EXTRACTING IMPACTED TOOTH

 As a consultant Oral and Maxillofacial Surgeon we most often come across minor oral surgical cases amongst which extraction of impacted third molar is the most common referral case.

Now these impacted third molar can be either mandibular third molars, canine impactions or maxillary third molars.

Palatally or buccaly impacted canines are most often referred by orthodontists to maxfac surgeons.

Before starting orthodontic procedures, the orthodontists referr the patients to maxfac for exraction of impacted mandibular third molars, canines or maxillary third molars as they significantly affect the post treatment outcome.

Lets look at some tips while extracting impacted tooth..

• While extracting impacted third molars always give IAN block along with buccal infiltration.
• Prefer Langenbeck retractor for retracting flap.
• Use molts periosteal elevator for reflecting flap.
• Never attempt sectioning tooth before completely reflecting the mucoperiosteal flap.
• Do not section the tooth till the apex as it can affect the IAN nerve.
• Never use bone as fulcrum otherwise you will end up fracturing the bone itself!
• For mandibular molars preffer making a buccal gutter before applying intruments.
• Carefully analyse the radiograph and make a proper treatment plan before proceeding with extraction.
• Proper cleaning and debridement of extraction socket with normal saline and betadiene must be done.
• Always check for any sharp bony prominence after takng the tooth out. Use a bone file or rongeur to smooth out sharp bony edges.
• While suturing flap take care not to create watertight suture! You want the odematous fluid to escape. Is'nt it?
• While suturing also take care not to create a distal pocket distal to second molar. Specifically take a suture bite over distal pocket area.
• Post operative instructions should include ice packs, warm saline mouthwash only after first 24 hours, brushing and maintaining oral hygiene after 24 hours along with prescribed medications.