ODONTECTOMY

Chica, Danna Paula Louise

 A case when an impacted tooth fails to erupt into the dental arch within the expected time.
The tooth becomes impacted because its adjacent teeth, dense overlying bone, or excessive soft tissue prevents eruption. Because impacted teeth do not erupt, they are retained for the patient's lifetime unless surgically removed.

ODONTECTOMY

Armamentarium
Antiseptic Cotton Plier Gauze Aspirating Syringe 27 gauge long needle Elevators Periapical Curette Scalpel (2) 10cc syringe Soft tissue scissor Bone file Root Tip pick Water receptacle Hemostat Suturing Thread Saliva Ejector Topical Anesthesia Cotton Mouth Mirror Local Anesthesia Gum separator #16 forceps Minnesota Retractor #15 Blade NSS Ronguer Chisel and mallet Periosteal Elevator Waste Receptacle Suturing Needle Needle Holder Suction Machine

Premedications
Mefenamic acid (500mg) Disp. #1 Take 1 cap 1 hour before the treatment to lessen pain. Amoxicillin (500mg) Disp. #1 Take 1 cap 1 hour before the treatment to prevent infection. Tranexamic acid (500mg) Disp. #1 Take 1 cap 1 hour before the treatment to prevent excessive bleeding.

Procedure
1. Aseptic Technique-minimizes wound contamination by pathogens through the following:
a. Sterilization of Instruments b. Operatory Disinfections c. Surgical Staff Preparation

2. Pain and Anxiety Control

a. Dry the mucosa and apply topical anes, on surgical area b. Admin. Local anes, using Mandibular Block Tech.

3. Flap Design
a. Full thickness flap will be used to reflect the soft tissue for removal of impacted molar.

SURGICAL PROCEDURE
1. To have an adequate area of exposure, incise the tissue from retromolar area down to the bone making it a full thickness flap. 2. The incision will run from ramus area for posterior extension. 3. The posterior extension should diverge laterally to avoid lingual nerve injury. 4. Reflect the incision laterally to expose the underlying bone covering the impactd 3rd molar.

MANDIBULAR NERVE BLOCK

Anesthetize the tooth using mandibular block and local infiltration technique

SURGICAL PROCEDURE
1. Bone removal Assess the need and extent of the bone to be removed. Remove bone on buccal cortical plate using surgical bur and handpiece to expose the greatest convexity of the crown. Irrigate to remove debris and to avoid overheating due to constant friction. Using surgical bur, exposed crown is then cut up to the portion of the crown. This creates a slot wherein the angular elevator is inserted and then rotated to completely split the tooth. Coronal part is delivered first out of the socket using angular elevator from a mesiobucccal direction. Using a cryer elevator, the apical portion is then luxated out of the socket. Curette the socket and remove the follicular sac. Smoothen the sharp and bony spicules using a bone file. Irrigate the area using NSS then suction.

2.

3. 4. 5.

SURGICAL PROCEDURE
6. Place appropriate amount of gel foam on the socket for 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 is multiple interrupted sutures. 9. Provide instructions for post operative phase to the patient. 10. Recall after 1 week.

The preferred incision for the removal of an impacted mandibular third molar is an envelope incision that extends from the mesial papilla of the mandibular first molar, around the necks of the teeth to the distobuccal line angle of the second molar, and then posteriorly to and laterally up the anterior border of the mandible A, Envelope incision is most commonly used to reflect soft tissue for removal of impacted third molar. Posterior extension of incision should laterally diverge to avoid injury to lingual nerve. B, Envelope incision is laterally reflected to expose bone overlying impacted tooth. C, When three-cornered flap is made, a releasing incision is made at mesial aspect of second molar. D, When soft tissue flap is reflected by means of a releasing incision, greater visibility is possible, especially at apical aspect of surgical field.

POST OPERATIVE INSTRUCTION

Relax after surgery. Physical activity may increase bleeding. Have a soft diet and gradually add solid foods to your diet as healing progresses. Do not drink alcohol or hot fluids such as tea or coffee and avoids spicy foods until the gum is fully healed. Many surgeons recommend the use of ice packs on the face to help prevent postoperative swelling. Avoid smoking After the first day, gently rinse your mouth with warm salt water several times a day to reduce swelling and relieve pain. Avoid rubbing the area with your tongue or touching it with your fingers.

POST MEDICATION
Mefenamic acid (500mg) Disp. #6 Sig. Take 1 cap every 6 hours for pain (p.r.n) Amoxicillin (500mg) Disp. #21 Sig. Take 1 cap every 8 hours 3 times a day for 7 days to prevent infection. Tranexamic acid (500mg) Disp. #2 Take 1 cap if there is an excessive bleeding

POSTOPERATIVE FOLLOW-UP VISIT

All patients should be given a return appointment so that the surgeon can check the patient's progress after the surgery. In routine, uncomplicated procedures, a follow-up visit at 1 week is usually adequate. If sutures are to be removed, that can be done at the 1-week postoperative appointment. Moreover, patients should be informed that should any question or problem arise, they should call the dentist and request an earlier follow-up visit. The most likely reasons for an earlier visit are prolonged and bothersome bleeding, pain that is not responsive to the prescribed medication, and infection.

PATIENTS INFORMATION
PATIENT NAME: Quina, Dianne Isabella ADDRESS: AGE: 18 SEX: Female

PATIENTS INFORMATION
MEDICAL HISTORY: The patient is healthy and no history of any diseases.

PATIENTS INFORMATION
DENTAL HISTORY: The patients last dental visit was last 2013. Class I occlusion

FRONT VIEW

SIDE VIEW

INTRAORAL