Richard Martin's Series on 3rd Molars Implants Soft Tissues Grafting
Filipe Lopes

  2. 3rd Molars

    Surgical Management

     

    Richard Martin

    3rd Molars' Early Removal

    (17-20 years of age)

    reduces post-operative morbidity:

     

    1. less root formation - ease of removal

    2. better periodontal healing  on distal of second molar

    3. improved incidence of nerve healing if injured

     

     

    PERICORONITIS

    It can be life threatening, because of anaerobic bacteriae

     

    HOW TO MANAGE PERICORONITIS?

    1. Irrigation of pocket with saline chlorhexidine or diluted hydrogen peroxide

    2. Removal of mandibular 3rd molar

    3. Antibiotics

    4. Operculectomy

    5. Removal of maxillary 3rd molar

     

     

    WHAT CAN WE DO IF THE MANDIBULAR 3RD MOLAR IS IN CLOSE PROXIMITY TO THE INFERIOR ALVEOLAR NERVE (IAN)?

    CORONECTOMY with the goal of leaving 1/3 of the root and get bone fill over 6-12 months.

     

    Note: sometimes when you do coronectomy, the rest of the root will actually extrude and migrate to a more coronal position, making it easier to remove the rest of the tooth later, as it's further away from the IAN

     

     

     

    PRE-OPERATIVE ASSESSMENT

    Medical history, ASA, anxiety

    Medical clearance

    Airway Mallampati

    Sedation vs Local (watch lidocain toxicity)

    Physical Plant, Emergency Meds, AED

     

     

    FLAP DESIGN AND INCISIONS

    Important note: incision must not be a straight line posteriorly, because it may damage the lingual nerve

     

    Tooth grasper forceps

     

     

     

    MAXILLARY IMPACTION

     

     

     

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