Coronectomy Alternative Wisdom Teeth Extraction Health And Social Care Essay

Coronectomy Alternative Wisdom Teeth Extraction wellness And Social Cargon EssayClinical ScenarioA female tolerant aged 23 attends her cosmopolitan dental consonant consonant practitioner with repeated episodes of cark from the back of her take down lecture. Intra oral examination reveals swelling, soreness and erythema overlying the operculum of a partially extravasateed light tooth, indicating pericoronitis. Radiographic examination reveals an impacted wisdom tooth with change of the root and loss of the humble alveolar canal lamina dura.Realising the electromotive force complications, the general dental practitioner refers the longanimous to the oral and maxillo seventh cranial pith department of the dental hospital where you ar working as a Senior tin Officer. Upon consultation, the patient reveals that she is worried ab unwrap the complications associated with the effect, and whether it allow for move her future career as an actress. She informs you that a fr iend of hers recently underwent wisdom tooth pedigree and as a number can no longer feel her lower lip and tongue. She asks you questions such as what are the go ons of this happening to me? how long will it last? and is there are any alternative treatments? Upon reviewing the radiographs, you realise the associated game risk of pith maltreat to this patient, and recall that you recently overheard a sheik colleague talking about coronectomy as an alternative to extraction of wisdom dentition. You remember the colleague saying that this technique reduces post operative complications, and query if this technique would be a suitable treatment option for this patient. onwards informing the patient, you want to know if there is any evidence to bear this technique, and its potential harms and benefits.IntroductionIf present, trey grinder teeth normally erupt between the ages of eighteen and twenty four.3 An evolutionary reduction in jaw size coupled with a less abrasive diet makes the line of work of impacted wisdom teeth somewhat inevitable in newfangled humans.1 Impaction arises when there is prevention of realised tooth eruption due to pretermit of space, obstruction or development in an abnormal position.3 This may result in the tooth erupting partially or not at all. Pericoronitis can be defined as an infection involving the soft tissues surrounding the crown of a partially erupting tooth, and is the most common reason for wisdom tooth extraction. Its signs and symptoms include facial and intra-oral swelling, soreness, erythema, trismus, raised temperature, lymphadenopathy and general malaise.Hospital episode statistics for 2009/2010 show almost 12,000 out patient and 65,000 in patient admissions for surgical removal of wisdom teeth, fashioning it the most common oral surgery procedure performed in the UK.The beautiful guidelines for extraction of third molar teeth suggest that their surgical removal should be limited to patients with evide nce of pathology.3 Such pathology includes unrestorable caries, non-treatable pulpal and/or periapical pathology, cellulitis, abscess and osteomyelitis, internal/ orthogonal resorption of the tooth or adjacent teeth, fracture of tooth, disease of the follicle including cyst/tumour, tooth/teeth impeding jaw surgery, and when a tooth is involved in or deep down the field of tumour resection.3 According to the NICE guidelines wisdom tooth extractions cost the NHS in England and Wales up to 12million per year.3 The guidelines published in 2000 dramatically changed the practice of wisdom tooth extraction. The guidelines do not support the prophylactic removal of pathology free impacted third molars, even in situations where future pathology is inevitable. This is a topic of huge hand at present.Unfortunately the removal of third molar teeth has potential complications. These include damage to the wanting(p) alveolar and linguistic nerves, pain, swelling, infection, haemorrhage and alv eolar osteitis. Damage to the inferior alveolar nerve may occur if the nerve and tooth are in close law of proximity. The intimate relationship of the nerve and the tooth is most commonly observed on panoral radiography. At present research into the benefits of strobilus beam computed tomography is underway, and shows promising results for assessing teeth in close proximity to the inferior alveolar nerve canal. There are several radiological signs visible on regular radiographs that predispose to change magnitude likelihood of inferior alveolar nerve spot (see figure 1).5 These includeCanal devianceCanal narrowingPeriapical radiolucencyNarrowing of the rootDarkening of the rootscurved of the rootLoss of canal lamina dura.5Figure 1 Radiographic signs of change magnitude risk to the inferior alveolar nerve.5Nerve damage is also a potential complication, the majority of which are temporary but permanent hypoaesthesia, paresthesia or even more worryingly dysaesthesia may occur. (Se e table 1 for definitions).Table 1 Definitions of different pain pathologies.8Research into nerve damage by Seddon and Sunderland classified five degrees of nerve reproach ranging from conduction plosive consonant to complete transaction of nerve fibres.9 Each of these five degrees of nerve injury may be created by wisdom tooth extraction.9 Different methods of nerve injury include compression injuries causing neuropraxia, crush injuries inducing wallerian degeneration, stretch injuries such as that possible during lingual retraction and complete nerve sectioning.8 suffering to the nerve can occur from its compression either directly by elevators or indirectly by forces on the root during extraction.This neurosensory deficit associated with nerve damage can cause problems with speech and mastication, which may consequently affect the patients quality of life. Third molar surgery related inferior alveolar nerve injury has been reported as temporary in up to 8% of cases, and perman ent in up to 3.6%.6,7 Risk factors include increased age of patient, difficult extraction and perhaps most importantly, the proximity of the tooth to the inferior alveolar nerve canal.Many different surgical techniques and approaches to wisdom tooth extraction exist with evidence of geographic preferences. A buccal mucoperiosteal work over is unremarkably raised using a Howarths or similar periosteal elevator. Opinion varies as to whether a lingual flap should be raised. This improves visibility and involves protecting of the lingual nerve using a Howarths elevator or retractor. This has traditionally been the procedure of choice in the UK. It is less common in Europe and the ground forces where the lingual flap is not used in order to empty possible damage to the lingual nerve. The tooth can wherefore be sectional if necessary to assist removal using a Cryers or Warwick-James elevator. meliorate by primary intention is ideal, however in practice this is seldom achieved and su tures may be get hold ofed to assist healing.Coronectomy is an alternative procedure to complete extraction and aims to remove the crown of an impacted Mandibular third molar whilst leaving the root undisturbed. It involves raising a buccal flap with sequent removal of buccal bone down to the amelocemental junction of the tooth. The crown is then partly sectioned from the root using a fissure bur, and overhead railway using a suitable instrument. There is a small chance that on elevation the roots may loosen and become mobile.2 This is more and more likely in young females, and those with conically shaped roots.2 If the roots are mobilised, they must be removed. A rose head bur should be used to remove any remaining enamel from the tooth, and the buccal flap closed using 4/0 Vicryl sutures. There is no need to medicate the pulp and antibiotics are conta-indicated. Pre- and post-operative corsodyl mouthwash, and good oral hygiene are sufficient. Alveolar osteitis is a possible pos t-operative complication and patients must be do aware of this and the need to seek further treatment if there is relentless pain or swelling. The tooth must be high risk, vital and the patient must not be immunocompromised.