ODONTECTOMY

Chica, Danna Paula Louise

 ODONTECTOMY
A case when an impacted tooth fails to
erupt into the dental arch within the
expected time.

The tooth becomes impacted because

its adjacent teeth, dense overlying
bone, or excessive soft tissue prevents
eruption. Because impacted teeth do not
erupt, they are retained for the
patient's lifetime unless surgically
removed.
Armamentarium
Antiseptic Mouth Mirror
Cotton Plier Local Anesthesia
Gauze Gum separator
Aspirating Syringe #16 forceps
27 gauge long needle Minnesota Retractor
Elevators #15 Blade
Periapical Curette NSS
Scalpel Ronguer
(2) 10cc syringe Chisel and mallet
Soft tissue scissor Periosteal Elevator
Bone file Waste Receptacle
Root Tip pick Suturing Needle
Water receptacle Needle Holder
Hemostat Suction Machine
Suturing Thread
Saliva Ejector
Topical Anesthesia
Cotton
 Premedications
Mefenamic acid (500mg)
Disp. #1
Take 1 cap 1 hour before the treatment to lessen
pain.
Amoxicillin (500mg)
Disp. #1
Take 1 cap 1 hour before the treatment to
prevent infection.
Tranexamic acid (500mg)
Disp. #1
Take 1 cap 1 hour before the treatment to
prevent excessive bleeding.
 Procedure
1. Aseptic Technique-minimizes wound contamination by
pathogens through the following:
a. Sterilization of Instruments
b. Operatory Disinfections
c. Surgical Staff Preparation
2. Pain and Anxiety Control
a. Dry the mucosa and apply topical anes, on surgical area
b. Admin. Local anes, using Mandibular Block Tech.
3. Flap Design
a. Full thickness flap will be used to reflect the soft tissue for
removal of impacted molar.
 SURGICAL PROCEDURE
1. To have an adequate area of exposure,
incise the tissue from retromolar area down
to the bone making it a full thickness flap.
2. The incision will run from ramus area for
posterior extension.
3. The posterior extension should diverge
laterally to avoid lingual nerve injury.
4. Reflect the incision laterally to expose the
underlying bone covering the impactd 3rd
molar.
 MANDIBULAR NERVE BLOCK

Anesthetize the
tooth using
mandibular block
and local
infiltration
technique
 SURGICAL PROCEDURE
1. Bone removal
Assess the need and extent of the bone to be removed.
Remove bone on buccal cortical plate using surgical bur and
handpiece to expose the greatest convexity of the crown.
Irrigate to remove debris and to avoid overheating due to
constant friction.
2. Using surgical bur, exposed crown is then cut up to the portion
of the crown. This creates a slot wherein the angular elevator is
inserted and then rotated to completely split the tooth. Coronal
part is delivered first out of the socket using angular elevator
from a mesiobucccal direction. Using a cryer elevator, the apical
portion is then luxated out of the socket.
3. Curette the socket and remove the follicular sac.
4. Smoothen the sharp and bony spicules using a bone file.
5. Irrigate the area using NSS then suction.
 SURGICAL PROCEDURE
6. Place appropriate amount of gel foam on the
socket for promotion of hemostasis on the area.
7. Prepare for suturing. Stabilize loose tissue
forceps. Coaptate the loose and movable tissue.
8. Suture with sterile suturing material. Suture
design is multiple interrupted sutures.
9. Provide instructions for post operative phase to
the patient.
10. Recall after 1 week.
The preferred incision for the removal of an impacted
mandibular third molar is an envelope incision that extends
from the mesial papilla of the mandibular first molar, around
the necks of the teeth to the distobuccal line angle of the
second molar, and then posteriorly to and laterally up the
anterior border of the mandible

A, Envelope incision is most commonly used to reflect soft

tissue for removal of impacted third molar. Posterior
extension of incision should laterally diverge to avoid injury
to lingual nerve.
B, Envelope incision is laterally reflected to expose bone
overlying impacted tooth.
C, When three-cornered flap is made, a releasing incision is
made at mesial aspect of second molar.
D, When soft tissue flap is reflected by means of a releasing
incision, greater visibility is possible, especially at apical
aspect of surgical field.
 POST OPERATIVE
INSTRUCTION
Relax after surgery. Physical activity may increase
bleeding.
Have a soft diet and gradually add solid foods to your
diet as healing progresses.
Do not drink alcohol or hot fluids such as tea or coffee
and avoids spicy foods until the gum is fully healed.
Many surgeons recommend the use of ice packs on the
face to help prevent postoperative swelling.
Avoid smoking
After the first day, gently rinse your mouth with warm
salt water several times a day to reduce swelling and
relieve pain.
Avoid rubbing the area with your tongue or touching it
with your fingers.
 POST MEDICATION
Mefenamic acid (500mg)
Disp. #6
Sig. Take 1 cap every 6 hours for pain (p.r.n)

Amoxicillin (500mg)
Disp. #21
Sig. Take 1 cap every 8 hours 3 times a day for 7
days to prevent infection.

Tranexamic acid (500mg)

Disp. #2
Take 1 cap if there is an excessive bleeding
 POSTOPERATIVE FOLLOW-UP
VISIT
All patients should be given a return appointment so
that the surgeon can check the patient's progress after
the surgery. In routine, uncomplicated procedures, a
follow-up visit at 1 week is usually adequate. If sutures
are to be removed, that can be done at the 1-week
postoperative appointment.
Moreover, patients should be informed that should any
question or problem arise, they should call the dentist
and request an earlier follow-up visit. The most likely
reasons for an earlier visit are prolonged and
bothersome bleeding, pain that is not responsive to the
prescribed medication, and infection.
PATIENTS INFORMATION
PATIENT NAME: Quina, Dianne Isabella
ADDRESS:
AGE: 18
SEX: Female
PATIENTS INFORMATION
MEDICAL HISTORY: The patient is
healthy and no history of any diseases.
PATIENTS INFORMATION
DENTAL HISTORY: The patients last
dental visit was last 2013.

Class I occlusion
FRONT VIEW
SIDE VIEW
INTRAORAL