Causes of eruption disorders
The main factors leading to retention and dystopia include anatomical obstacles: lack of space in the dental arch or general hypoplasia of the mandible. Eruption is also frequently hindered by an overly dense mucous membrane around the wisdom tooth.
The process may be complicated by local inflammatory events. Poor oral hygiene and regular mucosal trauma during meals contribute to their development.
Stages of atraumatic extraction
Complex clinical situations (e.g., a horizontal position of the lower third molar abutting the adjacent tooth) preclude whole-tooth extraction. In such cases, the surgery follows a strict algorithm:
- Access creation: the tooth is exposed from the surrounding soft and bone tissues.
- Crown removal: a dental bur is used to make a cut separating the crown from the root portion, after which it is extracted. This provides the necessary working space.
- Root separation: the remaining roots are further divided from each other using a bur.
- Extraction: each root is luxated with elevators and extracted along its longitudinal axis. This prevents trauma to the intact neighbor and bone.
- Wound debridement: the empty socket is checked for residual fragments, and sharp bone edges are smoothed with a bur for normal healing.
Complications: acute pericoronitis
Difficult eruption of wisdom teeth is frequently accompanied by inflammation — pericoronitis. Patients complain of pain in the second molar and tongue, as well as swelling of the mucosa over the unerupted tooth and restricted mouth opening.
A characteristic symptom is edema in the submandibular region, which occurs due to enlargement of regional lymph nodes. Pronounced pain during swallowing often appears due to the spread of the inflammatory process to the lateral wall of the pharynx and the pterygomandibular raphe.
Local therapy at the exacerbation stage includes rinsing the space beneath the mucosal "hood" with antiseptics. For this purpose, a 3% hydrogen peroxide solution or a 0.05% chlorhexidine solution is used.
Treatment tactics and wound closure
The choice of surgical intervention volume for pericoronitis depends on many factors: the type of inflammation, the patient's general condition, the desire to preserve the tooth, and the surgeon's qualifications. Extraction surgery is performed only after inflammatory symptoms subside.
After extraction, the method of bone wound management is selected:
- Primary closure: the method of choice. The wound is sutured tightly using resorbable materials.
- Open method: used when tight socket closure is impossible. An iodoform gauze strip is placed into the cavity to prevent infection and alveolitis.
To memorize the indications for using iodoform gauze, use the "HAE" rule: Hemostasis, Antisepsis, Drainage.
Class and exam questions
Why does it hurt to swallow in acute pericoronitis?
Pain on swallowing is caused by the spread of inflammation from the wisdom tooth area to the pterygomandibular raphe and the lateral wall of the pharynx.
When is a wisdom tooth extracted during pericoronitis?
Tooth extraction is performed after the complete subsidence of acute inflammatory phenomena. In the acute period, local antiseptic treatment is indicated.
Why are the crown sawed off and the roots separated during impacted tooth removal?
If the tooth is blocked by bone tissue or abuts the adjacent tooth, its fragmentation allows each part to be extracted along its longitudinal axis. This makes the extraction atraumatic and preserves surrounding tissues.
Which instrument to choose for lower wisdom tooth extraction with restricted mouth opening?
When the tooth is correctly positioned in the dental arch but mouth opening is restricted, front-cutting forceps curved on the flat side are used.
What else to study on this topic
- Criteria for choosing between primary closure and open socket management
- Factors determining the extent of surgical intervention in pericoronitis
- Differential diagnosis of causes of restricted mouth opening
- Prevention of postoperative alveolitis
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Other topics in the section "Chapter 6. Retention, dystopia, tooth eruption disorders (A.M. Panin)"
Entire section «Chapter 6. Retention, Dystopia, and Tooth Eruption Disorders (A.M. Panin)»Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.