Hi Dr Reznick
Would appreciate your opinion on the surgical plan for the extraction of upper left wisdom tooth UL8. (I practice in Australia so we use a different numbering system).
The patient is a 33 year old male, medical history unremarkable. The periodontist has advised extraction of UL8 for periodontal debridement purposes. Clinically the tooth is partially erupted, and impacted against the distal of the UL7. The UL8 is neither buccally or palatally placed. Panoramic radiograph shows the UL8 to be mesioangular impacted with a tapering/conical root formation.
My surgical plan is
1. Buccal flap
2. Bone removal to expose as much of the crown as possible, to allow a smooth path for the elevation of the tooth, most likely buccal?
It would be great if you can comment how to approach angulated impacted uppers in general. E.g I know with lower wisdom teeth they always “wants” to come out distally, so I always raise flap, gutter,and section with that in mind. Do upper wisdom teeth always “want” to come out buccally? Do we ever have to section an upper like we do for lowers? For uppers I have always just removed bone and elevated them.
I have not done a mesioangular upper before, only lowers. I do know your saying of “knowing” I can do it, not “thinking” I can do it. I do feel that I have enough experience with impacted wisdom teeth in general to attempt this case. In private practice with wisdom teeth I have never had to get an oral surgeon to get me out of trouble, so I like to think I am quite sensible with case selections.
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