My last cases of 2016 -What IMPACT will it have on the dentition ?

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Posted on By richard martin In Other

Hello XP family - As I was approaching the holidays, The beauty of a tooth business is the influx of cases that at times makes the most challenging implant case look like a breath of fresh air. This is the story of a 17-year-old young man that was sent to me by the orthodontist for removal of third molars and luxation of the second molars-please let me know what your management second molars would be and also where do you think 1& 16 are located? This was my first case of the morning prior to the New Year's holiday-Although Panorex shows braces in place on consult visit when he came in for surgery his braces had been removed

The next case is was my last case of the morning prior to the holiday this 23-year-old patient was sent for removal of third molars Only #1was symptomatic




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13 Comments

Richard all I have to say is thank god for CBCT's. As a periodontist I am always fascinated by the skill oral surgeons have in removing these complicated impactions. I wish more of theses cases were highlighted and surgeries presented to give respect for your skills as it is due. I don't want to even ask about the stress level here.
Regards, Naheed


Reply

Naheed,

Thank you for the kind words yes these are challenging cases and decisions have to be made that can have long-lasting effects. I agree with the benefits of the CBCT however I come from a time when we had to make decisions based on plain films .We had to make the decision on how to manage these cases. Whenever I look at one of these X-rays 7 clinically I always say if I didn't have the fancy films how would I manage this. I approach canine exposure with the same attitude

I will post follow ups as soon as I can as well as some additional interesting cases

Cheers,

Richard


Reply


Richard,
This kind of surgery is stressful and painful (during surgery and afterwards for patient, clinician, assistance). Good thing, when compared with implants – once the wisdom teeth are out, they don`t come back with periimplantitis. But there is also no high endorphin level when we achieve and maintain nice results.
Your first case: for low jaw are a very good assistance and fresh burs important. I prefer to fragment the tooth, it drives me crazy when it rolls and dances while touching. Upper jaw: CBCT and taking out the tooth that is vestibular.
Retained teeth luxation - I don´t like this idea. I would like to know what forum - orthodontics think about it.
Your second case: it will be even more fun when the patient returns for orthodontics implant placement for second molars up righting
An another question (not in connection with these two cases): how often you make decision for coronectomy? In this PET time….
Happy and funny NY
Snjezana


Reply

Hi Richard, you are starting 2017 with challenging cases, lol.

As Naheed mentioned C.B.C.T will show you about the location of the teeth, and thats not new to you.
In your first case, lower second molars are not yet completely formed (roots), iam really curious to see how your orthodontist pulls these teeth in to occlusion once you are done with luxation, please follow up this case in this forum.

In 2nd case, i think some thing is not correct with #2, it has a big restoration, that could be the symptomatic tooth, its my gut feeling probably further diagnostic tests will reveal the secrete. In lowers dont you think its better not to touch unless until its symptomatic, even if it has to be removed, if there is no decay in 3rd molars, i prefer submerging rather surgical removal of the entire tooth. Whats your treatment plan. Regards, Ashok.


Reply

Snjezana,

Yes I agree with stress and burs, and rollers are no fun!

The plan for first case is to luxate lower 2nd molars and see what they do- and then try to bring in- as you will see on post X-ray - ortho removed right before I extracted - Take a look at CBCT- you will see maxillary thirds - palatal which in my experience 98 % of time- (even before CBCT- shiftshot anyone- SLOB rule?:)....

Second case - plan was to remove max thirds to restore 2&15- my restorative doc looked at decay after removal
To answer you question about coronectomy- yes I do when risk is way up :)

Cheers,
8 days

Richard

Post op


Reply

Ashok,

HNY,

As I mentioned to Snjezana, clinical decision and experience but I did get the CBCT;)

Plan is to luxate but as you can see ortho removed when I saw him for surgery - Ortho had removed braces - so surgery as planned - removed thirds- luxated mandibular 2nd molars- ortho back on 2 weeks

2nd Case- not touching lowers unless symptomatic and if occurs- coronectomy

Please see Pano in response to Snjezana.

Cheers,

Richard


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Richard,
a Challenging case of wisdom teeth removal, nice to see the resolution pictures.
regards
Vladimir


Reply

Richard; Tough case but not for you...in our office, we would extract the 3rd molars and subluxate the 2nd molars and WAIT & SEE if they emerge on their own....let's see how you managed these and keep posting. HNY. Mo


Reply

Vlad,

HNY

Will keep you posted!

Cheers,

Richard


Reply

Hi,

HNY !
Tough cases for the last 2016 day in office :))
Have you done something to these patients on that day ? if i were one of these patients, i dont think i would carry on with extraction on that day :) nothing would happen if i would wait untill 2017 ?!
For your number 2 case, i think the symptoms came from number 2, not from the 3rd molar.


In your first case i would extract the 3rd and luxate the 2nd and wait.
I think 1 is more to the buccal and 16 is more to the palate. Clearly, a CBCT would help. If not, probably 2 PA for each tooth in different angulation could give more infos as to where the teeth are located.

Kind regards !


Reply

Mo,

You they say "Never let them see you sweat". Removed all thirds- maxillary 2nd molars will drop in my experience- mandibular 2nds with no ortho assistance and age 17? Thoughts..

Cheers,

Richard


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Cristian,

Did exactly what you suggested- take a look at CBCT..

Cheers,

Richard


Reply

Cristian,

Did exactly what you suggested- take a look at CBCT..

Cheers,

Richard

Axial view-palatal
In my experience - always in same location -can usually feel "bulge" on palate prior to removal


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