Impacted Molars

17 Rating(s).


Posted on By ashok gowda In Other

Hi dear colleagues , need your opinion on this case. This 19 yrs old male patient's chief complaint is pain in lower 3rd molar area. History says that area is edentulous from day one.

On examination his left lower molars were absent clinically and upper molars are extruded and one cusp is impinging on the lower mucosa where he has pain on chewing. IOPA Xray gave me a shock and later took a CBCT. Pic says everything. How will you handle this case. Appreciate your opinion.Thanks. Ashok.


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8 Comments

Reduce the cusp on the offending molar. Removal of the lower first or second molar will result in paresthesia.


Reply

Thanks Gregg, I did that initially up to some extent . He has symptoms even after that minor correction . More reduction will lead to sensitivity. Now iam planning how to go further. A


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Good afternoon.
After removal of the wisdom tooth, it is possible orthodontic traction of molars.Fixation of the titanium plate retromolarly and constant traction to molars.
How do you look at this plan?


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Thanks Zalim. I agree with your plan. Bonding bracket on that first molar which is so deep is a challenge. Any suggestion on that aspect?. A


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Hi Ashok,
I've not been on the forum for a long time. Interesting one. There's a pericoronal mixed radiolucency on the 7 & 6. I think you should establish a diagnosis on that first, before you think about a treatment plan involving orthodontics for the lowers. As far as the impingement goes, I would think intrusion mechanics for the maxillary molars is the right way, though how much can be realistically achieved remains to be seen. If the pericoronal lesion is one of low recurrence rate (Ameloblastic fibroma/ or somewhere in the spectrum till complex odontome), I would consider doing just a coronectomy for the 6 &7, and maybe try to upright the 8, then look at veritcal grafting and implants - All tough calls. But first the lesion


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Hi Narayan, thanks for your opinion. With respect to your pathological DD's you are spot on. CT shows some amount of premolar resorption due to 6. But radioopaque mass is not so evident.
As you said my first step is biopsy.
Regarding further ortho, implant and restorative treatments, yes it's really a tough call. Iam moving bit slow in this case. Regards. A


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Tough case and good discussion. Need biopsy and sound diagnosis before implementing any complete treatment plan.


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Agreed. Thanks Maurice.


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