To have an adequate area of exposure, incisethe tissue from retromolar area down to thebone making it a full thickness flap.2. The incision will run from ramus area forposterior extension.3. The posterior extension should diverge laterallyto avoid lingual nerve injury.4. Reflect the incision laterally to expose theunderlying bone covering the impactd 3rdmolar.
MANDIBULAR NERVE BLOCK• Anesthetize the toothusing mandibular blockand local infiltrationtechnique
SURGICAL PROCEDURE1. Bone removal Assess the need and extent of the bone to be removed. Remove bone on buccal cortical plate using surgical bur and handpiece toexpose the greatest convexity of the crown. Irrigate to remove debris and to avoid overheating due to constantfriction.1. Using surgical bur, exposed crown is then cut up to the ¾ portion ofthe crown. This creates a slot wherein the angular elevator isinserted and then rotated to completely split the tooth. Coronalpart is delivered first out of the socket using angular elevator froma mesiobucccal direction. Using a cryer elevator, the apical portionis then luxated out of the socket.2. Curette the socket and remove the follicular sac.3. Smoothen the sharp and bony spicules using a bone file.4. Irrigate the area using NSS then suction.
SURGICAL PROCEDURE6. Place appropriate amount of gel foam on the socketfor promotion of hemostasis on the area.7. Prepare for suturing. Stabilize loose tissue forceps.Coaptate the loose and movable tissue.8. Suture with sterile suturing material. Suture design ismultiple interrupted sutures.9. Provide instructions for post operative phase to thepatient.10.Recall after 1 week.
The preferred incision for the removal of an impacted mandibularthird molar is an envelope incision that extends from the mesialpapilla of the mandibular first molar, around the necks of theteeth to the distobuccal line angle of the second molar, and thenposteriorly to and laterally up the anterior border of the mandible A, Envelope incision is most commonly used to reflect soft tissue forremoval of impacted third molar. Posterior extension of incisionshould laterally diverge to avoid injury to lingual nerve.B, Envelope incision is laterally reflected to expose bone overlyingimpacted tooth.C, When three-cornered flap is made, a releasing incision is made atmesial aspect of second molar.D, When soft tissue flap is reflected by means of a releasingincision, greater visibility is possible, especially at apical aspect ofsurgical field.
POST OPERATIVEINSTRUCTIONRelax after surgery. Physical activity may increase bleeding.Have a soft diet and gradually add solid foods to your dietas healing progresses.Do not drink alcohol or hot fluids such as tea or coffee andavoids spicy foods until the gum is fully healed.Many surgeons recommend the use of ice packs on the faceto help prevent postoperative swelling.Avoid smokingAfter the first day, gently rinse your mouth with warm saltwater several times a day to reduce swelling and relievepain.Avoid rubbing the area with your tongue or touching it withyour fingers.
POST MEDICATIONMefenamic acid (500mg)Disp. #6Sig. Take 1 cap every 6 hours for pain (p.r.n)Amoxicillin (500mg)Disp. #21Sig. Take 1 cap every 8 hours 3 times a day for 7days to prevent infection.Tranexamic acid (500mg)Disp. #2Take 1 cap if there is an excessive bleeding
POSTOPERATIVE FOLLOW-UPVISITAll patients should be given a return appointment sothat the surgeon can check the patients progressafter the surgery. In routine, uncomplicatedprocedures, a follow-up visit at 1 week is usuallyadequate. If sutures are to be removed, that can bedone at the 1-week postoperative appointment.Moreover, patients should be informed that should anyquestion or problem arise, they should call the dentistand request an earlier follow-up visit. The most likelyreasons for an earlier visit are prolonged andbothersome bleeding, pain that is not responsive to theprescribed medication, and infection.