Wisdom tooth extraction
Gerard, a 24 years old patient, visited our clinic to for a regular check-up and concerned with his lower third molars, commonly known as wisdom teeth. For a complete control, the panoramic radiograph is mandatory. (Fig. 1).
In this case, two impacted wisdom teeth were diagnosed with a horizontal eruption. Due to the lack of space, both teeth were inclined forward to try to erupt. The lower left second molar has a distal decay (posterior), with onset of periapical lesion for possible necrosis. In the upper right third molar we can appreciate a tooth extrusion, and as a consequence the bite plane(red line) is incorrect, causing bite interferences and tooth spaces (blue circle). These spaces often result in decays similar to the lower left second molar and/or periodontal problems such as periodontal pockets or bone loss. (Fig. 3).
When one or several teeth don’t have antagonists (oposite tooth to contact), there is a physiological movement called extrusion. The tooth begins to leave the bone seeking contact with the antagonist tooth. In cases of wisdom teeth extraction, with few exceptions, usually all 4 teeth are extracted, precisely to avoid creating periodontal problems or biting interferences.
The treatment plan is an extraction of all 4 wisdom teeth and evaluation of the left second molar vitality. Before this surgery is important to assess the roots anatomy and its proximity to the inferior alveolar nerve, through a computerized tomography (CT). A CT scan is a radiographic test in 3 dimensions that help us to make a proper surgical planning. The patient chose to extract four teeth in one session, with general anesthesia.
After one week, we can see a very good post-operative without inflammation and with only a small restriction of mouth opening which disappears within a few days.