How difficult do you guys think extracting these bottom two wisdom teeth would be?

B

Big_Baner

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Went to a dentist for the first time in years last week due to having lifelong dental phobia. I knew that my bottom two wisdom teeth were horizontally impacted and will need to be extracted eventually. Had an x-ray done to see how they were and he said the extraction shouldn’t be too difficult but I’d need to get a CT scan to see exactly how close they are to the nerves. My question is, judging just from this x-ray, how difficult would removing those two be and what are the odds on having nerve damage? I understand you can only tell me so much without a 3D scan but I’d appreciate some comments nonetheless.
 

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Gordon

Gordon

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Different dentists will have different criteria of what makes an extraction difficult :)
Personally I'd be happy to tackle those but I've a surgical background and extracted thousands of teeth. The right one looks a bit closer to the nerve than the left but neither look too bad on that film.

Are you having problems with them? UK guidelines would be to monitor them and not intervene unless you were having issues.
 
C

comfortdentist

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Sometimes partial extractions are performed and in fact it seems to be a more popular option.
 
B

Big_Baner

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Different dentists will have different criteria of what makes an extraction difficult :)
Personally I'd be happy to tackle those but I've a surgical background and extracted thousands of teeth. The right one looks a bit closer to the nerve than the left but neither look too bad on that film.

Are you having problems with them? UK guidelines would be to monitor them and not intervene unless you were having issues.

Only problem with them is food impaction but I'm pretty diligent about flossing in that area. No pain though.
 
B

Big_Baner

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Sometimes partial extractions are performed and in fact it seems to be a more popular option.

I thought a coronectomy couldn't be performed on a horizontal wisdom tooth?
 
Gordon

Gordon

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They can be:
Coronectomy can be beneficial but success requires both good patient selection and operator technique. There are some simple guidelines which clinicians need to be aware of to avoid failure. They are as follows:

  1. Teeth with associated infection, particularly infection involving the root portion, should be excluded from this technique
  2. Teeth that are mobile should be excluded as they act as a mobile foreign body and become a nidus for infection or migration
  3. There is no evidence for the treatment of the exposed pulp of the tooth and root treatment appears to be contraindicated
  4. The technique of leaving the retained root fragment at least 3 mm inferior to the crest of bone seems appropriate and appears to encourage bone formation over the retained root fragment
  5. Late migration of the root fragment may occur in some cases, but is unpredictable. However, in all cases the root fragments move into a safer position with regard to the nerve, and it can be envisaged that should removal become necessary the nerve would not then be at high risk.Case reports have suggested that it can take up to ten years for the root fragments to erupt
  6. The operative site should be primarily closed in a tension free manner
  7. Dry socket can be treated in the conventional manner with irrigation and dressing.
 
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