Indian Journal of Dental Research

SHORT COMMUNICATION
Year
: 2010  |  Volume : 21  |  Issue : 2  |  Page : 309--310

Bilateral lower second molar impaction in teenagers: An emergent problem?


Elio H Shinohara1, Shajadi Carlos Pardo Kaba2, Irineu Gregnanin Pedron3, Jose Carlos Petorossi Imparato4,  
1 Post Graduation Program Araçatuba Dental School. UNESP- Univ Estadual Paulista, Hospital Israelita Albert Einstein and UNINOVE Dental School, São Paulo, Brazil
2 Department of Oral and Maxillofacial Surgery, Hospital Geral de Vila Penteado SUS/SP., Sao Paulo, Brazil
3 Department of Oral and Maxillofacial Surgery, Air Force Hospital, Sao Paulo, Brazil
4 Department of Pedodontics, School of Dentistry, Universidade, de Sao Paulo, Sao Paulo, Brazil

Correspondence Address:
Elio H Shinohara
Post Graduation Program Araçatuba Dental School. UNESP- Univ Estadual Paulista, Hospital Israelita Albert Einstein and UNINOVE Dental School, São Paulo
Brazil

Abstract

The frequency of simultaneously impacted second and third molars in teenagers is increasing and becoming a common occurrence in adolescent oral surgery practice. The traditional treatment is the removal of the third molar by conventional access but repositioning of the surgical flap to the distal face of the first molar can predispose to complications such as pericoronitis and delayed healing of the attached gingiva. We present a case in which we use the germectomy approach to remove the impacted third molar for the eruption of the second molar through a vestibular incision. This incision offers excellent bone exposure and exit route for the third molar without disturbing the gingiva attached architecture on the distal face of the first molar providing good healing environment.



How to cite this article:
Shinohara EH, Kaba SC, Pedron IG, Imparato JC. Bilateral lower second molar impaction in teenagers: An emergent problem?.Indian J Dent Res 2010;21:309-310


How to cite this URL:
Shinohara EH, Kaba SC, Pedron IG, Imparato JC. Bilateral lower second molar impaction in teenagers: An emergent problem?. Indian J Dent Res [serial online] 2010 [cited 2021 Mar 7 ];21:309-310
Available from: https://www.ijdr.in/text.asp?2010/21/2/309/66631


Full Text

The frequency of simultaneously impacted second and third molars in teenagers is increasing and becoming a common occurrence in adolescent oral surgery practice. The traditional treatment is the removal of the third molar by conventional access but repositioning of the surgical flap to the distal face of the first molar can predispose to complications such as pericoronitis and delayed healing of the attached gingiva. [1],[2] We present a case in which we use the germectomy approach [3],[4] to remove the impacted third molar for the eruption of the second molar through a vestibular incision. This incision offers excellent bone exposure and exit route for the third molar without disturbing the architecture of attached gingiva on the distal face of the first molar providing good healing environment.

 Technique



In teen patients with impacted second and third molars, where removal of the third molar is indicated [Figure 1], we perform an incision in the free gingiva over the external oblique line; following exposure of the underlying bone, ostectomy with high speed dental drill with copious cold saline solution is accomplished and the bud is removed [Figure 2] and [Figure 3]. The rest of the procedure is completed conventionally.

 Conclusion



We believe that this technique preserves the architecture of the attached gingiva in the distal face of the first molar, avoiding undesirable events like pericoronitis and delayed healing of the mucosa that can predispose the occurrence of periodontal pocket. Majority of the cases have full impacted third molar in a vestibular position in relation to the second molar, which is a favorable location during ostectomy, through the vestibular incision, for the exposure of the tooth. We recommend the use of this access for the removal of third molars to facilitate the eruption of impacted second molars [Figure 4].

References

1Kugelberg CF, Ahlstrφm U, Ericson S, Hugoson A. Periodontoal healing after impacted lower third molar surgery: A retrospective study. Int J Oral Surg 1985;14:29-40.
2Peng KY, Tseng YC, Shen EC, Chiu SC, Fu E, Huang YW. Mandibular second molar periodontal status after third molar extraction. J Periodontol 2001;72:1627-30.
3Finne K, Klδmfeldt A. Removal of lower third molar germs by lateral trepanation and conventional technique: A comparative study. Int J Oral Surg 1981;10:251-4.
4Bjψrnland T, Haanaes HR, Lind PO, Zachrisson B. Removal of third molar germs: Study of complications. Int J Oral Maxillofac Surg 1987;16:385-90.