Third molar surgery

Question 1

what is operculectomy and as part of operculectomy what other dental procedure can we perform

Answer 1

removal of the operculum. We can remove the opposing maxillary third molar tooth that is causing pain when biting down on the operculum only if it is low risk

Question 2

is operculectomy effective

Answer 2

no, usually this surger is ineffective and patient ends up getting their third molar removed

Question 3

why are pre-op analgesia important

Answer 3

these ensure that anti-inflammatories are working before the anaesthesia wears off

Question 4

what is a common analgesia given

Answer 4

400mg ibuprofen provided they have no contra-indications

Question 5

give the options for local anaesthesia of the mandibular arch

Answer 5

ID block, lingual and long buccal with lidocaine 2% or inferior alveolar, lingual and buccal infiltration with 4% articane with adrenaline

Question 6

give the options for local anaesthesia of the maxillary arch

Answer 6

buccal and palatal infiltrations using lidocaine or articaine

Question 7

what are the post-op analgesia given to the patient

Answer 7

400mg ibuprofen TDS and 1g paracetamol QDS for at least 48 hours and 24 hours recommend patient to do warm salt rinses QDS 1/52

Question 8

in surgery why is it recommended to remove as much tooth and leave as much bone in the mouth

Answer 8

bone removal will cause more pain and swelling for the patient

Question 9

describe how vertically impacted third molars are removed

Answer 9

the tooth is sectioned to the furcation and then the tooth is removed as if it was two separate roots

Question 10

describe how horizontally impacted third molars are removed

Answer 10

goes through de-corontating procedure

Question 11

of the different classifications of third molars which is the most difficult to remove

Answer 11

distoangular - usually these are referred to specialist

Question 12

describe the post-op care

Answer 12

instructions should be verbal and written, arrange a post-op call the next day, written emergency contact details, post op anagesia explained, no smoking or vaping for a week

Question 13

what is coronectomy

Answer 13

this is the intentional removal of the crown in cases like pericoronitis where the tooth is healthy and so is the patient but the tooth is at risk of damaging the inferior alveolar nerve and it is a high risk case

Question 14

can any dental professional carry out coronectomy

Answer 14

no only trained dental professionals

Question 15

describe the guidelines for coronectomy (7 points)

Answer 15

• Teeth with associated infection should be excluded – not appropriate
• Teeth that are mobile should be excluded
• No evidence for the treatment of the exposed pulp so we leave exposed pulp and RCT appears to be contraindicated
• Leaving the retained root fragment at least 3mm inferior to the crest of the bone seems appropriate – encourages bone formation over the fragment
• Late migration of the root fragment may occur but is unpredictable
• Operative site should be closed
• Dry socket can be treated in conventional way

Question 16

After this procedure (coronectomy) what can be predicted

Answer 16

patient may need a second surgery to remove the roots as they cause post op pain and roots get infected - the procedure is easier as there is evidence of roots migrating away from the canal so less risk of nerve damage

Question 17

what needs to be considered when carrying out corenectomy

Answer 17

must inform patient of everything, if roots become mobile during surgery they need to be removed, explain to patient there is a risk of second procedure f symptoms persist and that there is evidence of root migration