Mesioangular upper left wisdom tooth

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This topic contains 1 reply, has 2 voices, and was last updated by  Dr. Jay Reznick Mon Jul 30, 2018 03:52 pm.

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  • #3668

    Joe Zhou
    Participant

    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.

    Thank you

    Joe

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  • #3671

    Dr. Jay Reznick
    Keymaster

    Hi Joe-

    With a case like this, one of the first things that I think of is whether the impacted portion of the crown of UL8 has eroded into, or is attached to the roots of UL7. If you try to elevate UL8, if this is the situation, you will end up with 2 teeth in your hand. The best way to know is to get a CBCT before surgery. If there is an issue with UL7, then you have to spell out the benefits and risks of removal of UL8. If UL8 is clear of UL7, I would use a handpiece to remove a trough of bone on the buccal of the root, about half-way down the root, and expose as much of the crown as you can. I would use a Miller elevator to come from the top/palatal side and elevate the tooth to the buccal. If it does not move, I would section the crown off the roots. Remove the crown first to the buccal, and then you should be able to deliver the roots.

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