Extraction of 3rd molars 2 Flashcards
What are the aspects in an assessment determining whether 3rd molars require extraction?
History
Clinical assessment
Radiographs
Which medical conditions can affect healing after third molar surgery?
Diabetes
Renal/liver disease
Bleeding disorder
Chemo/radiotherapy
Medications- steroids, OCP, bisphosphonates
What is important to ascertain when asking patient about their history of extractions?
Any excess bleeding, surgicals, infections following
What is it important to remind patients about their recovery when removing third molars?
Time may have to be taken off of work/caring to recover
What EO checks are important when assessing third molars for extraction?
TMJs
Limited mouth opening- access?
Lymphadenopathy- tender, asymmetrical, enlarged?
Facial asymmetry
Muscles of Mastication- palpate
Why is a thorough examination of patient’s TMJs essential prior to carrying out third molar surgery?
TMD can present with peri-auricular pain, similar to pericoronitis (must be ruled out)
Cases with unerupted third molar and no communication with 7 are more likely to be caused by TMD
Which IO checks should be completed in a 3rd molar assessment?
Soft Tissue examination
M2M- prognosis and condition (informs tx)
Eruption status of the M3Ms
Condition of the remaining dentition
Occlusion
Oral hygiene
Caries/Periodontal status
When is a radiograph taken to look at 3rd molars?
Only if surgery is being considered
-> Check if patient has existing radiographs that can be used- limit radiation to patient
What should be checked when looking at an OPT in a third molar assessment?
Presence or absence of disease (in 3M or elsewhere)
Anatomy of 3M (crown size, shape, condition, root formation)
Depth of impaction
Orientation of impaction
Working distance (distal of lower 7 to ramus of mandible)
Follicular width
Periodontal status
Proximity of upper to the maxillary antrum and lowers to inferior dental canal
Any other assoc pathology
What are we looking for when analysing root morphology of 8s on a radiograph?
Hooks and curves
What are the different classes in depth of impaction of an 8?
Superficial- crown of 8 sits at same height as 7
Deep- 8 sits at same height of roots of adjacent 7
Moderate- in between
What is the follicle and the issue it may cause?
Tissue surrounding crown of developing tooth
-> Lost on eruption- if unerupted it is seen as a radiolucency
-> If this increases in size it may suggest cystic change (anything more than 2.5-3mm)
What are the radiographic signs that a third molars roots are in close proximity to IDC?
Interruption of tramlines by tooth- can be upper border only or both
Diversion/deflection- pathway changes (bends to take shape of apices- follows outline)
Deflection of root- appears that is curved away from canal (to avoid it)
Darkening of root where canal crosses- appears as dark banding
Narrowing of canal- goes back to full width after it passes apices
Narrowing of root as it crosses canal
Dark bifid root- appears to split or divide of the canal
Juxta apical area(lateral as opposed to tip)- radiolucency around the root (well defined/corticated)- lamina dura is intact and appearance is not pathological (take care to distinguish this from true pathology)
Which radiographs signs in particular are associated with significant risk of nerve damage in third molar surgery?
Diversion of the inferior dental canal
Darkening of the root where crossed by the canal
Interruption of the white lines of the canal
What can be done if you are concerned about the proximity between 8 and ID canal?
CBCT may be of benefit- 3D- can trace canal and assess exact relationship (presence of bone or compression of canal by tooth etc)
CT can be used if no access to CBCT
PA can also be helpful for caries detection
