case 24: impacted 8s

Question 2

Case Summary

Answer 2

C/O - no complaint but has been advised to have 8s xla. Very nervous and wants a second opinion.
DH - 2 previous eps of pericoronitis in LL8, second ep was unable to open.

Question 3

Things to assess when considering 8 xla:
Interincisal Opening

Answer 3

• assesses the difficulty of xla
• looks at how far pt can open

Question 4

If the first or second molars have a poor prognosis, what might be considered in order to safely extract the third molars?

Answer 4

transplanting

Question 5

What impact does poor oral hygiene have on the outcome of an extraction?

Answer 5

increases the risk of:
- dry socket
- soft tissue infection
- delayed healing

Question 6

A person’s risk of developing pericoronitis is impacted by what?

Answer 6

the positioning of the 3rd molars (vertical or distoangular lower 8s are more at risk than mesially impacted ones)

Question 7

How do nonfunctional upper 8s contribute to symptoms of pericoronitis?

Answer 7

they overerupt and traumatise the operculum over the lowers.

(may also erupt buccally and traumatise the cheek)

Question 8

Nice Guideline Indications for Wisdom Tooth Extraction:

Answer 8

1. evidence of pathology (unrestorable caries, non-treatable PA pathology, cellulitis, abscess or osteomyelitis, resorption of tooth or adjacent teeth etc.)
2. the second or subsequent episodes of pericoronitis

(the first episode unless severe should not be an indication)

Question 9

Which mnemonic can be used to assess wisdom tooth removal?

Answer 9

WHARFE
W - angulation using Winter’s lines (radiographic assessment)
A - angle of the second molar
R - root form and development
F - size of follicular sac
E - exit path of the tooth

Question 10

How does age contribute to the difficulty of wisdom tooth extraction?

Answer 10

easier in younger pts - more difficult in pts older than 30.

Question 11

In which gender is the extraction of wisdom teeth more easy?

Answer 11

females

Question 12

Which angulation is wisdom tooth extraction easier in?

Answer 12

mesio-angular or vertical

(disto-angular or horizontal is harder)

Question 13

Which kind of root morphology of 8s is easier for extraction?

Answer 13

conical roots are easier than multi rooted, divergent roots.

Question 14

Vertical or distal path of removal, makes the extraction of 8s ____ and may require ___.

Answer 14

makes it harder and may require sectioning

Question 15

Which type of radiograph should Winter’s lines be used on?

Answer 15

PAs, less accurate on OPGs

Question 16

Risks to warn the pt about for the extraction of 8s?

Answer 16

• swelling
• pain
• bleeding
• TMJ soreness / trismus
• damage to adjacent teeth
• dry socket
• temporary / permanent nerve damage to the lingual and inferior dental nerves

Question 17

What is a coronectomy?

Answer 17

removal of the crown, leaving the roots in the socket -
alternatice surgical approach for LOWER 8s.

Question 18

When would a coronectomy be offered?

Answer 18

when the 8 is close or associated with the ID nerve and there is no pathology present.

Question 19

5 contraindications for a coronectomy:

Answer 19

1. caries involving the pulp
2. apical periodontitis
3. internal or external resorption
4. mobility
5. periodontal involvement